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Management of Crohn DiseaseA Review

Educational Objective
To review the clinical management of Crohn disease.
1 Credit CME

Importance  Crohn disease, a chronic gastrointestinal inflammatory disease, is increasing in incidence and prevalence in many parts of the world. Uncontrolled inflammation leads to long-term complications, including fibrotic strictures, enteric fistulae, and intestinal neoplasia. Therefore, early and effective control of inflammation is of critical importance.

Observations  The optimal management approach for Crohn disease incorporates patient risk stratification, patient preference, and clinical factors in therapeutic decision-making. First-line therapy generally consists of steroids for rapid palliation of symptoms during initiation of anti–tumor necrosis factor α therapy. Other treatments may include monoclonal antibodies to IL-12/23 or integrin α4β7, immunomodulators, combination therapies, or surgery. Effective control of inflammation reduces the risk of penetrating complications (such as intra-abdominal abscesses and fistulae), although more than half of patients will develop complications that require surgery. Adverse reactions to therapy include antibody formation and infusion reactions, infections, and cancers associated with immune modulators and biologics and toxicity to the bone marrow and the liver. Both Crohn disease and corticosteroid use are associated with osteoporosis. Vaccinations to prevent infections, such as influenza, pneumonia, and herpes zoster, are important components of health maintenance for patients with Crohn disease, although live vaccines are contraindicated for patients receiving immune suppression therapy.

Conclusions and Relevance  The treatment of patients with Crohn disease depends on disease severity, patient risk stratification, patient preference, and clinical factors, including age of onset and penetrating complications, and includes treatment with steroids, monoclonal antibody therapies, immunomodulators, and surgery. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Peter D. R. Higgins MD, PhD, MSc, 1150 W Medical Center Dr, University of Michigan, Ann Arbor, MI 48109 (

Accepted for Publication: September 8, 2020.

Author Contributions: Drs Higgins and Cushing had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Administrative, technical, or material support: Higgins.
Supervision: Higgins.
Other - Literature review: Cushing.

Conflict of Interest Disclosures: Dr Higgins reported receiving grant funding from the National Institutes of Health, the Crohn's and Colitis Foundation, Pfizer, AbbVie, Eli Lilly, Twine Clinical Consulting, Target PharmaSolutions, Shire, Seres, Genentech, Janssen, Takeda, and UCB and consulting for Pfizer, Eli Lilly, Takeda, and Arena Pharmaceuticals. No other disclosures were reported.

Ng  SC , Shi  HY , Hamidi  N ,  et al.  Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies.   Lancet. 2018;390(10114):2769-2778. doi:10.1016/S0140-6736(17)32448-0PubMedGoogle ScholarCrossref
McGovern  DP , Kugathasan  S , Cho  JH .  Genetics of inflammatory bowel diseases.   Gastroenterology. 2015;149(5):1163-1176.e2. doi:10.1053/j.gastro.2015.08.001PubMedGoogle ScholarCrossref
Jostins  L , Ripke  S , Weersma  RK ,  et al; International IBD Genetics Consortium (IIBDGC).  Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease.   Nature. 2012;491(7422):119-124. doi:10.1038/nature11582PubMedGoogle ScholarCrossref
