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1  (IBDs, which include ulcerative colitis and Crohn disease).
2  are now the preferred treatment options for Crohn disease.
3 erum in patients with ulcerative colitis and Crohn disease.
4 ncluding vitiligo, rheumatoid arthritis, and Crohn disease.
5 herapeutic interventions in the treatment of Crohn disease.
6 hisms (SNP) of the NOD2 gene associated with Crohn disease.
7 ociated with the increased susceptibility to Crohn disease.
8 E) alone, in the assessment of patients with Crohn disease.
9 ding of active inflammation in patients with Crohn disease.
10  prominently involved in the pathogenesis of Crohn disease.
11 s, particularly the apthoid lesions of early Crohn disease.
12 ulation leads to increased susceptibility to Crohn disease.
13 the demonstration of early apthous ulcers of Crohn disease.
14 nd imaging features of active terminal ileal Crohn disease.
15 are the most sensitive CT findings of active Crohn disease.
16  biopsy were examined for CT signs of active Crohn disease.
17 iologists examined CT images for findings of Crohn disease.
18 opic and histologic findings of inflammatory Crohn disease.
19  variants have been associated with risk for Crohn disease.
20 t in the overall management of patients with Crohn disease.
21 re highly associated with the development of Crohn disease.
22  and may prevent recurrence of postoperative Crohn disease.
23 other specific nutrient deficiencies seen in Crohn disease.
24 he pathogenesis, treatment, and morbidity of Crohn disease.
25 e inflammatory terminal or neoterminal ileal Crohn disease.
26 hibitor infliximab in surgical patients with Crohn disease.
27  increased T(H)1 responses characteristic of Crohn disease.
28 nal ileum, similar to what is found in human Crohn disease.
29 e, in 23 patients known or suspected to have Crohn disease.
30 ve small bowel inflammation in patients with Crohn disease.
31 rder, Blau syndrome, and also predisposes to Crohn disease.
32 act that manifests as ulcerative colitis and Crohn disease.
33 fistulas occur in up to 43% of patients with Crohn disease.
34 f a gene (IBD5) conferring susceptibility to Crohn disease.
35 ine region in 5q31 confers susceptibility to Crohn disease.
36 s proximal in patients with peptic ulcer and Crohn disease.
37 c stricture, bowel obstruction, fibrosis, or Crohn disease.
38 es were found primarily in the children with Crohn disease.
39 liximab therapy in children with small bowel Crohn disease.
40 ts for quality and diagnostic confidence for Crohn disease.
41 onders among patients with clinically active Crohn disease.
42  RTE can be used to detect fibrosis in human Crohn disease.
43 ead use of HSCT for patients with refractory Crohn disease.
44 ients with no history of immunocompromise or Crohn disease.
45 et for several inflammatory diseases such as Crohn disease.
46 tation (HSCT) may benefit some patients with Crohn disease.
47 nt for the management of complex small bowel Crohn disease.
48  purely CRDD in the context of long-standing Crohn disease.
49  the pathogenetic parallels between CRDD and Crohn disease.
50 rheumatoid arthritis, ulcerative colitis and Crohn disease.
51 , lipid levels, height, body mass index, and Crohn disease.
52 when examining skin lesions in patients with Crohn disease.
53 se of LYG related to azathioprine therapy in Crohn disease.
54  currently the standard for imaging perianal Crohn disease.
55 olymorphism analysis in 160 individuals with Crohn disease, 149 individuals with ulcerative colitis,
56                          Thirty patients (15 Crohns disease, 15 ulcerative colitis) participated, and
57                             Two patients had Crohn disease, 2 had ulcerative colitis, and 3 had abdom
58 ity of life (HRQOL) in pediatric small bowel Crohn disease (a) change in response to infliximab thera
59 ary end point comprising clinical remission (Crohn Disease Activity Index (CDAI) <150 [range, 0-600])
60  with severe Crohn disease (CD) defined as a Crohn Disease Activity Index (CDAI) greater than 250, an
61 ents with severe Crohn disease, defined by a Crohn Disease Activity Index (CDAI) higher than 250 desp
62 l remission at week 8, measured by Pediatric Crohn Disease Activity Index (PCDAI) score and reduction
63 ory score <7, and/or a decrease >/=70 in the Crohn disease activity index score compared with baselin
64 onders among patients with clinically active Crohn disease after 6 weeks of pharmacologic treatment.
