bowel obstruction with no possibility of placement of a feeding tube beyond the obstruction, or if these attempts have failed other complications, such as an anastomotic leak or a high output intestinal fistula. B Show 3 more As per AAST/WSES 2021 guidelines: Reserve TPN for nutritionally deficient patients unable to tolerate enteral nutrition and when the enteral route is contraindicated, in critically ill patients presenting with signs of shock, intestinal ischemia, high output fistula, and/or severe intestinal hemorrhage. B Initiate TPN as the mode of choice in patients with complicated IBD requiring emergency surgery. A Nutritional support (energy requirements): ensure energy intake of 30-35 kcal/kg/day in patients with IBD, as their requirements are similar to the healthy population. Determine individual energy requirements using indirect calorimetry and an individual physical activity factor if there is a clinical suspicion of a different energy requirement in particular disease states. B Nutritional support (protein requirements): Ensure protein intake of ~ 1 g/kg/day in adult patients with IBD in remission, as their requirements are similar to the general population. B Increase protein intake to 1.2-1.5 g/kg/day in adult patients with active IBD. B Nutritional support (micronutrient requirements): assess for micronutrient deficiencies regularly in patients with IBD, including in the remission phase, and correct specific deficits appropriately. B Nutritional support (vitamin supplements): initiate vitamin B12 supplementation in patients with CD when > 20 cm of the distal ileum is resected, whether or not in combination with the ileocecal valve, or when vitamin B12 deficiency is documented. B Show 2 more Nutritional support (management of malnutrition): screen for malnutrition at the time of diagnosis and regularly thereafter in patients with IBD. B Show 2 more Nutritional support (avoidance of dehydration): make every effort to avoid dehydration in patients with IBD. B Nutritional support (avoidance of refeeding syndrome): consider undertaking standard precautions and interventions to prevent the refeeding syndrome, particularly concerning https://web.pathway.md/diseases/recFEepjgYMnE2bAn 14/28 6/23/23, 3:37 AM Crohn's disease Pathway phosphate and thiamine, in patients with IBD and nutritional deprivation extended over many days. C Probiotics: As per ESPEN 2023 guidelines: Do not offer probiotics for the treatment of active disease or for the prevention of relapse in the remission phase or postoperative recurrence of disease in patients with CD. D Do not offer prebiotics for the treatment of CD, neither in active disease nor for maintenance of remission. D As per AGA 2020 guidelines, offer probiotics in patients with CD only in the context of a clinical trial. B 7. Therapeutic procedures Fecal microbiota transplantation: insufficient evidence to recommend for or against fecal microbiota transplantation in patients with IBD. I 8. Perioperative care Preoperative medications: As per WSES 2021 guidelines: Wean off corticosteroids (preoperatively, ideally 4 weeks) and stop anti-TNFs before surgery, as soon as possible to decrease the risk of postoperative complications, in accordance with a gastroenterologist. B Recognize that preoperative anti-TNFs and corticosteroids are risk factors for intra-abdominal sepsis in patients requiring emergency resectional surgery. B As per ASCRS 2020 guidelines, attempt weaning corticosteroids before surgical intervention as preoperative high-dose corticosteroids increase the risk of postoperative infectious complications. B Show 2 more As per ECCO 2019 guidelines, consider reducing the dose of corticosteroids preoperatively, with a careful monitoring to avoid increasing disease burden, in order to reduce the rates of postoperative complications. C Show 2 more Perioperative nutrition: As per ESPEN 2023 guidelines, assess nutritional status before planned surgery. Administer dietetic interventions including nutritional therapy in patients with malnutrition or at nutritional risk. B Show 10 more As per WSES 2021 guidelines, provide preoperative nutritional support in severely undernourished patients. A https://web.pathway.md/diseases/recFEepjgYMnE2bAn 15/28 6/23/23, 3:37 AM Crohn's disease Pathway As per ASCRS 2020 guidelines, consider providing preoperative nutritional