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Approach to the Patient with Mild Crohn’s Disease: a 2016 Update

  • Inflammatory Bowel Disease (S Hanauer, Section Editor)
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Abstract

Mild Crohn’s disease (CD) is classified as those patients who are ambulatory, with <10 % weight loss, are eating and drinking without abdominal mass, tenderness, obstructive symptoms, or fever, and endoscopically they have non-progressive mild findings. Initial evaluation of mild CD should focus on assessment for high-risk features requiring more aggressive therapy. In contrast to moderate-to-severe disease, where therapy is focused on mucosal healing, the management of mild CD is focused on symptom management, while exposing the individual to minimal therapeutic risks. Budesonide is the most commonly used medication for mild CD given its safety profile. Assessment of inflammatory markers, in concert with computed-tomography (CT) or magnetic resonance (MR) enterographies and endoscopic studies, should be considered in clinical remission to ensure that mucosal inflammation is not present. Endoscopic inflammation can precede clinical recurrence. Individuals with mild CD require routine vaccination, monitoring for iron-deficiency anemia and vitamin D deficiency, and colorectal cancer screening when appropriate.

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Authors and Affiliations

  1. Crohn’s and Colitis Center, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 12605 E 16th Ave., Aurora, CO, 80045, USA

    Frank I. Scott

  2. Perelman Center for Advanced Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 7-South, Room 753, Philadelphia, PA, 19104, USA

    Gary R. Lichtenstein

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Correspondence to Frank I. Scott.

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Conflict of Interest

FIS reports grants from Takeda Pharmaceuticals and grants from NIH/NIDDK outside the submitted work. GRL reports consultancy for Abbott Corporation/Abbvie, Actavis, Alaven, Hospira, Pfizer Pharmaceuticals, Romark, and Takeda; consultancy/research for Ferring, Janssen Orthobiotech, Prometheus Laboratories Inc., Salix Pharmaceuticals/Valeant, Santarus, Shire Pharmaceuticals, and UCB; consultancy/honorarium (CME program) for Luitpold/American Regent and Ironwood; consulting/research/grant for Warner Chilcotte; editorship (honorarium) for Clinical Advances in Gastroenterology, Gastroenterology, and Hepatology (Gastro-Hep Communications); and Springer Science and Business Media; authorship (honorarium) from McMahon Publishing and UpToDate; funding from Janssen Orthobiotech to the University of Pennsylvania (IBD Fellow Education); and book royalties from SLACK Inc.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and were in compliance with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Scott, F.I., Lichtenstein, G.R. Approach to the Patient with Mild Crohn’s Disease: a 2016 Update. Curr Gastroenterol Rep 18, 50 (2016). https://doi.org/10.1007/s11894-016-0523-z

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