Skill Checkup: A 28-Year-Old Man With Diarrhea, Nausea, Vomiting, and Abdominal Cramping

Charles Bernstein, MD


February 01, 2022

The Canadian Association of Gastroenterology advises that in patients with moderate to severe Crohn disease who are unable to achieve complete remission with corticosteroids, thiopurines, or methotrexate, anti-TNF therapy (infliximab, adalimumab) may be used. In these cases, patients should be evaluated for a symptomatic response between 8 and 12 weeks after initiation. Considering that this patient began an anti-TNF regimen approximately 9 weeks ago, the response has been suboptimal and therapy and should be optimized. Critically, the patient should also be counseled to stop smoking.

Systematic reviews have concluded that there are no significant benefits on clinical outcomes when probiotic treatments are used for either induction or maintenance therapy. The use of omega-3 fatty acids and cannabis to induce or continue remission have shown no benefit and is also not recommended at this time.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.