support to decrease postoperative morbidity in patients with malnutrition. C As per ECCO 2019 guidelines, obtain preoperative nutritional assessment in all patients with CD planned to undergo surgery. Optimize nutritional status with enteral or parenteral nutrition before surgery in patients with nutritional deficiencies. B Preoperative smoking cessation: advise smoking cessation to reduce postoperative morbidity in patients with CD. B 9. Surgical interventions Indications for surgery, refractory disease: As per AAST/WSES 2021 guidelines: Perform surgical exploration by laparotomy in hemodynamically unstable patients with severe colitis not responding to medical treatment, taking into consideration damage control surgery principles with or without an open abdomen. B Perform subtotal colectomy with ileostomy in patients presenting with acute severe refractory colitis, and massive colorectal bleeding not responding to medical treatment, in a laparoscopic or open approach according to patient's hemodynamic stability and surgeon's skills. B As per ASCRS 2020 guidelines: Perform surgery in patients with severe acute colitis not adequately responding to medical therapy. B Consider performing surgery in patients with an inadequate response to, developing complications from, or being nonadherent with medical therapy. B Indications for surgery, hemorrhage: As per AAST/WSES 2021 guidelines, consider performing sigmoidoscopy and upper gastrointestinal endoscopy in hemodynamically stable patients with IBD presenting with gastrointestinal bleeding. C Attempt preoperative localization of the bleeding site with the aim of excluding upper gastrointestinal or anorectal bleeding to allow better planning of the surgical strategy. C Show 6 more As per ASCRS 2020 guidelines, consider evaluating and treating stable patients with gastrointestinal hemorrhage by endoscopic and/or interventional radiologic techniques. Perform operative exploration in unstable patients despite resuscitation efforts. B Indications for surgery, perforation: As per AAST/WSES 2021 guidelines, perform surgical exploration in the presence of radiological signs of pneumoperitoneum and free fluid within the peritoneal cavity in acutely unwell patients presenting with complicated CD or acute severe ulcerative colitis. B Show 4 more As per ASCRS 2020 guidelines: Perform surgery in patients with signs or symptoms of impending or actual perforation. B https://web.pathway.md/diseases/recFEepjgYMnE2bAn 16/28 6/23/23, 3:37 AM Crohn's disease Pathway Perform surgical resection of the perforated segment in patients with free perforation. B Indications for surgery, strictures: As per AAST/WSES 2021 guidelines, perform surgery in patients with CD with symptomatic intestinal strictures not responding to medical therapy and not amenable to endoscopic dilatation. B Show 3 more As per ASCRS 2020 guidelines, consider performing endoscopic dilation in patients with short- segment, non-inflammatory, symptomatic small bowel or anastomotic strictures. B Show 4 more As per ECCO 2019 guidelines, defer surgery in adult patients with CD presenting with acute small bowel obstruction without bowel ischemia or peritonitis. B Show 2 more Indications for surgery (toxic megacolon): perform surgical exploration by laparotomy in hemodynamically unstable patients presenting with toxic megacolon, taking into consideration damage control surgery principles with or without an open abdomen. B Show 3 more Indications for surgery, abdominal abscess: As per AAST/WSES 2021 guidelines, perform image-guided percutaneous drainage of intra- abdominal abscesses > 3 cm and administer early empiric antibiotic therapy and adapt antibiotics as soon as possible to microbiological cultures results. Reevaluate antibiotic therapy according to the patient's clinical and biochemical features. B Show 3 more As per ASCRS 2020 guidelines, consider administering antibiotics with or without drainage in patients with penetrating CD with abscess formation, followed by interval elective resection or medical therapy depending on the clinical situation and patient preferences. C As per ECCO 2019 guidelines: Perform image-guided percutaneous drainage as the primary treatment approach in patients with well-defined accessible intra-abdominal abscesses. B Consider initiating medical management following successful image-guided