Liu  JZ , van Sommeren  S , Huang  H ,  et al; International Multiple Sclerosis Genetics Consortium; International IBD Genetics Consortium.  Association analyses identify 38 susceptibility loci for inflammatory bowel disease and highlight shared genetic risk across populations.   Nat Genet. 2015;47(9):979-986. doi:10.1038/ng.3359PubMedGoogle ScholarCrossref
Khanna  S , Raffals  LE .  The microbiome in Crohn’s disease: role in pathogenesis and role of microbiome replacement therapies.   Gastroenterol Clin North Am. 2017;46(3):481-492. doi:10.1016/j.gtc.2017.05.004PubMedGoogle ScholarCrossref
Mahid  SS , Minor  KS , Soto  RE , Hornung  CA , Galandiuk  S .  Smoking and inflammatory bowel disease: a meta-analysis.   Mayo Clin Proc. 2006;81(11):1462-1471. doi:10.4065/81.11.1462PubMedGoogle ScholarCrossref
To  N , Gracie  DJ , Ford  AC .  Systematic review with meta-analysis: the adverse effects of tobacco smoking on the natural history of Crohn’s disease.   Aliment Pharmacol Ther. 2016;43(5):549-561. doi:10.1111/apt.13511PubMedGoogle ScholarCrossref
Nunes  T , Etchevers  MJ , Domènech  E ,  et al; Tobacco-Eneida Study Group of GETECCU.  Smoking does influence disease behaviour and impacts the need for therapy in Crohn’s disease in the biologic era.   Aliment Pharmacol Ther. 2013;38(7):752-760. doi:10.1111/apt.12440PubMedGoogle ScholarCrossref
Banerjee  R , Pal  P , Girish  BG , Reddy  DN .  Risk factors for diagnostic delay in Crohn’s disease and their impact on long-term complications: how do they differ in a tuberculosis endemic region?   Aliment Pharmacol Ther. 2018;47(10):1367-1374. doi:10.1111/apt.14617PubMedGoogle ScholarCrossref
Li  Y , Ren  J , Wang  G ,  et al.  Diagnostic delay in Crohn's disease is associated with increased rate of abdominal surgery: a retrospective study in Chinese patients.   Dig Liver Dis. 2015;47(7):544-548. doi:10.1016/j.dld.2015.03.004PubMedGoogle ScholarCrossref
Nguyen  VQ , Jiang  D , Hoffman  SN ,  et al.  Impact of diagnostic delay and associated factors on clinical outcomes in a U.S. inflammatory bowel disease cohort.   Inflamm Bowel Dis. 2017;23(10):1825-1831. doi:10.1097/MIB.0000000000001257PubMedGoogle ScholarCrossref
Lo  B , Vester-Andersen  MK , Vind  I ,  et al.  Changes in disease behaviour and location in patients with Crohn’s disease after seven years of follow-up: a Danish population-based inception cohort.   J Crohns Colitis. 2018;12(3):265-272. doi:10.1093/ecco-jcc/jjx138PubMedGoogle ScholarCrossref
Mosli  MH , Zou  G , Garg  SK ,  et al.  C-reactive protein, fecal calprotectin, and stool lactoferrin for detection of endoscopic activity in symptomatic inflammatory bowel disease patients: a systematic review and meta-analysis.   Am J Gastroenterol. 2015;110(6):802-819. doi:10.1038/ajg.2015.120PubMedGoogle ScholarCrossref
Thia  KT , Sandborn  WJ , Harmsen  WS , Zinsmeister  AR , Loftus  EV  Jr .  Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort.   Gastroenterology. 2010;139(4):1147-1155. doi:10.1053/j.gastro.2010.06.070PubMedGoogle ScholarCrossref
Zallot  C , Peyrin-Biroulet  L .  Clinical risk factors for complicated disease: how reliable are they?   Dig Dis. 2012;30(suppl 3):67-72. doi:10.1159/000342608PubMedGoogle ScholarCrossref
Karreman  MC , Luime  JJ , Hazes  JMW , Weel  AEAM .  The prevalence and incidence of axial and peripheral spondyloarthritis in inflammatory bowel disease: a systematic review and meta-analysis.   J Crohns Colitis. 2017;11(5):631-642.PubMedGoogle Scholar
