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How to Best Manage Crohn’s Disease

Dr. Kelly Cushing and Dr. Peter Higgins, two gastorenteroligists at Michigan Medicine, recently published an article in The Journal of the American Medical Association on the most effective evidence-based ways to manage and treat the Crohn’s disease. 

Although the cause of Crohn’s disease are unknown, the incidence rates of the chronic disease have been steadily growing over the past several years, particularly in countries that have adopted Westernized-diets and that have becoming incresingly industrialized. This increase lead Dr. Cushing, a clinical lecturer and gastroenterologist, and Dr. Higgins, a gastroenterologist and the director of the Inflammatory Bowel Disease Program at Michigan Medicine, to weigh in on the management and treatment of this growing disease. Overall, the pair analyzed 88 publications which included case-control, cohort and cross-sectional studies, as well as guidelines, editorials, and systemic reviews by experts.

The review highlights that fecal calprotectin, a stool marker for inflammation, is a sensitive screening test for inflammatory bowel disease in symptomatic individuals. Elevated levels of the calprotectin protein should lead to further evaluation of the patient via endoscopy. After collection of a biopsy, then can a definitive diagnosis be made. 

There have been many significant advancements in the treatment of Crohn’s disease, with a number of therapies available to help patients achieve long-term remission. The team found that although steroids help to achieve symptomatic control that they should not be used as a long-term treatment, as they aren’t effective at maintenence. With many immune suppressive therapies now available to achieve remission, a combination therapy approach is effective when it comes to individuals with moderate to severe Crohn’s disease. The researchers advised that clinicians monitor for objective responses to therapy, tailored to the specific patient’s disease location, as well as other medical conditions. Response rates to therapies should not be measured by symptoms alone. 

The pair also suggests that routine cancer screenings, vaccinations, and monitoring of adverse effects and reactions to medications be maintained. Dr. Cushing and Dr. Higgins recommended that patients continue to have a diverse diet, while limiting food avoidance. The final suggestion was that medical providers be aware of anxiety and depression in their patients and continue to monitor them for post-traumatic stress disorder (PTSD), as it’s increasingly experienced by those with Crohn’s disease due to hospitalizations and surgeries.

“It’s extremely important for clinicians to pay attention to all of these factors when it comes to treating this complex disease,” said Dr. Cushing.

  1. Cushing, Kelly, and Peter D. R. Higgins. “Management Of Crohn Disease”. JAMA, vol 325, no. 1, 2021, p. 69. American Medical Association (AMA), doi:10.1001/jama.2020.18936.
  2. Sawani, Jina. “How To Best Manage Crohn’s Disease”. University Of Michigan, 2021, https://labblog.uofmhealth.org/body-work/how-to-best-manage-crohns-disease.

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