drainage of an intra-abdominal abscess. Set a low threshold for surgery in the event of failure of medical therapy. C As per ACG 2018 guidelines, perform surgical or image-guided percutaneous drainage, along with antibiotic administration, for the treatment of patients with an intra-abdominal abscess. B Indications for surgery, anorectal abscess: As per AAST/WSES 2021 guidelines, perform adequate surgical drainage of a perianal abscess in patients with CD without searching for an associated fistula. B Show 3 more As per ACG 2018 guidelines, drain abscesses (surgically or percutaneously) before initiating anti-TNFs in patients with fistulizing CD. B https://web.pathway.md/diseases/recFEepjgYMnE2bAn 17/28 6/23/23, 3:37 AM Crohn's disease Pathway Indications for surgery (enteric fistulas): consider surgery in patients with enteric fistulas that persist despite appropriate medical therapy. B Indications for surgery (carcinoma or dysplasia): obtain endoscopic surveillance in patients with visible dysplasia undergone complete endoscopic excision. Perform total colectomy or total proctocolectomy if dysplasia is not amenable to endoscopic excision, is also found in the surrounding flat mucosa, or is multifocal, or if colorectal adenocarcinoma is diagnosed. B Show 2 more Choice of surgical intervention: As per WSES 2021 guidelines, use laparoscopic approach in hemodynamically stable patients presenting with complications related to IBD, when skills are available, in order to decrease morbidity and length of hospital stay. B Show 3 more As per ASCRS 2020 guidelines, consider performing endoscopic dilation, bypass, or strictureplasty in patients with symptomatic disease of the stomach or duodenum despite medical therapy. B Show 11 more As per ECCO 2019 guidelines, use laparoscopic approach as the first-line approach in surgery for CD, dependent on appropriate expertise. B Show 7 more 10. Specific circumstances Pediatric patients (nutritional therapy): Offer dietary therapy with exclusive enteral nutrition as first-line therapy for induction of remission in pediatric patients with active luminal CD. B Offer monotherapy with maintenance enteral nutrition (at least 50% of daily energy requirements) to prolong remission in pediatric patients with low-risk CD reached clinical remission. B Pediatric patients (induction of remission, corticosteroids): consider initiating corticosteroids for induction of remission in pediatric patients with active luminal CD if exclusive enteral nutrition is not an option. C Pediatric patients (induction of remission, TNF inhibitors): initiate anti-TNF therapy for induction of remission in pediatric patients with a new-onset disease at high risk for a complicated disease course. B Show 6 more Pediatric patients (induction of remission, monoclonal antibodies): consider initiating ustekinumab or vedolizumab in patients failed to achieve clinical remission on anti-TNF agents, despite anti-TNF dose optimization and immunomodulator use. C Pediatric patients (maintenance of remission, DMARDs): https://web.pathway.md/diseases/recFEepjgYMnE2bAn 18/28 6/23/23, 3:37 AM Crohn's disease Pathway Consider initiating methotrexate as a first-choice immunomodulator, or after thiopurine failure or intolerance, to maintain clinical remission in pediatric patients with CD. C Consider initiating thiopurines (azathioprine or 6-mercaptopurine) to maintain remission in pediatric patients reached remission. C Pediatric patients (maintenance of remission, TNF inhibitors): initiate anti-TNF agents for maintenance of remission in pediatric patients with active CD failed to maintain remission with an immunomodulator. B Show 2 more Pediatric patients (maintenance of remission, monoclonal antibodies): consider initiating ustekinumab or vedolizumab in patients failed to maintain clinical remission on anti-TNF agents, despite anti-TNF dose optimization and immunomodulator use. C Pediatric patients (therapies to avoid): do not use thiopurine monotherapy for induction of remission in pediatric patients with active CD. D Show 2 more Pediatric patients (monitoring of treatment response): consider assessing for a decrease of fecal calprotectin in the context of clinical improvement as a marker of treatment response in pediatric patients with luminal CD following induction therapy. C Show 5 more Pregnant patients: Monitor iron