Management of Crohn’s Disease in Adults

Gary R. Lichtenstein, MD, FACG1, Edward V. Loftus, Jr., MD, FACG2, Kim L. Isaacs, MD, PhD, FACG3, Miguel D. Regueiro, MD, FACG4, Lauren B. Gerson, MD, MSc, MACG (GRADE Methodologist)5,† and Bruce E. Sands, MD, MS, FACG

1Department of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA; 3Department of Medicine, Division of Gastroenterology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA; 4Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA; 5Department of Medicine, Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA; 6Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Deceased.

Am J Gastroenterol 2018; 113:481–517; doi: 10.1038/ajg.2018.27; published online 27 March 2018
Received 11 June 2017; accepted 11 January 2018

Correspondence: Gary R. Lichtenstein, MD, FACG, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Gastroenterology Division, 7th Floor, South Perelman Building, Room 753, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104-4283, USA. E-mail: grl@uphs.upenn.edu

Abstract

Crohn’s disease is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. The incidence of Crohn’s disease has steadily increased over the past several decades. The diagnosis and treatment of patients with Crohn’s disease has evolved since the last practice guideline was published. These guidelines represent the official practice recommendations of the American College of Gastroenterology and were developed under the auspices of the Practice Parameters Committee for the management of adult patients with Crohn’s disease. These guidelines are established for clinical practice with the intent of suggesting preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When exercising clinical judgment, health-care providers should incorporate this guideline along with patient’s needs, desires, and their values in order to fully and appropriately care for patients with Crohn’s disease. This guideline is intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. To evaluate the level of evidence and strength of recommendations, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.