Once the clinical suspicion is established, the diagnosis is based on the combination of clinical, biochemical, endoscopic, histological and/or radiological criteria.
Lennard-Jones diagnostic criteria
Clinical criteria
- Recurrent abdominal pain
- Diarrhoea
- Weight loss
- Abdominal mass
- Fever or low-grade fever
- Perianal disease
- Fistulas
- Extraintestinal manifestations
Radiological criteria
- Mucosal changes: aphthous ulcers, linear or rosebush thorn ulcers, longitudinal ulcers, inflammatory polyps, oedema of circular fold of small intestine
- Changes in calibre: stenosis, dilation, fistulas, asymmetry of lesions
Endoscopic criteria
- Colonic involvement: aphthous ulcers, deep or serpiginous linear ulcerations, cobblestone appearance, stenosis, fistulous orifices, pseudopolyps and polyps; characteristically segmental lesions, of variable extension with mostly preserved rectum
- Ileal involvement: aphthous ulcers, ulcers and/or stenosis
Anatomo-pathological criteria
- Major: transmural inflammation, non-caseating granulomas, lymphoid aggregates without germinal centre
- Minor: intermittent inflammation, inflammation of the submucosa with conserved epithelial architecture, mucus retention with minimal inflammation, fissures
Defined disease: granulomas and other criteria or absence of granulomas and 3 criteria.
Probable disease: absence of granulomas and 2 criteria.
References:
- Reinisch S, Schweiger K, Pablik E, Collet-Fenetrier B, Peyrin-Biroulet L, Alfaro I, Panés J, Moayyedi P, Reinisch W. An index with improved diagnostic accuracy for the diagnosis of Crohn’s disease derived from the Lennard-Jones criteria. Aliment Pharmacol Ther. 2016 Sep;44(6):601-11. [Medline]
- Ballester Ferré MP, Boscá-Watts MM, Mínguez Pérez M. Crohn’s disease. Med Clin (Barc). 2018 Jul 13;151(1):26-33. [Medline]
Created Sep 27, 2019.