status and folate levels regularly in pregnant patients with IBD and supplement iron and folic acid in case of deficiencies. B Monitor nutritional status regularly in patients with IBD when breastfeeding and supplement in case of deficiencies. B Patients with obesity: as per ESPEN 2023 guidelines, advise weight loss in patients with IBD and obesity only in phases of stable remission and then according to current obesity guidelines. B Patients with TPMT deficiency (adjustment of azathioprine): Reduce doses of azathioprine in patients with a heterozygous variant TPMT genotype. Start at 30-70% of the full dose (such as 1-1.5 mg/kg/day) and adjust doses based on patient tolerance. Allow 2-4 weeks to reach a steady state after each dose adjustment. A Consider initiating alternative nonthiopurine immunosuppressant therapy, rather than azathioprine, in patients with a homozygous variant TPMT genotype. Start with drastically reduced doses of azathioprine (reduce daily dose by 10-fold and dose three times weekly, instead of daily), and adjust doses based on the degree of myelosuppression and disease- specific guidelines. Allow 4-6 weeks to reach a steady state after each dose adjustment. B Patients with TPMT deficiency (adjustment of 6-mercaptopurine): Reduce doses of 6-mercaptopurine in patients with a heterozygous variant TPMT genotype. Start at 30-70% of the full dose (such as 0.75 mg/kg/day) and adjust doses based on the degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach a steady state after each dose adjustment. A https://web.pathway.md/diseases/recFEepjgYMnE2bAn 19/28 6/23/23, 3:37 AM Crohn's disease Pathway Consider initiating alternative nonthiopurine immunosuppressant therapy, rather than 6- mercaptourine, in patients with a homozygous variant TPMT genotype being treated for nonmalignant conditions. B Patients with fistulizing disease, anti-TNFs: As per AAST/WSES 2021 guidelines, consider initiating infliximab or adalimumab as first-line therapy in combination with azathioprine following adequate surgical drainage, if indicated, in patients with complex perianal fistulizing disease. Consider combining anti-TNF therapy with ciprofloxacin for improved short-term outcomes. B As per AGA 2021 guidelines, initiate infliximab B or consider initiating adalimumab for induction and maintenance of fistula remission in adult outpatients with CD and active perianal fistula. B As per ECCO 2020 guidelines: Initiate infliximab B or consider initiating adalimumab for induction and maintenance of remission in patients with complex perianal fistulas. B Insufficient evidence regarding the effect of adding immunomodulators to anti-TNF therapy on fistula healing in patients with complex perianal fistulas. I As per CAG 2019 guidelines, initiate anti-TNF therapy to induce a symptomatic response in patients with CD and evidence of fistulizing disease. B Show 2 more As per ACG 2018 guidelines: Consider initiating infliximab for the treatment of perianal, enterocutaneous and rectovaginal fistulas in patients with CD. Consider adding antibiotics to infliximab therapy for better outcomes in patients with perianal fistulas. B Consider initiating adalimumab or certolizumab pegol for the treatment of perianal fistulas in patients with CD. B Patients with fistulizing disease, other biologics: As per AGA 2021 guidelines, consider initiating ustekinumab or vedolizumab for induction or maintenance of fistula remission in adult outpatients with CD and active perianal fistula. C As per ECCO 2020 guidelines, insufficient evidence to support the use of ustekinumab I or vedolizumab for fistula healing in patients with CD and complex perianal fistula. I Patients with fistulizing disease, thiopurines: As per ECCO 2020 guidelines, avoid using thiopurine monotherapy (azathioprine, mercaptopurine) for fistula closure in patients with CD and complex perianal fistula. D As per ACG 2018 guidelines, consider initiating thiopurines (azathioprine or 6-mercaptopurine) for the treatment of patients with fistulizing CD. B Patients with fistulizing disease (tacrolimus): consider initiating a short-term course of tacrolimus for the treatment of perianal and cutaneous fistulas in patients with CD. B Patients with fistulizing disease, antibiotics: As per AGA 2021 guidelines: https://web.pathway.md/diseases/recFEepjgYMnE2bAn 20/28 6/23/23, 3:37 AM Crohn's