65 onfers increased risk for the development of Crohn disease, although the mechanisms by which single d
66                Trends in age at diagnosis of Crohn disease among birth cohorts were determined by cal
67 ren with inflammatory bowel disease (12 with Crohn disease and 12 with ulcerative colitis) and in 23
68 nety subjects (45 with active terminal ileal Crohn disease and 45 without Crohn disease) underwent CT
69  show applications to sequencing studies for Crohn disease and autism spectrum disorders.
70 n associated with two inflammatory diseases, Crohn disease and Blau syndrome, and are thought to cont
71  inherited inflammatory disorders, including Crohn disease and Blau syndrome.
72 ease based on ileocolonoscopy or established Crohn disease and imaging features of active terminal il
73 amiliar with MR imaging features of perianal Crohn disease and knowledgeable about what features may
74 effective therapy for active and fistulizing Crohn disease and may even be helpful in some patients w
75 gestive of neutrophil activity, and those in Crohn disease and mouse sera were suggestive of both mac
76 y fibrosis of the mucosal layer, develops in Crohn disease and not in ulcerative colitis.
77       Inflammatory bowel disease, especially Crohn disease and periodontal disease, appear to be over
78 diated intestinal inflammation, particularly Crohn disease and pouchitis, whereas viral, bacterial, f
79 tional disorders and ulcerative colitis from Crohn disease and predicting complications of disease.
80 er genetic risk locus shared by sarcoidosis, Crohn disease and psoriasis.
81 sent a categorization of complex small bowel Crohn disease and review its surgical treatment as a pot
82  in phase 2 clinical trials in patients with Crohn disease and rheumatoid arthritis.
83  was recently approved for the management of Crohn disease and rheumatoid arthritis.
84              Application of this strategy to Crohn disease and type 2 diabetes predicts a number of g
85 ontributor to inflammatory diseases, such as Crohn disease and type 2 diabetes.
86                                              Crohn disease and ulcerative colitis are caused by an ex
87                              Celiac disease, Crohn disease and ulcerative colitis are inflammatory di
88 ked to protection against the development of Crohn disease and ulcerative colitis in humans.
89                                              Crohn disease and ulcerative colitis patients exhibit pa
90                                      In both Crohn disease and ulcerative colitis there is an increas
91   Inflammatory bowel diseases (IBD), such as Crohn disease and ulcerative colitis, are chronic relaps
92  Inflammatory bowel disease (IBD), including Crohn disease and ulcerative colitis, is characterized b
93 ic inflammatory bowel disease (IBD), such as Crohn disease and ulcerative colitis.
94 incipal forms of inflammatory bowel disease: Crohn disease and ulcerative colitis.
95 rize the latest information on biomarkers of Crohn disease and ulcerative colitis.
96 of some patients with previously intractable Crohn disease, and further TNF-alpha directed therapies
97 disease, but not ulcerative colitis or ileal Crohn disease, and may prevent recurrence of postoperati
98  human diseases, including lupus, psoriasis, Crohn disease, and obesity.
99 s of obesity, gastrointestinal malignancies, Crohn disease, and perioperative complications including
100 doscopy had the highest diagnostic yield for Crohn disease, and SBFT had the lowest, but these differ
101  modern trends in the surgical management of Crohn disease, and the increasing use of laparoscopy in
102 ut the risk allele for rheumatoid arthritis, Crohn disease, and ulcerative colitis.
103 f occurrence of prior abscesses, duration of Crohn disease, and use of steroid treatment.
104 ed to treat rheumatoid arthritis, psoriasis, Crohns disease, and osteoporosis, with a total market of
105 cutely inflamed from fibrotic intestine in a Crohn disease animal model.
106  anti-TNF therapy not only in RA but also in Crohn disease, ankylosing spondylitis, and several other
107                                   Women with Crohn disease appear to be at risk for early delivery an
108 onclude that further HSCT studies for severe Crohn disease appear warranted.
109 n addition, advances in biologic therapy for Crohn disease are beginning to be formally evaluated in
110 dase deficiencies, short bowel syndrome, and Crohn disease are discussed.
111 e disease and one fourth of outpatients with Crohn disease are malnourished.
