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