Crohn’s disease guidelines: a pocket summary

  • Feld L & al.
  • JAMA
  • 10 Apr 2019

  • International Clinical Digest
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Takeaway

  • A quick reference for American College of Gastroenterology guidelines for managing Crohn’s disease (CD), highlighting those with the broadest clinical relevance.

Why this matters

  • The full guidelines were published in March 2018.
  • This version offers a quick-look refresher.

Key recommendations

  • Fecal calprotectin can aid in diagnosing CD vs irritable bowel syndrome, with a sensitivity of 93% (95% CI, 0.85%-0.97%) and specificity of 96% (95% CI, 0.79%-0.99%). 
  • Mesalamine is not recommended for active CD based on results of 4 randomized trials showing no benefit over placebo. 
  • Anti-TNF drugs are recommended in cases of steroid resistance.
  • Combination of anti-TNF agents, immunomodulators is preferred in absence of contraindications.
  • Strong recommendation to consider anti-integrin for moderately to severely active CD.
  • Recommendations against using any therapy for which high-quality evidence is lacking.
  • JAMA summary notes potential harm in guidelines including promotion of expensive, potentially hard-to-access therapies.
  • Anti-TNFs and other agents carry risks; this summary also notes including for lymphoma, opportunistic infections, urinary or upper respiratory tract infections.

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