ACG Clinical Guideline: Management of Crohn's Disease in Adults

Am J Gastroenterol. 2018 Apr;113(4):481-517. doi: 10.1038/ajg.2018.27. Epub 2018 Mar 27.

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.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adalimumab / therapeutic use
  • Adrenal Cortex Hormones / therapeutic use
  • Antibodies, Monoclonal / therapeutic use*
  • Certolizumab Pegol / therapeutic use
  • Crohn Disease / complications
  • Crohn Disease / diagnosis
  • Crohn Disease / pathology
  • Crohn Disease / therapy*
  • Disease Progression
  • Endoscopy, Gastrointestinal
  • Feces / chemistry
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Immunologic Factors / therapeutic use
  • Infliximab / therapeutic use
  • Intestinal Fistula / etiology*
  • Leukocyte L1 Antigen Complex / analysis
  • Magnetic Resonance Imaging
  • Maintenance Chemotherapy
  • Mesalamine / therapeutic use
  • Symptom Assessment
  • Tomography, X-Ray Computed
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal
  • Gastrointestinal Agents
  • Immunologic Factors
  • Leukocyte L1 Antigen Complex
  • Tumor Necrosis Factor-alpha
  • Mesalamine
  • Infliximab
  • Adalimumab
  • Certolizumab Pegol