- 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.
- 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.