Crohn's Disease: ACG Releases Updated Management Guidelines

Lisa M. Croke

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Dec 15, 2018 Issue

Practice Guidelines

Crohn’s Disease: ACG Releases Updated Management Guidelines

Am Fam Physician. 2018 Dec 15;98(12):756-757.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Fecal calprotectin testing can help distinguish inflammatory bowel disease from irritable bowel syndrome.

• Short-term oral corticosteroids can be prescribed to treat moderate to severe Crohn’s disease.

• Nonsteroidal anti-inflammatory drugs and cigarette smoking should be avoided because of their link to worsening disease activity.

From the AFP Editors

Options for managing Crohn’s disease continue to increase, as does the prevalence of the disease. The American College of Gastroenterology (ACG) has released an updated clinical practice guideline outlining features of the disease, as well as diagnosis and treatment options. Treatment guidance is based on the location and severity of disease, adverse effects, and prognosis; treatment options should be individualized to each patient based on their response and tolerance levels. Patients with mild to moderate Crohn’s disease are typically ambulatory and can tolerate oral nutrition without adverse effects (e.g., dehydration, intestinal obstruction, abdominal pain, weight loss), whereas patients with moderate to severe disease are those whose condition is not amenable to treatment used for mild to moderate disease or who experience more severe symptoms such as significant weight loss, abdominal pain, or anemia. Patients with severe disease have symptoms of intestinal obstruction and peritoneal signs or symptoms that persist despite treatment with corticosteroids or biologic agents in the outpatient setting.

Recommendations

HIGH-LEVEL EVIDENCE

Moderate to Severe Disease. In persons with moderate to severe Crohn’s disease who are naïve to immunomodulators or infliximab (Remicade), treatment with these medications combined is more effective than monotherapy. Patients in whom corticosteroids, thiopurines, methotrexate, or anti– tumor necrosis factor (TNF) inhibitors have been ineffective, as well as those who have not taken anti-TNF inhibitors previously, should receive ustekinumab (

Lisa Croke, AFP Senior Associate Editor

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

Copyright © 2018 by the American Academy of Family Physicians.
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