Crohn's disease - Revision history

Danbot: Add MedicationDose entries (methylprednisolone, prednisone) with SMW annotations

2026-03-20T18:48:21Z

Add MedicationDose entries (methylprednisolone, prednisone) with SMW annotations

← Older revision		Revision as of 18:48, 20 March 2026
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	**Adalimumab (Humira), Natalizumab or certolizumab pegol can also be used		**Adalimumab (Humira), Natalizumab or certolizumab pegol can also be used



			==Medication Dosing==
			{{MedicationDose
			\| drug = Methylprednisolone
			\| dose = 20mg IV q6hr
			\| route = IV
			\| context = Severe/fulminant flare (inpatient)
			\| indication = Crohn's disease
			\| population = Adult
			}}
			{{MedicationDose
			\| drug = Prednisone
			\| dose = 40-60mg daily with taper once remission induced
			\| route = PO
			\| context = Moderate flare
			\| indication = Crohn's disease
			\| population = Adult
			}}

	==Disposition== <!--T:23-->		==Disposition== <!--T:23-->

Ostermayer: Marked this version for translation

2026-01-14T12:54:50Z

Marked this version for translation

← Older revision		Revision as of 12:54, 14 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	*Can involve any part of the GI tract from the mouth to the anus		*Can involve any part of the GI tract from the mouth to the anus
	*Bimodal distribution: 15-22yr, 55-60yr		*Bimodal distribution: 15-22yr, 55-60yr
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	==Clinical Features==		==Clinical Features== <!--T:3-->

			<!--T:4-->
	[[File:Aphthous stomatitis.jpg\|thumb\|An aphthous mouth ulcer ([[Special:MyLanguage/aphthous stomatitis\|aphthous stomatitis]]) on seen with Crohn's disease.]]		[[File:Aphthous stomatitis.jpg\|thumb\|An aphthous mouth ulcer ([[Special:MyLanguage/aphthous stomatitis\|aphthous stomatitis]]) on seen with Crohn's disease.]]
	[[File:A single EN.jpg\|thumb\|A single lesion of erythema nodosum.]]		[[File:A single EN.jpg\|thumb\|A single lesion of erythema nodosum.]]

	===GI Symptoms===		===GI Symptoms=== <!--T:5-->

			<!--T:6-->
	*[[Special:MyLanguage/Abdominal pain\|Abdominal pain]]		*[[Special:MyLanguage/Abdominal pain\|Abdominal pain]]
	*[[Special:MyLanguage/Diarrhea\|Diarrhea]]		*[[Special:MyLanguage/Diarrhea\|Diarrhea]]
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	===Extraintestinal Symptoms (50%)===		===Extraintestinal Symptoms (50%)=== <!--T:7-->

			<!--T:8-->
	*[[Special:MyLanguage/Arthritis\|Arthritis]]		*[[Special:MyLanguage/Arthritis\|Arthritis]]
	**Peripheral [[Special:MyLanguage/arthritis\|arthritis]]		**Peripheral [[Special:MyLanguage/arthritis\|arthritis]]
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:9-->

	</translate>		</translate>
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	<translate>		<translate>

	===Other===		===Other=== <!--T:10-->

			<!--T:11-->
	*[[Special:MyLanguage/Appendicitis\|Appendicitis]]		*[[Special:MyLanguage/Appendicitis\|Appendicitis]]


	==Evaluation==		==Evaluation== <!--T:12-->


	===Work-Up===		===Work-Up=== <!--T:13-->

			<!--T:14-->
	*Rule out alternate etiologies for symptoms		*Rule out alternate etiologies for symptoms
	*Evaluate for complications (e.g. fistulae, abscess, obstruction)		*Evaluate for complications (e.g. fistulae, abscess, obstruction)
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	***[[Special:MyLanguage/Clostridium difficile\|C.diff]] toxin		***[[Special:MyLanguage/Clostridium difficile\|C.diff]] toxin

			<!--T:15-->
	*Consider imaging:		*Consider imaging:
	**CT A/P if concern for [[Special:MyLanguage/small bowel obstruction\|small bowel obstruction]], perforation, or toxic megacolon		**CT A/P if concern for [[Special:MyLanguage/small bowel obstruction\|small bowel obstruction]], perforation, or toxic megacolon
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	===Diagnosis===		===Diagnosis=== <!--T:16-->


	==Management==		==Management== <!--T:17-->

			<!--T:18-->
	[[File:CT scan gastric CD.jpg\|thumb\|CT scan showing Crohn's disease in the fundus of the stomach.]]		[[File:CT scan gastric CD.jpg\|thumb\|CT scan showing Crohn's disease in the fundus of the stomach.]]

