A 14yo boy presents with recurrent abdominal pain, malaise and weight loss over 6m. Exam:
vague mass is felt in RIF. Colonoscopy shows transmural inflammation and granulomata. What is
the most appropriate management?
a. Sulfasalazine
b. Paracetamol
c. Metronidazole
d. Ibuprofen
answer: A
Crohns is transmural and has granulomatas
UC is mucosal and no granulomas
The best choice from the options given would be A, but it is not the best choice for Crohns in general, here is a summary of the management based on NICE
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Induce remission > steriod, if steroid contraindicated/unwanted> ASA(much less effective) +/- azathioprine or mercaptopurine or methotrexate. If refractory> biologics.
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Maintaining remission: (1st-line) azathiprone or mercaptopurine, (2nd-line) methotrexate
Antibiotics: add metronidazole or ciprofloxacin for peri-anal disease (limited efficacy)
Anti-diarrheals: must be avoided during exacerbations as increase risk of toxic megacolon