ACG updates guideline on diagnosis, management of Crohn's disease

The American College of Gastroenterology (ACG) guideline includes a strong recommendation on diagnosis stating that fecal calprotectin is a helpful test that should be considered to help differentiate inflammatory bowel disease from irritable bowel syndrome.


The American College of Gastroenterology recently released an updated guideline on management of Crohn's disease in adults.

The guideline notes that the incidence of Crohn's disease has steadily increased over the past several decades and that diagnosis and treatment have evolved since publication of the society's last practice guideline on the subject. The new guideline includes 60 recommendations with grades and strengths determined by the level of evidence support. It was published online by the American Journal of Gastroenterology on March 27.

Regarding diagnosis of Crohn's disease, the guideline includes one strong recommendation on laboratory testing: Fecal calprotectin is a helpful test that should be considered to help differentiate inflammatory bowel disease from irritable bowel syndrome. Four conditional recommendations address the use of endoscopy. Other strong recommendations advise against NSAIDs and smoking and in favor of assessment and management of patients' stress, depression, and anxiety. According to a conditional recommendation, antibiotic use should not be restricted in order to prevent disease flares.

The guideline also offers graded recommendations on a number of medical therapy options, including sulfasalazine, mesalamine, budesonide, metronidazole, corticosteroids, thiopurines, and anti-tumor necrosis factor agents. The recommendations are organized by severity of disease: mild to moderately severe disease, moderate to severe disease, severe/fulminant disease, fistulizing disease, and luminal disease. There are also recommendations on surgical management of Crohn's disease, including when to refer patients to surgery and how to prevent disease recurrence.

Additional, ungraded “summary statements” address the disease's clinical features, natural history, related intestinal malignancy, diagnosis (including lab, genetic, and serologic testing; endoscopy; imaging studies; and other topics), and management. The guideline authors noted that the document 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.”