	===Acute Flare Management===		===Acute Flare Management=== <!--T:19-->

			<!--T:20-->
	*[[Special:MyLanguage/IVF\|IVF]]		*[[Special:MyLanguage/IVF\|IVF]]
	*Bowel rest		*Bowel rest
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	===Chronic Treatment===		===Chronic Treatment=== <!--T:21-->

			<!--T:22-->
	''Alterations should be discussed with GI''		''Alterations should be discussed with GI''
	*Aminosalicylates (5-ASA) - Mild-to-moderate Crohn's disease. Give with probiotics.		*Aminosalicylates (5-ASA) - Mild-to-moderate Crohn's disease. Give with probiotics.
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	==Disposition==		==Disposition== <!--T:23-->


	===Inpatient Admission===		===Inpatient Admission=== <!--T:24-->

			<!--T:25-->
	*Significant metabolic derangements (i.e. [[Special:MyLanguage/electrolyte imbalance\|electrolyte imbalance]] or severe [[Special:MyLanguage/dehydration\|dehydration]])		*Significant metabolic derangements (i.e. [[Special:MyLanguage/electrolyte imbalance\|electrolyte imbalance]] or severe [[Special:MyLanguage/dehydration\|dehydration]])
	*Fulminate [[Special:MyLanguage/colitis\|colitis]]		*Fulminate [[Special:MyLanguage/colitis\|colitis]]
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	===Surgical Intervention===		===Surgical Intervention=== <!--T:26-->

			<!--T:27-->
	''Consult EARLY if any of the following suspicions''		''Consult EARLY if any of the following suspicions''
	*Perforation		*Perforation
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	==Complications==		==Complications== <!--T:28-->

			<!--T:29-->
	*[[Special:MyLanguage/Bowel obstruction\|Bowel obstruction]]		*[[Special:MyLanguage/Bowel obstruction\|Bowel obstruction]]
	**Due to stricture or bowel wall edema		**Due to stricture or bowel wall edema
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	===Therapy complications===		===Therapy complications=== <!--T:30-->

			<!--T:31-->
	*[[Special:MyLanguage/Leukopenia\|Leukopenia]]/[[Special:MyLanguage/thrombocytopenia\|thrombocytopenia]]		*[[Special:MyLanguage/Leukopenia\|Leukopenia]]/[[Special:MyLanguage/thrombocytopenia\|thrombocytopenia]]
	*[[Special:MyLanguage/Fever\|Fever]]/infection		*[[Special:MyLanguage/Fever\|Fever]]/infection
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	==See Also==		==See Also== <!--T:32-->

			<!--T:33-->
	*[[Special:MyLanguage/Ulcerative Colitis\|Ulcerative Colitis]]		*[[Special:MyLanguage/Ulcerative Colitis\|Ulcerative Colitis]]
	*[[Special:MyLanguage/Colitis\|Colitis]]		*[[Special:MyLanguage/Colitis\|Colitis]]


	==References==		==References== <!--T:34-->

			<!--T:35-->
	<references/>		<references/>
	[[Category:GI]]		[[Category:GI]]
	1. Thomas N, Wu AW. Large intestine. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Elsevier; 2023.		1. Thomas N, Wu AW. Large intestine. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Elsevier; 2023.
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:58:35Z

Prepared the page for translation

Show changes

Rossdonaldson1: /* Acute Flare Management */

2023-09-13T15:27:42Z

Acute Flare Management

← Older revision		Revision as of 15:27, 13 September 2023
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	*[[Electrolyte repletion\|Electrolyte correction]]		*[[Electrolyte repletion\|Electrolyte correction]]
	*Consider [[steroid]] burst		*Consider [[steroid]] burst
	**[[Methylprednisolone]] (e.g., 30mg IV bid) or [[prednisone]] (e.g., 60 mg day 1, then 40 mg daily x 4 days) ~~or budesonide~~ for mild to moderate disease due to fewer systemic side effects		**[[Methylprednisolone]] (e.g., 30mg IV bid) or [[prednisone]] (e.g., 60 mg day 1, then 40 mg daily x 4 days), OR
			**[[Budesonide]] for mild to moderate disease due to fewer systemic side effects
	*Antidiarrheals are contraindicated		*Antidiarrheals are contraindicated

Cmb23: /* References */

2023-09-09T21:40:36Z

References

← Older revision		Revision as of 21:40, 9 September 2023
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	*[[Electrolyte repletion\|Electrolyte correction]]		*[[Electrolyte repletion\|Electrolyte correction]]
	*Consider [[steroid]] burst		*Consider [[steroid]] burst
	**[[Methylprednisolone]] (e.g., 30mg IV bid) or [[prednisone]] (e.g., 60 mg day 1, then 40 mg daily x 4 days)		**[[Methylprednisolone]] (e.g., 30mg IV bid) or [[prednisone]] (e.g., 60 mg day 1, then 40 mg daily x 4 days) or budesonide for mild to moderate disease due to fewer systemic side effects
	*Antidiarrheals are contraindicated		*Antidiarrheals are contraindicated

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	<references/>		<references/>
	[[Category:GI]]		[[Category:GI]]
			1. Thomas N, Wu AW. Large intestine. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Elsevier; 2023.