112  Emerging innovative treatments for perianal Crohn disease are now available and have the promise to
113 g oligomerization domain 2 (NOD2) protein to Crohn disease are still poorly understood.
114 ses (IBDs), including ulcerative colitis and Crohn disease, are chronic inflammatory disorders of the
115 -related p47 GTPase Irgm1 has been linked to Crohn disease as well as susceptibility to tuberculosis.
116             We also show that the three main Crohn disease-associated mutants of NOD2 (1007fs, R702W,
117                                              Crohn disease-associated mutations in CARD15/NOD2 predom
118 patients undergoing intestinal resection for Crohns disease at The Mount Sinai Hospital from 1976 to
119 on and cancer, as well as conditions such as Crohn disease, atherosclerosis, and Alzheimer disease.
120 tive Crohn disease was active terminal ileal Crohn disease based on ileocolonoscopy or established Cr
121 hen flagellin, was elevated in patients with Crohn disease, but not in patients with ulcerative colit
122  and ciprofloxacin selectively treat colonic Crohn disease, but not ulcerative colitis or ileal Crohn
123  with disease chronicity and angiogenesis in Crohn disease, but not with histologic and clinical mark
124 ed to induce remission in moderate to severe Crohn disease, but they do not maintain remission.
125                The complexity of small bowel Crohn disease can be sorted into several categories: tec
126            A total of 217 patients [123 with Crohn disease (CD) and 94 with ulcerative colitis (UC)]
127 nd uncovered significant association between Crohn Disease (CD) and the IL12/IL23 pathway, harboring
128                                              Crohn disease (CD) and ulcerative colitis (UC) are 2 com
129                                              Crohn disease (CD) and ulcerative colitis (UC) are overl
130 e chronic inflammatory bowel diseases (IBDs)-Crohn disease (CD) and ulcerative colitis (UC)-are idiop
131 tory but have been linked in some studies to Crohn disease (CD) and ulcerative colitis (UC).
132 that have been traditionally classified into Crohn disease (CD) and ulcerative colitis (UC).
133 diopathic inflammatory bowel diseases (IBD), Crohn disease (CD) and ulcerative colitis (UC).
134 y toward inflammatory bowel diseases (IBDs): Crohn disease (CD) and ulcerative colitis (UC).
135 risk for IBD among those diagnosed as having Crohn disease (CD) and ulcerative colitis (UC).
136                                              Crohn disease (CD) and vitamin D deficiency are associat
137                       Blau syndrome (BS) and Crohn disease (CD) are both characterized by granulomato
138           Early pathological descriptions of Crohn disease (CD) argued for a potential defect in lymp
139 o the Wellcome Trust Case-Control Consortium Crohn disease (CD) data set.
140 ansplantation (HSCT) in patients with severe Crohn disease (CD) defined as a Crohn Disease Activity I
141                                              Crohn disease (CD) exhibits a 2-4-fold increased frequen
142                                  The risk of Crohn disease (CD) has a large genetic component.
143                                        While Crohn disease (CD) has been clearly identified as a Th1
144  role of adherent-invasive E. coli (AIEC) in Crohn disease (CD) has been in debate for decades.
145                                              Crohn disease (CD) in children is associated with low bo
146                                              Crohn disease (CD) is a chronic inflammatory bowel disea
147                                              Crohn disease (CD) is a chronic inflammatory process of
148                                              Crohn disease (CD) is a chronic, panenteric intestinal i
149                                              Crohn disease (CD) is associated with osteoporosis and o
150     The use of narcotics among patients with Crohn disease (CD) is endemic.
151  severity of disease and additional surgery, Crohn disease (CD) may result in intestinal failure (IF)
152 gut microbial community likely contribute to Crohn disease (CD) pathogenesis; however, direct evidenc
153                           Family studies for Crohn disease (CD) report extensive linkage on chromosom
154 is useful in patients undergoing surgery for Crohn disease (CD) to avoid wide small-bowel resections.
155 he odds of having ulcerative colitis (UC) or Crohn disease (CD) were elevated in carriers of the SLC2
156                                   Studies of Crohn disease (CD), a chronic inflammatory disease of th
157 n genetic risk factor in the pathogenesis of Crohn disease (CD), a chronic relapsing inflammatory dis
158                                              Crohn disease (CD), an inflammatory bowel disease, is a
159 diopathic inflammatory bowel diseases (IBD), Crohn disease (CD), and ulcerative colitis (UC).
