Clinical Guidelines

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

  • The American Journal of Gastroenterology volume 113, pages 481517 (2018)
  • doi:10.1038/ajg.2018.27
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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.

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Author information

Author notes

    • Lauren B Gerson

    Deceased

Affiliations

  1. Department of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA

    • Gary R Lichtenstein
  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

    • Edward V Loftus
  3. Department of Medicine, Division of Gastroenterology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA

    • Kim L Isaacs
  4. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA

    • Miguel D Regueiro
  5. Department of Medicine, Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA

    • Lauren B Gerson
  6. Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    • Bruce E Sands

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Competing interests

Guarantor of the article: Gary R. Lichtenstein, MD, FACG.

Specific author contributions: Gary R. Lichtenstein, Edward V. Loftus, Jr, Kim L. Isaacs, Miguel D. Regueiro, Lauren B. Gerson, and Bruce E. Sands: planning the paper, collecting and interpreting data, and drafting the manuscript. Approved the final draft submitted. Lauren B. Gerson performed the Grade analysis. She did not approve the final draft submitted as she passed away before approval.

Financial support: The American College of Gastroenterology supported creation of this guideline.

Potential competing interests: Dr. Lichtenstein has served as a consultant or received funds for CME programs from AbbVie, Actavis, Alaven, CellCeutrix, Celgene, Ferring, Gilead, Hospira, Janssen Orthobiotech, Ironwood, Luitpold/American Regent, Merck, Pfizer, Prometheus Laboratories, Romark, Salix Pharmaceuticals/Valeant, Santarus/Receptos/Celgene, Shire Pharmaceuticals, Takeda, UCB. He has received research funding from Celgene, Janssen Orthobiotech, Takeda, Salix Pharmaceuticals/Valeant Pharmaceuticals, Santarus/Receptos/Celgene, Shire Pharmaceuticals. He has served as an editor and received honorarium for Gastro-Hep Communications, McMahon Publishing, Springer Science, and Business Media and Up-To-Date. He has received book royalty from SLACK. He has received support for IBD fellowship training from: Janssen Orthobiotech, Takeda, and Pfizer. Dr. Loftus has received research support from Janssen, Takeda, UCB, AbbVie, Pfizer, Amgen, Genentech, Receptos, Gilead, Celgene, Seres Therapeutics, MedImmune, Allergan, and Robarts Clinical Trials. He has consulted for Janssen, Takeda, UCB, AbbVie, Pfizer, Amgen, Eli Lilly, Celgene, Celltrion Healthcare, and Napo Pharmaceuticals. Dr. Sands has been a consultant and received research grants from Pfizer, AbbVie, Amgen, AstraZeneca, Celgene, Janssen, MedImmune, Prometheus Laboratories, and Takeda, has been a consultant for Akros Pharma, Allergan, Arena Pharmaceuticals, Forest Research Institute, Boehringer-Ingelheim, Forward Pharma, Immune Pharmaceuticals, Lilly, Luitpold Pharmaceuticals, Receptos, Salix Pharmaceuticals, Syngergy Pharmaceuticals, Theravance Biopharma R&D, TiGenix, TopiVert Pharma, UCB, and Vedanta Biosciences, and has received honoraria for speaking in a CME program from the American College of Gastroenterology. Dr. Regueiro has received research support from Janssen, Abbvie, and Takeda, and has served as a consultant and was on advisory boards for Amgen, AbbVie, Janssen, Takeda, Pfizer, UCB, Celgene, and Miraca. Dr. Isaacs has received research support from Janssen, Takeda, UCB, Abbvie, Roche, Eli Lily, and Celgene. She has received support for IBD fellowship training from Takeda, Abbvie, and Pfizer. She is part of DSMB for Medimmune and Janssen. Dr. Gerson declares no conflict of interest.

Corresponding author

Correspondence to Gary R Lichtenstein.

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