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Uptodate Reference Title
Algorithm for management of Crohn disease patients in clinical remission after surgery
Algorithm for management of Crohn disease patients in clinical remission after surgery
Refer to UpToDate topics for additional details on the medical management of Crohn disease.
CD: Crohn disease; AZA: azathioprine; 6MP: 6-mercaptopurine. * Lower risk patients: Nonsmokers, no prior surgery, long-standing CD, history of focal, short stricture. Higher risk patients: Smokers, history of greater than one prior CD surgery, penetrating/fistulizing disease, patients under age 30 years. ¶ If symptoms of active Crohn disease develop, refer to the UpToDate content regarding evaluation and management of Crohn disease. Δ For patients naïve to treatment, begin postoperative therapy with AZA/6-MP and 3 months of metronidazole if no history of intolerance to metronidazole. For patients previously treated with AZA/6-MP or anti-TNF, begin anti-TNF agent. ◊ Rutgeerts ≥i2. § Check fecal calprotectin and C-reactive protein every 6 months for 2 years after surgery. ¥ For patients on anti-TNF: Options include increasing anti-TNF dose, changing to another biologic, or adding AZA/6-MP. For patients on AZA/6-MP: Start anti-TNF agent with or without continuation of AZA/6-MP.