160  inflamed intestinal mucosa of patients with Crohn disease (CD), but not in patients with ulcerative
161 testinal fibrosis is a major complication of Crohn disease (CD), but the precise mechanism by which i
162 e associated with rheumatoid arthritis (RA), Crohn disease (CD), type 1 diabetes (T1D), or type 2 dia
163 ole in chronic inflammatory diseases such as Crohn disease (CD), ulcerative colitis, psoriasis, and t
164    Here, we concentrate on an application to Crohn disease (CD).
165 anal stenosis are manifestations of perianal Crohn disease (CD).
166 ence of periodontal disease in patients with Crohn disease (CD).
167 e clinically and histologically from that of Crohn disease (CD); however, mucocutaneous granulomatous
168 dentified but 22 subsequently proved to have Crohns disease (CD).
169 types related to inflammatory bowel disease (Crohn disease [CD] and ulcerative colitis [UC]) and diab
170 ergence of inflammatory bowel diseases (IBD: Crohn disease [CD] and ulcerative colitis [UC]) where in
171 is (RA) and inflammatory bowel disease (IBD; Crohn disease [CD], ulcerative colitis [UC]) and is inve
172 ation in enterocytes have been documented in Crohn disease, celiac disease, surgical stress, and inte
173        For more information on adalimumab in Crohn disease, click here.
174 7 levels were decreased in actively inflamed Crohn disease colonic tissues, where CD98 expression was
175 a sensitivity of 90% (18 of 20) for definite Crohn disease (compared with a sensitivity of 80% [16 of
176 cidences of pediatric ulcerative colitis and Crohn disease continue to evolve with geographic variati
177 e presentation of eating disorders including Crohn disease (CrD), celiac disease, gastroesophageal re
178 a diverse range of simulated data sets and a Crohn disease data set was assessed.
179 disease-associated genetic variations in the Crohn disease data set.
180                 The methods are applied to a Crohn disease data set.
181                     Two patients with severe Crohn disease, defined by a Crohn Disease Activity Index
182  P = 5.73 x 10-6 for AD, and 6.57 x 10-5 for Crohn disease) demonstrated the same direction of alleli
183 ed clinical trial of 56 children with active Crohn disease despite immunosuppressive treatment, condu
184 raphy for active inflammatory terminal ileal Crohn disease, despite an inferior subjective image qual
185  infectious (HIV) and noninfectious (CGD and Crohn disease) diseases that have been associated with i
186             Eleven consecutive patients with Crohn disease (eight female patients, three men; mean ag
187  in responders (those with a decrease in the Crohn disease endoscopic index of severity score of 25-4
188  was the most sensitive visual CT finding of Crohn disease for both radiologists.
189        Fibrosis is a serious complication of Crohn disease for which there is no effective therapy.
190 nd affected gut segments in 10 patients with Crohn disease (four women, six men; median age, 49 years
191                             In patients with Crohn disease, gadolinium-enhanced fat-suppressed spoile
192                       Ulcerative colitis and Crohn disease (granulomatous colitis) are rarely associa
193 s study provides evidence that children with Crohn disease have alterations in circulating antioxidan
194 e principles of modern surgical treatment of Crohn disease have evolved to bowel conservation such as
195 rich repeat domain, which is associated with Crohn disease, impairs the interaction with FRMPD2, and
196   Seventy-nine patients presented RVF due to Crohn disease in 34 (43%), postoperative in 25 (32%), ob
197 ials have evaluated new drugs for refractory Crohn disease in children.
198 s, 80%) for enabling the detection of active Crohn disease in comparison with CT enteroclysis with na
199 proposed to be at least one of the causes of Crohn disease in humans.
200 hese results have important implications for Crohn disease in particular and LD mapping in general.
201 rminal ileoscopy for the detection of active Crohn disease in the terminal ileum.
202 is distinguished from granulomatous colitis (Crohn disease) in terms of location of involvement, exte
203 at it occurs in polygenic disorders, such as Crohn disease, in which its mechanism cannot be explaine
204 ly our approach to a genome-wide analysis of Crohn disease, in which we replicate association with 17
205 d CTE images were each visually assessed for Crohn disease involvement in 54 bowel segments with path
206              The relative risk of developing Crohn disease is estimated to be in the range of 2 to 3
207                                              Crohn disease is frequently complicated by various skin
208 lysis study where the pretest probability of Crohn disease is high.