Harbord  M , Annese  V , Vavricka  SR ,  et al; European Crohn’s and Colitis Organisation.  The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease.   J Crohns Colitis. 2016;10(3):239-254. doi:10.1093/ecco-jcc/jjv213PubMedGoogle ScholarCrossref
Larsen  S , Bendtzen  K , Nielsen  OH .  Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management.   Ann Med. 2010;42(2):97-114. doi:10.3109/07853890903559724PubMedGoogle ScholarCrossref
Vavricka  SR , Brun  L , Ballabeni  P ,  et al.  Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort.   Am J Gastroenterol. 2011;106(1):110-119. doi:10.1038/ajg.2010.343PubMedGoogle ScholarCrossref
Dave  M , Elmunzer  BJ , Dwamena  BA , Higgins  PD .  Primary sclerosing cholangitis: meta-analysis of diagnostic performance of MR cholangiopancreatography.   Radiology. 2010;256(2):387-396. doi:10.1148/radiol.10091953PubMedGoogle ScholarCrossref
Feld  LD , Rubin  DT , Feld  AD .  Legal risks and considerations associated with inflammatory bowel disease: a primer.   Am J Gastroenterol. 2018;113(11):1577-1579. doi:10.1038/s41395-018-0204-7PubMedGoogle ScholarCrossref
Lim  WC , Wang  Y , MacDonald  JK , Hanauer  S .  Aminosalicylates for induction of remission or response in Crohn's disease.   Cochrane Database Syst Rev. 2016;7(7):CD008870. doi:10.1002/14651858.CD008870.pub2PubMedGoogle Scholar
Feagan  BG , Rochon  J , Fedorak  RN ,  et al; The North American Crohn’s Study Group Investigators.  Methotrexate for the treatment of Crohn’s disease.   N Engl J Med. 1995;332(5):292-297. doi:10.1056/NEJM199502023320503PubMedGoogle ScholarCrossref
Feagan  BG , Fedorak  RN , Irvine  EJ ,  et al; North American Crohn’s Study Group Investigators.  A comparison of methotrexate with placebo for the maintenance of remission in Crohn’s disease.   N Engl J Med. 2000;342(22):1627-1632. doi:10.1056/NEJM200006013422202PubMedGoogle ScholarCrossref
Colombel  JF , Sandborn  WJ , Reinisch  W ,  et al; SONIC Study Group.  Infliximab, azathioprine, or combination therapy for Crohn’s disease.   N Engl J Med. 2010;362(15):1383-1395. doi:10.1056/NEJMoa0904492PubMedGoogle ScholarCrossref
Chande  N , Patton  PH , Tsoulis  DJ , Thomas  BS , MacDonald  JK .  Azathioprine or 6-mercaptopurine for maintenance of remission in Crohn's disease.   Cochrane Database of Syst Rev. 2015(10):CD000067. doi:10.1002/14651858.CD000067.pub3uPubMedGoogle Scholar
Panés  J , López-Sanromán  A , Bermejo  F ,  et al; AZTEC Study Group.  Early azathioprine therapy is no more effective than placebo for newly diagnosed Crohn’s disease.   Gastroenterology. 2013;145(4):766-74.e1. doi:10.1053/j.gastro.2013.06.009PubMedGoogle ScholarCrossref
Cosnes  J , Bourrier  A , Laharie  D ,  et al; Groupe d’Etude Thérapeutique des Affections Inflammatoires du Tube Digestif (GETAID).  Early administration of azathioprine vs conventional management of Crohn’s Disease: a randomized controlled trial.   Gastroenterology. 2013;145(4):758-65.e2. doi:10.1053/j.gastro.2013.04.048PubMedGoogle ScholarCrossref
Hanauer  SB , Sandborn  WJ , Rutgeerts  P ,  et al.  Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial.   Gastroenterology. 2006;130(2):323-333. doi:10.1053/j.gastro.2005.11.030PubMedGoogle ScholarCrossref
Colombel  JF , Sandborn  WJ , Rutgeerts  P ,  et al.  Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial.   Gastroenterology. 2007;132(1):52-65. doi:10.1053/j.gastro.2006.11.041PubMedGoogle ScholarCrossref
