NICE has published guidance on the role of new and established treatments for the management of Crohn’s disease in adults and children. There are currently around 115,000 people living with Crohn’s disease in the UK and between 3000 and 6000 new cases are diagnosed each year.
An estimated 5% of patients have severe disease, but the proportion of people with moderate Crohn’s disease is unclear. The condition can lead to delay of growth and puberty in children, as well as affecting fertility and sexual relationships in adults. In the last decade, there have been a number of new drugs licensed for the condition. Glucocorticosteroids can be offered to induce remission in people with Crohn’s disease and azathioprine or mercaptopurine can be offered as maintenance treatment. The new guidance covers the use of these drugs in the care pathway for Crohn’s disease. Aimed at all healthcare professionals involved in the management of Crohn’s disease, recommendations include:
• Offer monotherapy with a conventional glucocorticosteroid to induce remission in people with a first presentation or a single inflammatory exacerbation of Crohn’s disease in a 12 month period.
• Discuss with people with Crohn’s disease, and/or their carer, options for managing their disease when they are in remission, including both no treatment and treatment. The discussion should include the risk of inflammatory exacerbations (with and without drug treatment) and the potential side effects of drug treatment. Record the person’s views in their notes.
• Offer azathioprine or mercaptopurine as monotherapy to maintain remission when previously used with a conventional glucocorticosteroid or budesonide to induce remission.
• Consider surgery as an alternative to medical treatment early in the course of the disease for people whose disease is limited to the distal ileum, taking into account the following: benefits and risks of medical treatment and surgery, risk of recurrence after surgery, individual preferences and any personal or cultural considerations. Record the person’s views in their notes.
• Offer adults, children and young people, and/or their parents or carers, ageappropriate multidisciplinary support to deal with any concerns about the disease and its treatment, including concerns about body image, living with a chronic illness, and attending school and higher education.
