The American College of Gastroenterology (ACG) has published updated guidelines — published March 2018 — that may improve health outcomes for patients by promoting more accurate diagnoses with the use of evidence-based treatments; however, expensive therapies including novel agents with possible adverse events have also been reported, according to the clinical guideline synopsis published in JAMA.

The global prevalence of Crohn disease in adults has increased, which consequently will increase the number of primary care clinicians who will provide care to these patients. New diagnostic tools and therapeutics are now available to facilitate this.  

The synopsis highlights some of the major guideline recommendations with moderate to high levels of evidence.

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  • To differentiate the presence of inflammatory bowel disease from irritable bowel syndrome, fecal calprotectin should be considered (strong recommendation; moderate level of evidence).
  • Oral mesalamine should not be used to treat patients with active Crohn disease (strong recommendation; moderate level of evidence).
  • Anti-tumor necrosis factor agents (ie, adalimumab) should be used to treat Crohn disease that is resistant to corticosteroids or requires ongoing steroid treatment (strong recommendation; moderate level of evidence).
  • Infliximab in combination with immunomodulators is more effective than either treatment alone in patients who have not received these treatments in the past (high level of evidence).
  • Anti-integrin therapy with or without an immunomodulator should be considered to reduce remission in patients with moderately or severely active Crohn disease and objective evidence of active disease (strong recommendation; high level of evidence).

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Nearly a third of patients with Crohn disease have mild disease and do not require a biologic agent. The comparative efficacy of many novel drugs is still unknown, limiting the current treatment recommendations.

“The ability to use risk factors and biomarkers to predict response could result in improved outcomes and more cost-effective care,” the authors wrote. “As novel therapies are developed, the importance of tailoring treatment algorithms will become even greater, highlighting the need for testing the comparative efficacy of these various treatments.”


Feld L, Glick LR, Cifu AS. Diagnosis and management of Crohn disease. JAMA. 2019;321(18):1822-1823.