209                                              Crohn disease is immunologically mediated and characteri
210 Malnutrition, which can be present even when Crohn disease is in remission, can affect growth, cellul
211                              Pediatric-onset Crohn disease is more aggressive than adult-onset diseas
212 nding oligomerization domain 2 (NOD2), cause Crohn disease is poorly understood.
213           Appropriate surgical management of Crohn disease is predicated on multiple variables, but s
214                                 Treatment of Crohn disease is rapidly evolving, with the induction of
215  conditions such as rheumatoid arthritis and Crohn disease, is in part driven by discordant productio
216 ory bowel disease , particularly small bowel Crohn disease, it has also proven useful in assessing th
217 reover, NOD2 deficiency or the presence of a Crohn disease-like Card15 mutation increased Toll-like r
218 y improves disease in a spontaneous model of Crohn Disease-like ileitis.
219 on is also implicated in the pathogenesis of Crohn disease, linking these otherwise unrelated entitie
220 enesis of chronic inflammatory diseases like Crohn disease, might thus be considered as a major actor
221                        An acute inflammation Crohn disease model was produced by treating eight Lewis
222  associated with autoimmune diseases such as Crohn disease, multiple sclerosis, and ulcerative coliti
223 ariants predisposing to atrial fibrillation, Crohn disease, multiple sclerosis, rheumatoid arthritis,
224 (n = 16), tubo-ovarian inflammation (n = 5), Crohn disease (n = 10), and internal bowel fistula due t
225  may contribute to the clinical phenotype of Crohn disease, necrotizing enterocolitis, and, perhaps,
226           A specific susceptibility gene for Crohn disease, NOD2, is located on chromosome 16q12, and
227 ith impaired quality of life from refractory Crohn disease not amenable to surgery despite treatment
228         Among adult patients with refractory Crohn disease not amenable to surgery who had impaired q
229              Understanding the complexity of Crohn disease of the small bowel is important for the su
230                The clinical presentations of Crohn disease of the small bowel vary from low to high c
231 dge of the effects of ulcerative colitis and Crohn disease on fetal outcome.
232 ty-six year old Caucasian woman with colonic Crohn disease on maintenance azathioprine therapy presen
233  categorized as either ulcerative colitis or Crohn disease on the basis of clinical, radiologic, and
234 d, the level of HIV control, and the risk of Crohn disease only among those carrying an intact miR-14
235  had a secondary ICD-9-CM diagnosis code for Crohn disease or if the patient was not continuously enr
236 e of each of these cell types in fibrosis in Crohn disease or other inflammatory bowel diseases is de
237 e), juvenile RA, inflammatory bowel disease (Crohn disease or ulcerative colitis), psoriasis, and pri
238 ents with inflammatory bowel disease, either Crohn disease or ulcerative colitis, are at an increased
239 h colonic levels of CCDC88b in patients with Crohn disease or ulcerative colitis, identifying that ex
240 eroids and other immunosuppressive agents in Crohn disease or ulcerative colitis.
241 ease (OR 0.85 [95% CI 0.74-0.98]; p < 0.03), Crohn disease (OR 0.81 [95% CI 0.70-0.94]; p < 0.005), p
242 egulated or excessive T helper cell (T(H))1 (Crohn disease) or T(H)2 (ulcerative colitis) responses.
243 ickness correlated significantly with active Crohn disease (P < .001).
244 ssociated stimulated dendritic cell genes in Crohn disease (p = 1.6 x 10(-5)).
245 ion false discovery rate P = .009 for AD and Crohn disease, P = 5.73 x 10-6 for AD, and 6.57 x 10-5 f
246  evaluation of both experimental colitis and Crohn disease patients and thereby offers promising tran
247    In addition, (18)F-FDG PET/CT scans of 25 Crohn disease patients were analyzed, and colonic (18)F-
248 hy may effectively be used to follow up both Crohn disease patients without jejunal disease and in pe
249 an Th17 cells, including those isolated from Crohn disease patients, and it is linked to disease, as
250 ession in a subset of ulcerative colitis and Crohn disease patients.
