A child complains of RIF pain and diarrhea. On colonoscopy, granular transmural ulcers are seen
near the ileo-cecal junction. What should be the management?
a. Sulfasalazine
b. Paracetamol
c. Ibuprofen
d. Metronidazole
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 recommendations:
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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