Fast Five Quiz: Management of Crohn Disease

Jaime Shalkow, MD; Cristian Puerta, MD


January 12, 2022

For patients with low risk for disease progression, treatment of active symptoms with antidiarrheal medication, along with other over-the-counter medications and dieting, may be sufficient. Patients should be counseled to watch for symptoms and other signs of inflammation, with the particular consideration that symptoms do not always reflect presence of inflammation.

Elemental, semi-elemental, and defined diets may be beneficial for some patients with Crohn disease, but symptoms and active inflammation generally reappear once the patient resumes a normal diet. Therefore, current guidelines put forth that dietary therapies may be considered as a complementary approach to other therapies with the goal of inducing disease remission.

Enteric-coated budesonide is recommended as the first-line treatment for inducing remission in low-risk patients with mildly active Crohn disease of the ileum and proximal colon.

In patients who cannot successfully taper budesonide, treatment escalation with immunosuppressants (such as azathioprine or its active metabolite, 6-MP) is indicated, which is similar to the treatment of moderate to severe Crohn disease.

It is not necessary to restrict the use of antibiotics to prevent disease flares. Nonsteroidal anti-inflammatory drugs (NSAIDs), however, should be avoided.

Learn more about lifestyle modifications in Crohn disease.


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