Chronic transmural granulomatous inflammation anywhere from mouth to anus, skip lesions.
History taking
- • Diarrhoea ± blood, abdominal pain, weight loss
- • Perianal disease, fistulae
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Colonoscopy + biopsy, MR enterography
- • Faecal calprotectin, CRP, CBC, B12, ferritin
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Induction: budesonide / prednisolone
- • Maintenance: azathioprine, methotrexate, anti-TNF (infliximab, adalimumab)
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Smoking cessation reduces flares
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