Sandborn  WJ , Feagan  BG , Stoinov  S ,  et al; PRECISE 1 Study Investigators.  Certolizumab pegol for the treatment of Crohn’s disease.   N Engl J Med. 2007;357(3):228-238. doi:10.1056/NEJMoa067594PubMedGoogle ScholarCrossref
Schreiber  S , Khaliq-Kareemi  M , Lawrance  IC ,  et al; PRECISE 2 Study Investigators.  Maintenance therapy with certolizumab pegol for Crohn’s disease.   N Engl J Med. 2007;357(3):239-250. doi:10.1056/NEJMoa062897PubMedGoogle ScholarCrossref
Feagan  BG , Sandborn  WJ , Gasink  C ,  et al; UNITI–IM-UNITI Study Group.  Ustekinumab as induction and maintenance therapy for Crohn’s Disease.   N Engl J Med. 2016;375(20):1946-1960. doi:10.1056/NEJMoa1602773PubMedGoogle ScholarCrossref
Sandborn  WJ , Feagan  BG , Rutgeerts  P ,  et al; GEMINI 2 Study Group.  Vedolizumab as induction and maintenance therapy for Crohn’s disease.   N Engl J Med. 2013;369(8):711-721. doi:10.1056/NEJMoa1215739PubMedGoogle ScholarCrossref
Lichtenstein  GR , Loftus  EV , Isaacs  KL , Regueiro  MD , Gerson  LB , Sands  BE .  ACG clinical guideline: management of Crohn’s disease in adults.   Am J Gastroenterol. 2018;113(4):481-517. doi:10.1038/ajg.2018.27PubMedGoogle ScholarCrossref
Colombel  JF , Panaccione  R , Bossuyt  P ,  et al.  Effect of tight control management on Crohn’s disease (CALM): a multicentre, randomised, controlled phase 3 trial.   Lancet. 2018;390(10114):2779-2789. doi:10.1016/S0140-6736(17)32641-7PubMedGoogle ScholarCrossref
Khanna  R , Bressler  B , Levesque  BG ,  et al; REACT Study Investigators.  Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomised controlled trial.   Lancet. 2015;386(10006):1825-1834. doi:10.1016/S0140-6736(15)00068-9PubMedGoogle ScholarCrossref
Colombel  J-F , D’haens  G , Lee  W-J , Petersson  J , Panaccione  R .  Outcomes and strategies to support a treat-to-target approach in inflammatory bowel disease: a systematic review.   J Crohns Colitis. 2020;14(2):254-266. doi:10.1093/ecco-jcc/jjz131PubMedGoogle ScholarCrossref
Chatu  S , Subramanian  V , Pollok  RC .  Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease.   Aliment Pharmacol Ther. 2012;35(5):529-539. doi:10.1111/j.1365-2036.2011.04975.xPubMedGoogle ScholarCrossref
Council  NR .  Health Risks From Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. National Academies Press; 2006.
French  H , Mark Dalzell  A , Srinivasan  R , El-Matary  W .  Relapse rate following azathioprine withdrawal in maintaining remission for Crohn’s disease: a meta-analysis.   Dig Dis Sci. 2011;56(7):1929-1936. doi:10.1007/s10620-011-1671-5PubMedGoogle ScholarCrossref
Gisbert  JP , Marín  AC , Chaparro  M .  The risk of relapse after anti-TNF discontinuation in inflammatory bowel disease: systematic review and meta-analysis.   Am J Gastroenterol. 2016;111(5):632-647. doi:10.1038/ajg.2016.54PubMedGoogle ScholarCrossref
Govani  SM , Noureldin  M , Higgins  PDR ,  et al.  Defining an optimal adherence threshold for patients taking subcutaneous anti-TNFs for inflammatory bowel diseases.   Am J Gastroenterol. 2018;113(2):276-282. doi:10.1038/ajg.2017.438PubMedGoogle ScholarCrossref
Mahadevan  U , McConnell  RA , Chambers  CD .  Drug safety and risk of adverse outcomes for pregnant patients with inflammatory bowel disease.   Gastroenterology. 2017;152(2):451-462.e2. doi:10.1053/j.gastro.2016.10.013PubMedGoogle ScholarCrossref
Bröms  G , Granath  F , Linder  M , Stephansson  O , Elmberg  M , Kieler  H .  Birth outcomes in women with inflammatory bowel disease: effects of disease activity and drug exposure.   Inflamm Bowel Dis. 2014;20(6):1091-1098. doi:10.1097/MIB.0000000000000060PubMedGoogle Scholar
