Crohn Disease

Use ileocolonoscopy with segmental biopsy as the first-line test at index presentation. It assesses colonic and terminal ileal extent and supplies histology, which remains particularly important for separating Crohn disease from infection, medication-related injury, ischemia, and other mimics before medical therapy is initiated. BMJBMJBritish Society of Gastroenterology guidelines on ...

Pair endoscopy with cross-sectional imaging when small-bowel extent, transmural inflammation, penetrating disease, obstruction, or extraluminal complications are suspected. In an uncertain presentation, fecal calprotectin can help determine whether ileocolonoscopy and imaging are warranted. Wolters KluwerWolters KluwerCrohn's Disease: Diagnosis and Management : American Family Physician Capsule endoscopy is an adjunct for patients with high clinical suspicion of small-bowel Crohn disease; deep enteroscopy is not routine but can provide tissue when small-bowel sampling is required. The LancetThe LancetCore indicators of an evaluation and guidance system for quality of care in inflammatory bowel disease centers: A critical review

Obtain a baseline CBC and inflammatory markers, recognizing their limitations. Anemia and thrombocytosis are common hematologic abnormalities; CRP and ESR are standard acute-phase surrogates, but normal values do not exclude active disease in an individual patient. Oxford Academic+1Oxford Academic3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management | Journal of Crohn's and Colitis | Oxford Academicema europa euCrohn's Overview of Comments Screen for iron, 25-hydroxyvitamin D, folate, and vitamin B12 deficiency. Wolters KluwerWolters KluwerCrohn's Disease: Diagnosis and Management : American Family Physician

For moderate-to-severe uncomplicated luminal Crohn disease, systemic corticosteroids are recommended for initial induction. Patients with extensive disease or poor prognostic features should be considered for earlier biologic therapy rather than repeated conventional-treatment cycles. BMJBMJBritish Society of Gastroenterology consensus guidelines ... Corticosteroids should be viewed as induction agents, not a strategy for durable disease control.

For mild-to-moderate disease, available evidence summaries describe budesonide, sulfasalazine, and dietary modifications as induction options, with treatment choice influenced by disease location and severity. Wolters KluwerWolters KluwerCrohn's Disease: Diagnosis and Management : American Family Physician Do not extrapolate ulcerative colitis practice to Crohn disease: 5-aminosalicylates have little to no role in Crohn disease management, including postoperative maintenance. BMJBMJBritish Society of Gastroenterology guidelines on ...

For steroid-dependent or steroid-resistant disease, older ECCO guidance summarized in a quality review identifies azathioprine or mercaptopurine as first-line steroid-sparing options and methotrexate when purine analogues are ineffective or not tolerated; biologic therapy is appropriate when conventional therapy fails, is not tolerated, or disease is moderate to severe. The Lancet+1The LancetCore indicators of an evaluation and guidance system for quality of care in inflammatory bowel disease centers: A critical reviewWolters KluwerTreatment Pathways Leading to Biologic Therapies... : Clinical and Translational Gastroenterology Contemporary agent selection requires current guideline and labeling review because the supplied evidence does not provide U.S. dosing, safety screening, or comparative positioning among biologics and small molecules.

Assess patients in remission regularly with clinical review plus CRP and/or fecal calprotectin as adjunctive markers. Oxford AcademicOxford Academic3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management | Journal of Crohn's and Colitis | Oxford Academic A rise in fecal calprotectin should prompt evaluation for inflammatory recurrence, but decisions should account for disease location, baseline biomarker behavior, and alternative causes of symptoms or marker elevation.

Endoscopy remains the reference standard for assessing mucosal activity and confirming mucosal healing, although it is invasive and costly. Oxford AcademicOxford AcademicEuropean evidence based consensus for endoscopy in inflammatory bowel disease | Journal of Crohn's and Colitis | Oxford Academic Fecal calprotectin can reduce the need for repeated endoscopy in selected settings: in one study, a value of 250 micrograms/g or less predicted endoscopic remission defined as CDEIS 3 or less with sensitivity 94.1% and negative predictive value 96.6%, but specificity was 62.2% and positive predictive value 48.5%. Oxford AcademicOxford AcademicEuropean evidence based consensus for endoscopy in inflammatory bowel disease | Journal of Crohn's and Colitis | Oxford Academic This threshold should not be treated as universally applicable.

After intestinal resection, fecal calprotectin measurement has a potentially valuable role in monitoring recurrence. GastroenterologyGastroenterologyMeasurement of Fecal Calprotectin Improves Monitoring ... One monitoring strategy evaluates fecal calprotectin at 3 months after surgery and considers earlier endoscopy if it rises, followed by endoscopic assessment after the initial postoperative evaluation. Oxford AcademicOxford AcademicOptimising monitoring in the management of Crohn's disease

Consider surgery for localized disease and involve colorectal surgery promptly for life-threatening complications. Emergency surgery is indicated for intestinal perforation, refractory bleeding, or toxic megacolon; elective surgery is indicated for dysplasia or malignancy, refractory disease, or inability to tolerate long-term immunosuppression or other pharmacologic therapy. Laparoscopy is preferred when feasible. The LancetThe LancetCore indicators of an evaluation and guidance system for quality of care in inflammatory bowel disease centers: A critical review

Perianal and fistulizing disease requires control of infection followed by advanced medical therapy. Wolters KluwerWolters KluwerCrohn's Disease: Diagnosis and Management : American Family Physician The supplied evidence does not provide procedural sequencing, drainage technique, antibiotic regimens, or biologic dosing; these decisions should be coordinated with an experienced multidisciplinary IBD and colorectal surgery team.

Document vaccination history at diagnosis and before immunomodulator or biologic therapy, then update vaccines as appropriate. Live vaccines should not be administered during immunosuppressive therapy; if feasible, give them at least 4 weeks before treatment initiation or at least 3 months after immunosuppression has stopped. BMJBMJBritish Society of Gastroenterology consensus guidelines ...

Monitor and correct nutritional and hematinic deficits, including iron, vitamin D, folate, and vitamin B12. Wolters KluwerWolters KluwerCrohn's Disease: Diagnosis and Management : American Family Physician For colorectal cancer surveillance, an evidence summary notes that most guidelines recommend colonoscopy beginning 8 years after symptom onset, with subsequent intervals determined by additional risk factors. Wolters KluwerWolters KluwerCrohn's Disease: Diagnosis and Management : American Family Physician The supplied evidence does not specify risk-stratified U.S. surveillance intervals.