Fast Five Quiz: Management of Crohn Disease

Jaime Shalkow, MD

Disclosures

January 12, 2022

The American Gastroenterological Association supports a top-down approach to therapy for adult patients with moderate to severe luminal Crohn disease. This method advocates for early use of biologic agents, with or without immunomodulators, instead of a stepwise strategy. The patient's response to their regimen should be determined in the 12-week period after the initiation of therapy. Endoscopy or transmural responses to therapy should be assessed after 6 months.

The Crohn's Disease Activity Index (CDIA) is used to assess disease severity and divides patients into these categories:

Clinical remission (CDAI < 150): These patients are asymptomatic and without symptomatic inflammatory sequelae. This status is achieved either spontaneously or after medical or surgical intervention. Patients requiring glucocorticoids to remain asymptomatic are not considered to be in remission but are referred to as being steroid-dependent.

Mild Crohn disease (CDAI 150-220): These patients are typically ambulatory and tolerating an oral diet. They have < 10% weight loss and no symptoms of systemic disease (such as fever, tachycardia, and abdominal tenderness) and no signs or symptoms of obstruction.

Moderate to severe Crohn disease (CDAI 220-450): This group comprises patients who have failed to respond to treatment for mild to moderate disease, or those patients with prominent symptoms such as fever, weight loss, abdominal pain and tenderness, intermittent nausea and vomiting, or anemia.

Severe-fulminant disease (CDAI > 450): These are patients with persistent symptoms despite treatment with glucocorticoids or biologic agents (infliximab, adalimumab, certolizumab pegol, natalizumab, vedolizumab, or ustekinumab) as outpatients, or individuals presenting with high fever, persistent vomiting, intestinal obstruction, peritoneal signs, cachexia, or evidence of an abscess.

Both symptomatic remission and normalization of C-reactive protein are targets in a treat-to-target approach, as are decrease in calprotectin, endoscopic healing, and normalized quality of life. Histologic healing may represent an informal treatment target in the context of ulcerative colitis.

Learn more about treatment of Crohn disease.

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