An American Family Physician review, dated August, sets out diagnosis and management of Crohn's disease for family physicians. Diarrhoea, abdominal pain, fatigue, weight loss and fever are common, and children may present with slowed growth or delayed puberty. Initial evaluation includes endoscopy and cross-sectional imaging, and faecal calprotectin helps decide whether ileocolonoscopy and imaging are needed in uncertain cases.
The review notes that mucosal inflammation can persist after symptoms settle and inflammatory markers normalise, so objective monitoring matters. Patients should be tested for iron, vitamin D, folate and vitamin B12 deficiency. Because colon cancer risk is raised, most guidelines advise colonoscopy 8 years after symptom onset, with monitoring depending on other risk factors.
For mild to moderate disease the review lists budesonide, sulfasalazine and dietary modification to induce remission, and for moderate to severe disease corticosteroids or biologic therapy with or without an immunomodulator. In India, intestinal tuberculosis is an important mimic, so tuberculosis should be considered before starting immunosuppression. This is a narrative review, not a trial.
- Use faecal calprotectin to help decide who needs ileocolonoscopy and imaging when the picture is uncertain
- Check iron, vitamin D, folate and vitamin B12 in patients with confirmed disease
- Do not rely on symptoms alone to judge remission, since inflammation can persist
- Think of intestinal tuberculosis as a mimic and exclude it before immunosuppression
- Plan surveillance colonoscopy around 8 years after symptom onset, as most guidelines advise
Why it matters
It gives a practical, non-invasive step for deciding who needs invasive investigation, in a condition often labelled as irritable bowel.
Don't overread it
A narrative review summarises existing guidance; it is not new trial evidence and does not change any guideline.
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