Crohn's

Question 1

Presentation of IBD?

Answer 1

Diarrhoea
Abdominal pain
Passing blood
Weight loss

Question 2

Testing for IBD?

Answer 2

Routine bloods for anaemia, infection, thyroid, kidney and liver function
CRP indicates inflammation and active disease
Faecal calprotectin (released by the intestines when inflamed) is a useful screening test (> 90% sensitive and specific to IBD in adults)
Endoscopy (OGD and colonoscopy) with biopsy is diagnostic
Imaging with ultrasound, CT and MRI can be used to look for complications such as fistulas, abscesses and strictures.

Question 3

Management of Crohn’s

Answer 3

Inducing Remission

First line: Steroids (e.g. oral prednisolone or IV hydrocortisone)

If steroids alone don’t work, consider adding immunosuppressant medication under specialist guidance:

Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab

Maintaining Remission

Tailored to individual patients based on risks, side effects, nature of the disease and patient’s wishes. It is reasonable not to take any medications whilst well.

First line:

Azathioprine
Mercaptopurine

Alternatives:

Methotrexate
Infliximab
Adalimumab

Surgery

When the disease only affects the distal ileum it is possible to surgically resect this area and prevent further flares of the disease. Crohns typically involves the entire GI tract

Surgery can also be used to treat strictures and fistulas secondary to Crohns disease.