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Fistulas
79%
171/217
Toxic megacolon
8%
17/217
Widening of the intestinal lumen
3%
6/217
Plummer-Vinson syndrome
2%
5/217
Paneth cell metaplasia
6%
14/217
Select Answer to see Preferred Response
Fistulas due to transmural inflammation are a common feature of Crohn's disease. Involvement may be throughout the gastrointestinal system but commonly near the terminal ileum. Common symptoms include malaise, diarrhea, weight loss, and abdominal discomfort. Though the exact mechanism is still under investigation, it is believed that the combination of an impaired barrier function of epithelial cells and the subsequent ability for bacterial components to access immune cells contributes to the disease. The result is inflammation throughout the thickness of the gastrointestinal tissue (transmural inflammation). This transmural inflammation contributes to many of the endoscopic findings - ulcers, strictures, and fistulas. Illustration A depicts an intestinal biopsy showing the presence of a noncaseating granuloma; a manifestation that may be found in up to one-third of intestinal biopsies from Crohn's patients. Illustration B shows a colo-colic fistula (thick arrow) as well as a ileocolic fistula (thin arrow) on barium enema in a patient with Crohn's disease. Incorrect Answers: Answer 2: Toxic megacolon would be more consistent with ulcerative colitis Answer 3: Stricture formation (narrowing of the lumen), not widening of the lumen, is more consistent with Crohn's disease. Answer 4: Plummer-Vinson syndrome (esophageal webs, iron-deficiency, and glottitis) is not consistent with Crohn's disease. Answer 5: Though paneth cell metaplasia can occur in Crohn's disease, it is not a direct consequence of transmural thickening.
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