251 prebiotics can potentially prevent and treat Crohn disease, pouchitis, and possibly ulcerative coliti
252                    An 81-year-old woman with Crohn disease presented with fever and an acute eruption
253 as previously reported to be associated with Crohn disease, psoriasis, alopecia areata, and leprosy.
254                   Twenty-eight patients with Crohn disease received 2% barium sulfate and water enema
255 ix children with newly diagnosed small bowel Crohn disease receiving infliximab therapy were prospect
256                         Use of probiotics in Crohn disease remains unsubstantiated.
257 f the CARD15/NOD2 protein as contributing to Crohn disease represents a major advance in defining dis
258 rition as an alternative to major surgery in Crohn disease should be considered.
259 housands of control subjects from studies of Crohn disease, showing how it controls false positives,
260                                           In Crohn disease similar remission rates are achieved with
261      Numerous case reports of angioectasias, Crohn disease, small bowel tumors, and other small bowel
262 with a specific role in the investigation of Crohn disease, small-bowel obstruction, and unexplained
263                Pancreatic autoantibodies are Crohn disease-specific serologic markers.
264  In children and adolescents with refractory Crohn disease, thalidomide compared with placebo resulte
265 vern, PA) for the treatment of children with Crohn disease that does not respond to conventional mana
266 gh mesalamines are still often used to treat Crohn disease, the evidence for their efficacy is lackin
267                                           In Crohn disease, the provision of adequate protein and cal
268  effective in the treatment of patients with Crohn disease, their use should continue to be restricte
269  the inflamed intestine has revealed that in Crohn disease there is predominantly a T helper cell typ
270 ects, whereas in patients with HIV, CGD, and Crohn disease, there was a significant increase in the p
271 ents underwent HSCT and 22 received standard Crohn disease treatment (controls).
272                      All were given standard Crohn disease treatment as needed.
273 ion, diet, and antibiotics and shed light on Crohn disease treatments.
274 ies of the distal gut microbiome, such as in Crohn disease, ulcerative colitis, and infectious coliti
275 nclude the putative susceptibility genes for Crohn disease, ulcerative colitis, and psoriasis.
276 Genomics of Alzheimer's Project stage 1) and Crohn disease, ulcerative colitis, rheumatoid arthritis,
277 d pleiotropy between PD and type 1 diabetes, Crohn disease, ulcerative colitis, rheumatoid arthritis,
278 itis, Graves disease, Hashimoto thyroiditis, Crohn disease, ulcerative colitis, systemic lupus erythe
279                                Patients with Crohns disease undergoing first and second reoperation h
280  terminal ileal Crohn disease and 45 without Crohn disease) underwent CT enterography with a dual-sou
281 eference standard for confirmation of active Crohn disease was active terminal ileal Crohn disease ba
282                                  Severity of Crohn disease was correctly depicted at gadolinium-enhan
283                                              Crohn disease was depicted by capsule endoscopy in 12 pa
284 which all included patients were at risk for Crohn disease was equal and that all patients had develo
285                            The children with Crohn disease were malnourished compared with the ulcera
286                       Thirteen patients with Crohn disease were prospectively enrolled in this pilot
287 o have or suspected of having nonobstructive Crohn disease were recruited.
288                     Findings consistent with Crohn disease were tabulated for each imaging examinatio
289 nd CT enterography may depict nonobstructive Crohn disease when techniques such as ileoscopy and SBFT
290  associated with a higher susceptibility for Crohn disease, which highlights the physiological import
291 Mutations in NOD2 are highly associated with Crohn disease, which is characterized by dysregulated in
292  is an effective treatment for patients with Crohn disease who are naive to the chimeric TNF antagoni
293 equently than placebo in adult patients with Crohn disease who cannot tolerate infliximab or have sym
294 een evaluated prospectively in patients with Crohn disease who had responded to another anti-TNF agen
295 hy images were evaluated in 19 patients with Crohn disease who had strictures that underwent surgical
296 oncurrent use of infliximab in patients with Crohn disease who have undergone surgery.
297          Medical records of 32 patients with Crohn disease who underwent PAD from 1985 to 1999 were r
298 ars +/- 9) with a proved diagnosis of active Crohn disease who were scheduled to begin therapy with b
299 ermine the clinical results of patients with Crohns disease who require surgical resection.
300 reviews each category of complex small bowel Crohn disease, with special emphasis on appropriate surg

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