This guideline is mainly relevant for secondary care and doesn’t really change our practice. There are a few useful bits for us.

General Information:

  • Stop Smoking – encourage this as has a huge impact on relapse rates
  • Fertility – ensure women are aware of the impact of medication / surgery on their fertility.
  • Osteopenia and fracture risk – ensure you assess patients for fracture risk as per the recent NICE guideline. Remember that patients may have low BMI or frequent use of steroids which also increases risk.

Spotting Severe Crohn’s

The following features would be consistent with a severe episode:

  • General  very poor health
  • Loss of Weight
  • Severe Abdo Pain
  • Fever
  • Frequent Diarrhoea (3 or more times a day).

Special considerations for drugs:

Remember that most of the drugs used in Crohn’s disease require regular blood monitoring. If doing a prescription – check that they are in date for their bloods…

Inducing Remission:

Most of the time, patients will be managed by specialists.

If we do need to start anything, it will normally be oral prednisolone.

Patients may end up with add on treatment (eg azathioprine / mercaptopurine / methotrexate / 5ASA drugs / Infliximab / Adalimumab).

2 Responses

  1. Kathy Grant
    thanks Louise, these posts are very helpful, Kathy Grant (non-Pallant GP locum!)
  2. Karyn Knight
    Thanks Louise for this. I went to a talk recently by Dr Quine. She briefly discussed Crohns and the take home message was that if a patient with Crohns has >2 exacerbations ( with steroids ) a year they should be on oral azathiprine or MCP/MTX. She was really keen on using ASAs 1st line in Crohns (as well as UC) as maintenance Rx as she says SE are pretty minimal and it is a pretty safe drug to use ( ie:Pentasa) can stay on continuously /increase dose as needed. up to max. M/R preparation good for disease from R colon onwards as that's where it starts dissolving.We do occasionally see pts with Crohns on no maintenance Rx perhaps lost to f/up so we need to send them back to gastro if > 2 courses steroids to reduce risk of fistulas/surgery. Also for proctitis use suppositories steroids/ASAs), If higher disease 10-20 cm use enemas(lower volume is better!). For above 20 cm need oral meds. If a bit of all above needs a combination of all above !

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