Narula  N , Al-Dabbagh  R , Dhillon  A , Sands  BE , Marshall  JK .  Anti-TNFα therapies are safe during pregnancy in women with inflammatory bowel disease: a systematic review and meta-analysis.   Inflamm Bowel Dis. 2014;20(10):1862-1869. doi:10.1097/MIB.0000000000000092PubMedGoogle ScholarCrossref
Nguyen  GC , Seow  CH , Maxwell  C ,  et al; IBD in Pregnancy Consensus Group; Canadian Association of Gastroenterology.  The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy.   Gastroenterology. 2016;150(3):734-757.e1. doi:10.1053/j.gastro.2015.12.003PubMedGoogle ScholarCrossref
Huang  W , Tang  Y , Nong  L , Sun  Y .  Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn’s disease: a meta-analysis of observational studies.   J Crohns Colitis. 2015;9(3):293-301. doi:10.1093/ecco-jcc/jju028PubMedGoogle ScholarCrossref
Limketkai  BN , Parian  AM , Shah  ND , Colombel  JF .  Short bowel syndrome and intestinal failure in Crohn’s disease.   Inflamm Bowel Dis. 2016;22(5):1209-1218. doi:10.1097/MIB.0000000000000698PubMedGoogle ScholarCrossref
Barnes  EL , Lightner  AL , Regueiro  M .  Perioperative and postoperative management of patients with Crohn's disease and ulcerative colitis.   Clin Gastroenterol Hepatol. 2020;18(6):1356-1366. doi:10.1016/j.cgh.2019.09.040PubMedGoogle ScholarCrossref
Regueiro  M , Feagan  BG , Zou  B ,  et al; PREVENT Study Group.  Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease after ileocolonic resection.   Gastroenterology. 2016;150(7):1568-1578. doi:10.1053/j.gastro.2016.02.072PubMedGoogle ScholarCrossref
Rutter  M , Saunders  B , Wilkinson  K ,  et al.  Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis.   Gastroenterology. 2004;126(2):451-459. doi:10.1053/j.gastro.2003.11.010PubMedGoogle ScholarCrossref
Bojesen  RD , Riis  LB , Hogdall  E , Nielsen  OH , Jess  T .  Inflammatory bowel disease and small bowel cancer risk, clinical characteristics, and histopathology: a population-based study.   Clin Gastroenterol Hepatol. 2017;15(12):1900-1907. doi:10.1016/j.cgh.2017.06.051PubMedGoogle ScholarCrossref
Canavan  C , Abrams  KR , Mayberry  J .  Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn’s disease.   Aliment Pharmacol Ther. 2006;23(8):1097-1104. doi:10.1111/j.1365-2036.2006.02854.xPubMedGoogle ScholarCrossref
Singh  S , Nagpal  SJ , Murad  MH ,  et al.  Inflammatory bowel disease is associated with an increased risk of melanoma: a systematic review and meta-analysis.   Clin Gastroenterol Hepatol. 2014;12(2):210-218. doi:10.1016/j.cgh.2013.04.033PubMedGoogle ScholarCrossref
Long  MD , Martin  CF , Pipkin  CA , Herfarth  HH , Sandler  RS , Kappelman  MD .  Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease.   Gastroenterology. 2012;143(2):390-399. doi:10.1053/j.gastro.2012.05.004PubMedGoogle ScholarCrossref
Lemaitre  M , Kirchgesner  J , Rudnichi  A ,  et al.  Association between use of thiopurines or tumor necrosis factor antagonists alone or in combination and risk of lymphoma in patients with inflammatory bowel disease.   JAMA. 2017;318(17):1679-1686. doi:10.1001/jama.2017.16071PubMedGoogle ScholarCrossref
Kotlyar  DS , Osterman  MT , Diamond  RH ,  et al.  A systematic review of factors that contribute to hepatosplenic T-cell lymphoma in patients with inflammatory bowel disease.   Clin Gastroenterol Hepatol. 2011;9(1):36-41. doi:10.1016/j.cgh.2010.09.016PubMedGoogle ScholarCrossref
