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

Charles Bernstein, MD


February 01, 2022

In patients with moderate to severe Crohn disease who are unable to achieve complete remission with of corticosteroids, thiopurines, methotrexate, or anti-TNF therapy, the Canadian Association of Gastroenterology recommends vedolizumab to achieve complete remission. Data from cohort studies suggests that some patients can achieve mucosal healing with vedolizumab therapy.

According to a recent meta-analysis, the 10-year risk for surgical resection in Crohn disease is over 30%. Data suggest that while the annual rate of hospitalization is highest in the first year after diagnosis, annual hospitalization rate decreases in the following years. If there are no indications for surgery or other contraindications, the patient may also be switched to another anti-TNF biologic. In patients whose disease has not responded to a treatment with one mechanism of action despite optimization, switching to a treatment with a different mechanism of action may be beneficial.

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