Crohn’s Disease Flare Pathway

Flare pathway for adults with known Crohn's Disease without a stoma or an individual care plan. Exclusions : age under 16 , have a stoma or fistula , have had surgery or are on immunomodulators - azathioprine , mercaptopurine , methotrexate or a biological therapy ( e.g. Humira )

Exclude intercurrent gastrointestinal infection . Ask about triggers . Check adherence to medication. Stop NSAIDS. Consider self-care for mild symptoms including dietary advice and reducing stress. See rcgp.org.uk/ibd and signpost to crohnsandcolitis.org.uk. Check inflammatory blood markers and faecal calprotectin , but initiate treatment before results are available if clinical suspicion is high.

Where is the main site of onset Perinal - is there a hot fluctuant swelling or is the patient vomiting ? Phone on-call surgical SpR No - Metronidazole or ciprofloxacin ( unlicenced indications ) alone or in combination , can improve symptoms of fistulating Crohn's but complete healing occurs rarely. Metronidazole is usually given for 1 month , but no longer than 3 months because of peripheral neuropathy concerns. Discuss all cases of perianal Crohn's with the IBD team.

Ileal or ileo-colonic - are there obvious signs of obstruction ( vomiting , post-prandial pain and weight loss ) or...