Axelrad  JE , Fowler  SA , Friedman  S , Ananthakrishnan  AN , Yajnik  V .  Effects of cancer treatment on inflammatory bowel disease remission and reactivation.   Clin Gastroenterol Hepatol. 2012;10(9):1021-1027. doi:10.1016/j.cgh.2012.06.016PubMedGoogle ScholarCrossref
Shelton  E , Laharie  D , Scott  FI ,  et al.  Cancer recurrence following immune-suppressive therapies in patients with immune-mediated diseases: a systematic review and meta-analysis.   Gastroenterology. 2016;151(1):97-109.e4. doi:10.1053/j.gastro.2016.03.037PubMedGoogle ScholarCrossref
Mamtani  R , Clark  AS , Scott  FI ,  et al.  Association between breast cancer recurrence and immunosuppression in rheumatoid arthritis and inflammatory bowel disease: a cohort study.   Arthritis Rheumatol. 2016;68(10):2403-2411. doi:10.1002/art.39738PubMedGoogle ScholarCrossref
Waljee  AK , Higgins  PDR , Jensen  CB ,  et al.  Anti-tumour necrosis factor-α therapy and recurrent or new primary cancers in patients with inflammatory bowel disease, rheumatoid arthritis, or psoriasis and previous cancer in Denmark: a nationwide, population-based cohort study.   Lancet Gastroenterol Hepatol. 2020;5(3):276-284. doi:10.1016/S2468-1253(19)30362-0PubMedGoogle ScholarCrossref
Long  MD , Martin  C , Sandler  RS , Kappelman  MD .  Increased risk of pneumonia among patients with inflammatory bowel disease.   Am J Gastroenterol. 2013;108(2):240-248. doi:10.1038/ajg.2012.406PubMedGoogle ScholarCrossref
Long  MD , Farraye  FA , Okafor  PN , Martin  C , Sandler  RS , Kappelman  MD .  Increased risk of pneumocystis jiroveci pneumonia among patients with inflammatory bowel disease.   Inflamm Bowel Dis. 2013;19(5):1018-1024. doi:10.1097/MIB.0b013e3182802a9bPubMedGoogle ScholarCrossref
Khan  N , Patel  D , Trivedi  C ,  et al.  Overall and comparative risk of herpes zoster with pharmacotherapy for inflammatory bowel diseases: a nationwide cohort study.   Clin Gastroenterol Hepatol. 2018;16(12):1919-1927. doi:10.1016/j.cgh.2017.12.052PubMedGoogle ScholarCrossref
Khanna  S , Shin  A , Kelly  CP .  Management of Clostridium difficile infection in inflammatory bowel disease: expert review from the Clinical Practice Updates Committee of the AGA Institute.   Clin Gastroenterol Hepatol. 2017;15(2):166-174. doi:10.1016/j.cgh.2016.10.024PubMedGoogle ScholarCrossref
Farraye  FA , Melmed  GY , Lichtenstein  GR , Kane  SV .  ACG clinical guideline: preventive care in inflammatory bowel disease.   Am J Gastroenterol. 2017;112(2):241-258. doi:10.1038/ajg.2016.537PubMedGoogle ScholarCrossref
Shergill  AK , Lightdale  JR , Bruining  DH ,  et al.  The role of endoscopy in inflammatory bowel disease.   Gastrointest Endosc. 2015;81(5):1101-1121. doi:10.1016/j.gie.2014.10.030PubMedGoogle ScholarCrossref
Parkes  GC , Whelan  K , Lindsay  JO .  Smoking in inflammatory bowel disease: impact on disease course and insights into the aetiology of its effect.   J Crohns Colitis. 2014;8(8):717-725. doi:10.1016/j.crohns.2014.02.002PubMedGoogle ScholarCrossref
Nos  P , Domènech  E .  Management of Crohn’s disease in smokers: is an alternative approach necessary?   World J Gastroenterol. 2011;17(31):3567-3574. doi:10.3748/wjg.v17.i31.3567PubMedGoogle ScholarCrossref
Tkacz  J , Brady  BL , Meyer  R , Lofland  JH , Ruetsch  C , Coelho-Prabhu  N .  An assessment of the AGA and CCFA quality indicators in a sample of patients diagnosed with inflammatory bowel disease.   J Manag Care Spec Pharm. 2015;21(11):1064-1076. doi:10.18553/jmcp.2015.21.11.1064PubMedGoogle Scholar