Rossdonaldson1: /* Inpatient Admission */

2022-09-07T17:45:59Z

Inpatient Admission

← Older revision		Revision as of 17:45, 7 September 2022
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	==Disposition==		==Disposition==
	===Inpatient Admission===		===Inpatient Admission===
	*~~Metabolic~~ derangements (ie [[electrolyte imbalance]] or severe [[dehydration]])		*Significant metabolic derangements (i.e. [[electrolyte imbalance]] or severe [[dehydration]])
	*Fulminate [[colitis]]		*Fulminate [[colitis]]
	*[[SBO\|Obstruction]]		*[[SBO\|Obstruction]]

Rossdonaldson1: /* Work-Up */

2022-09-07T17:40:59Z

Work-Up

← Older revision		Revision as of 17:40, 7 September 2022
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	**Chemistry		**Chemistry
	**LFTs/lipase		**LFTs/lipase
	**Type and screen if concern for significant bleeding		**May additionally consider:
	**Consider ESR/CRP		***ESR/CRP
	**Fecal calprotectin (sensitive indicator of intestinal inflammation, unreliable in select Crohn's patients)<ref>van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.</ref>		***Type and screen (if concern for significant bleeding)
	**[[Clostridium difficile\|C.diff]] toxin		***Fecal calprotectin (sensitive indicator of intestinal inflammation, unreliable in select Crohn's patients)<ref>van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.</ref>
			***[[Clostridium difficile\|C.diff]] toxin

	*Consider imaging:		*Consider imaging:

Rossdonaldson1: /* Evaluation */

2022-09-07T17:39:29Z

Evaluation

← Older revision		Revision as of 17:39, 7 September 2022
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	**CBC		**CBC
	**Chemistry		**Chemistry
	**~~ESR~~/~~CRP~~		**LFTs/lipase
	**~~Positive ASCA~~ and ~~negative atypical p-ANCA is specific~~ for ~~Crohn's disease~~		**Type and screen if concern for significant bleeding
			**Consider ESR/CRP
	**Fecal calprotectin (sensitive indicator of intestinal inflammation, unreliable in select Crohn's patients)<ref>van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.</ref>		**Fecal calprotectin (sensitive indicator of intestinal inflammation, unreliable in select Crohn's patients)<ref>van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.</ref>
	**[[Clostridium difficile\|C.diff]] toxin		**[[Clostridium difficile\|C.diff]] toxin
	**Type and screen if any bleeding suspicion
	*Consider imaging:		*Consider imaging:
	**~~Plain abdominal films - rule out~~ [[small bowel obstruction]], perforation ~~and~~ toxic megacolon		**CT A/P if concern for [[small bowel obstruction]], perforation, or toxic megacolon
	**CT A/P
	***Most useful diagnostic test in patients with acute symptoms who have known or suspected Crohn		***Most useful diagnostic test in patients with acute symptoms who have known or suspected Crohn
	***Findings: bowel wall thickening, mesenteric edema, local abscess, fistulas		***Findings: bowel wall thickening, mesenteric edema, local abscess, fistulas

			===Diagnosis===

	==Management==		==Management==

Kfarzam: /* Work-Up */

2022-08-17T02:59:05Z

Work-Up

← Older revision		Revision as of 02:59, 17 August 2022
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	**Chemistry		**Chemistry
	**ESR/CRP		**ESR/CRP
			**Positive ASCA and negative atypical p-ANCA is specific for Crohn's disease
	**Fecal calprotectin (sensitive indicator of intestinal inflammation, unreliable in select Crohn's patients)<ref>van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.</ref>		**Fecal calprotectin (sensitive indicator of intestinal inflammation, unreliable in select Crohn's patients)<ref>van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.</ref>
	**[[Clostridium difficile\|C.diff]] toxin		**[[Clostridium difficile\|C.diff]] toxin

Rossdonaldson1: /* Acute Flare Management */

2022-05-03T21:28:12Z

Acute Flare Management

← Older revision		Revision as of 21:28, 3 May 2022
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	*Consider [[steroid]] burst		*Consider [[steroid]] burst
	**[[Methylprednisolone]] (e.g., 30mg IV bid) or [[prednisone]] (e.g., 60 mg day 1, then 40 mg daily x 4 days)		**[[Methylprednisolone]] (e.g., 30mg IV bid) or [[prednisone]] (e.g., 60 mg day 1, then 40 mg daily x 4 days)
	*~~antidiarrheal~~ are contraindicated		*Antidiarrheals are contraindicated

	===Chronic Treatment===		===Chronic Treatment===