Crohn's Disease: Management

Key points

• General: strongly advise smoking cessation (smoking aggravates Crohn's, unlike UC).
• Inducing remission: glucocorticoids (oral/topical/IV) first-line; budesonide is an alternative in a subgroup; exclusive enteral (elemental) nutrition especially in children.
• 5-ASA (mesalazine) is much less effective in Crohn's than in UC. Add azathioprine or mercaptopurine (check TPMT first) as a steroid-sparing agent, or methotrexate.
• Moderate-to-severe, refractory or fistulating Crohn's → biologics: anti-TNF (infliximab, adalimumab), ustekinumab, vedolizumab, or upadacitinib. Metronidazole/ciprofloxacin for perianal disease; surgery for strictures/fistulae.
• Maintaining remission: smoking cessation is the priority; azathioprine/mercaptopurine or methotrexate; continue a biologic that induced remission.

Decision points in this pathway

• Refractory or specific phenotype?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.