Melmed  GY , Siegel  CA .  Quality improvement in inflammatory bowel disease.   Gastroenterol Hepatol (N Y). 2013;9(5):286-292.PubMedGoogle Scholar
Harer  KN .  Irritable bowel syndrome, disordered eating, and eating disorders.   Gastroenterol Hepatol (N Y). 2019;15(5):280-282.PubMedGoogle Scholar
Zimmerman  J , Fisher  M .  Avoidant/restrictive food intake disorder (ARFID).   Curr Probl Pediatr Adolesc Health Care. 2017;47(4):95-103. doi:10.1016/j.cppeds.2017.02.005PubMedGoogle ScholarCrossref
Pedersen  N , Ankersen  DV , Felding  M ,  et al.  Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease.   World J Gastroenterol. 2017;23(18):3356-3366. doi:10.3748/wjg.v23.i18.3356PubMedGoogle ScholarCrossref
Cox  SR , Lindsay  JO , Fromentin  S ,  et al.  Effects of low FODMAP diet on symptoms, fecal microbiome, and markers of inflammation in patients with quiescent inflammatory bowel disease in a randomized trial.   Gastroenterology. 2020;158(1):176-188.e7. doi:10.1053/j.gastro.2019.09.024PubMedGoogle ScholarCrossref
Neuendorf  R , Harding  A , Stello  N , Hanes  D , Wahbeh  H .  Depression and anxiety in patients with inflammatory bowel disease: a systematic review.   J Psychosom Res. 2016;87:70-80. doi:10.1016/j.jpsychores.2016.06.001PubMedGoogle ScholarCrossref
Bhamre  R , Sawrav  S , Adarkar  S , Sakaria  R , J Bhatia  S .  Psychiatric comorbidities in patients with inflammatory bowel disease.   Indian J Gastroenterol. 2018;37(4):307-312. doi:10.1007/s12664-018-0870-9PubMedGoogle ScholarCrossref
Mikocka-Walus  A , Knowles  SR , Keefer  L , Graff  L .  Controversies revisited: a systematic review of the comorbidity of depression and anxiety with inflammatory bowel diseases.   Inflamm Bowel Dis. 2016;22(3):752-762. doi:10.1097/MIB.0000000000000620PubMedGoogle ScholarCrossref
Selinger  CP , Eaden  J , Selby  W ,  et al.  Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views.   J Crohns Colitis. 2013;7(6):e206-e213. doi:10.1016/j.crohns.2012.09.010PubMedGoogle ScholarCrossref
Marri  SR , Ahn  C , Buchman  AL .  Voluntary childlessness is increased in women with inflammatory bowel disease.   Inflamm Bowel Dis. 2007;13(5):591-599. doi:10.1002/ibd.20082PubMedGoogle ScholarCrossref
Mountifield  R , Bampton  P , Prosser  R , Muller  K , Andrews  JM .  Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions.   Inflamm Bowel Dis. 2009;15(5):720-725. doi:10.1002/ibd.20839PubMedGoogle ScholarCrossref
Taft  TH , Bedell  A , Craven  MR , Guadagnoli  L , Quinton  S , Hanauer  SB .  Initial assessment of post-traumatic stress in a US cohort of inflammatory bowel disease patients.   Inflamm Bowel Dis. 2019;25(9):1577-1585. doi:10.1093/ibd/izz032PubMedGoogle ScholarCrossref
Bennebroek Evertsz’  F , Sprangers  MAG , Sitnikova  K ,  et al.  Effectiveness of cognitive-behavioral therapy on quality of life, anxiety, and depressive symptoms among patients with inflammatory bowel disease: a multicenter randomized controlled trial.   J Consult Clin Psychol. 2017;85(9):918-925. doi:10.1037/ccp0000227PubMedGoogle ScholarCrossref
Kristensen  MS , Kjærulff  TM , Ersbøll  AK , Green  A , Hallas  J , Thygesen  LC .  The influence of antidepressants on the disease course among patients with Crohn’s disease and ulcerative colitis-a danish nationwide register-based cohort study.   Inflamm Bowel Dis. 2019;25(5):886-893. doi:10.1093/ibd/izy367PubMedGoogle ScholarCrossref
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