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La enfermedad de Crohn (CD) con características específicas que elevan el riesgo de cáncer más allá de la R...

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IDRF-CHRONIC-IBD-CROHNS-SPECIFIC-PREVENTION
TipoSeñal de alerta
Situaciónreviewed 2026-05-20 | pending_clinical_signoff
EnfermedadesDIS-CRC
FuentesSRC-AGA-IBD-CRC-2024 SRC-BEAUGERIE-CESAME-2013 SRC-ESMO-CRC-2024

Origen de la bandera roja

DefiniciónCrohn's disease (CD) with specific features that elevate cancer risk beyond the broader RF-IBD-CRC-PREVENTION (which covers UC and Crohn- colitis sharing colon-inflammation pathway). This Crohn-specific anchor captures the distinct cancer signals: (1) small bowel adenocarcinoma — Crohn's patients with chronic small-bowel inflammation (especially distal ileum) carry RR ~20-40 vs. population baseline for small bowel adenocarcinoma; absolute lifetime risk remains low (~0.5-2%) because small-bowel adenocarcinoma is rare at baseline, but Crohn's is one of the few definable high-risk cohorts worth flagging. (2) Lymphoma — Crohn's disease per se elevates lymphoma risk modestly (RR ~1.5-2 in immunosuppressant-naive cohorts; higher with anti-TNF + thiopurine combinations, but that iatrogenic signal is captured by RF-IATROGENIC-ANTI-TNF-LYMPHOMA- PREVENTION and RF-IATROGENIC-AZATHIOPRINE-LONGTERM...
Dirección clínicainvestigación
Categoríaotros

Lógica de activación

{
  "any_of": [
    {
      "finding": "inflammatory_bowel_disease_crohn_disease_small_bowel_ge_8y",
      "value": true
    },
    {
      "finding": "inflammatory_bowel_disease_crohn_disease_with_stricture_or_fistula",
      "value": true
    },
    {
      "finding": "inflammatory_bowel_disease_crohn_disease_extensive_disease_ge_10y",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notas

v0.3 wave-N niche pathway — Crohn's-disease-specific cancer prevention. Distinct from the broader RF-IBD-CRC-PREVENTION (which covers UC ≥8y + Crohn-colitis ≥8y + PSC-IBD — focused on colorectal cancer via colitis-associated dysplasia pathway). This Crohn-specific RF adds three signals: (1) Small bowel adenocarcinoma in chronic distal-ileum inflammation cohort (RR ~20-40 vs. population, absolute ~0.5- 2%). No validated surveillance protocol — capsule endoscopy or MR enterography has been studied in case series but no evidence-based recommendation. Clinical vigilance for new-onset obstructive symptoms, unexplained anemia, unintended weight loss is the actionable component. (2) Lymphoma — Crohn's per se RR ~1.5-2 (immunosuppressant- naive). The iatrogenic component (anti-TNF + thiopurine combination → hepatosplenic T-cell lymphoma + EBV-driven post-transplant-like B-cell lymphomas) is captured by existing dedicated iatrogenic RFs (RF-IATROGENIC-ANTI-TNF- LYMPHOMA-PREVENTION, RF-IATROGENIC-AZATHIOPRINE-LONGTERM- PREVENTION). When a patient is on those therapies, all three RFs fire — engine routes to PreventionPlan with deduplication; the iatrogenic RFs carry their own surveillance pr...

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