New Guidelines for Managing Crohn's Disease

The American College of Gastroenterology has published new guidelines for managing Crohn's disease, incorporating the latest treatments available since 2018. The therapeutic protocol suggests the preferred management of the disease, based on published literature.

Gary Lichtenstein, director of the Center for Inflammatory Bowel Diseases at the Hospital of the University of Pennsylvania, emphasized that the guideline is flexible and shared decision-making with the patient is recommended. Early initiation of advanced therapy is considered key for optimal results.

The guidelines include 35 recommendations for managing Crohn's disease, from diagnosis to postoperative care. They also describe 59 'key concepts' covering clinical characteristics, natural history, and medical/surgical management.

The use of fecal calprotectin testing is recommended to differentiate inflammatory from non-inflammatory bowel disease, as well as regular endoscopic monitoring for colon cancer in patients with Crohn's colitis.

Newer therapies include interleukin 23 (IL-23) inhibitors such as risankizumab, mirikizumab, and guselkumab, the interleukin 12 and 23 inhibitor ustekinumab, the JAK inhibitor upadacitinib, and the integrin inhibitor vedolizumab.

For moderate to severe Crohn's disease, oral corticosteroids are recommended for short-term induction of remission, but not for maintenance. Anti-tumor necrosis factor (TNF) therapies are also recommended for induction and maintenance.

Patients with intra-abdominal abscesses larger than two centimeters should be treated with drainage and antibiotics. Colonoscopy is recommended 6-12 months after surgery to assess for early recurrence.