disease Pathway Avoid using antibiotics alone for induction of fistula remission in adult outpatients with CD and active perianal fistula without perianal abscess. D Initiate biologic agents in combination with an antibiotic for induction of fistula remission in adult outpatients with CD and active perianal fistula without perianal abscess. B As per ECCO 2020 guidelines, avoid using antibiotics alone for fistula closure in patients with CD and complex perianal fistula. D As per CAG 2019 guidelines, consider initiating antibiotic therapy for initial management to achieve symptomatic response in patients with CD and evidence of fistulizing disease. C As per ACG 2018 guidelines, consider initiating antibiotics (imidazoles) for the treatment of simple perianal fistulas. B Patients with fistulizing disease (stem cell therapy): consider offering allogeneic C or autologous adipose-derived stem cell therapy in patients with complex perianal fistulas. C Patients with fistulizing disease (seton placement): consider placing setons for the treatment of patients with perianal fistulas, and to increase the efficacy of infliximab. B Patients with fistulizing disease (fibrin glue injection): consider administering fibrin glue injection in patients with complex perianal CD. C Patients with fistulizing disease (anal fistula plug): avoid using anal fistula plugs for ano- perineal fistula closure in patients with CD, as seton removal alone is equally effective. D Patients with fistulizing disease, abscess drainage: As per AAST/WSES 2021 guidelines, perform adequate surgical drainage of a perianal abscess without searching for an associated fistula in patients with CD. B Show 3 more As per ACG 2018 guidelines: Perform prompt surgical drainage of a perianal abscess in patients with CD. E Perform drainage of abscesses (surgically or percutaneously) before initiating anti-TNF treatment. B Patients with fistulizing disease, surgical management: As per CAG 2019 guidelines: Consider obtaining surgical consultation in patients with CD and evidence of complicated fistulizing disease. C Consider referring patients with CD and evidence of fistulizing disease for surgical management if there is an inadequate symptomatic response to medical management strategies. C As per ECCO 2019 guidelines, consider performing advancement flap repair as a therapeutic option in patients with CD and complex perianal fistulas. C Show 2 more Patients with fistulizing disease (nutritional support): https://web.pathway.md/diseases/recFEepjgYMnE2bAn 21/28 6/23/23, 3:37 AM Crohn's disease Pathway Consider administering all nutritional support via the enteral route (generally as food) in patients with a distal (low ileal or colonic) fistula and low output. C Administer nutritional support by partial or exclusive parenteral nutrition in patients with a proximal fistula and/or very high output. B Patients with enterocutaneous fistula (nutritional assessment): assess patients with enterocutaneous fistula for malnutrition at the time of diagnosis. Obtain periodic nutrition assessment if malnutrition is not present at baseline as patients with fistulas have a high likelihood of becoming malnourished due to nutrient malabsorption, fluid and electrolyte losses, and sepsis. B Show 2 more Patients with enterocutaneous fistula, medical therapy: As per BSG 2019 guidelines, consider initiating immunomodulator and biological therapy for the management of patients with IBD and low volume enterocutaneous fistulas. C Show 2 more As per ACG 2018 guidelines, consider initiating infliximab for the treatment of enterocutaneous fistulas in patients with CD. B Patients with enterocutaneous fistula, surgical management: As per ASCRS 2020 guidelines, consider surgery in patients with enteric fistulas that persist despite appropriate medical therapy. B As per BSG 2019 guidelines, offer surgery to achieve symptom control in patients with IBD and high-volume fistulas. B Patients with ostomy: Monitor fluid output and urine sodium and adapt fluid input accordingly (decrease hypotonic fluids, increase saline solutions, limit hypertonic fluids), taking into account food intolerances that may enhance fluid output, in patients with IBD with severe diarrhea or a high output jejunostomy or ileostomy. B Consider administering parenteral infusions (fluid and electrolytes) in patients with ongoing high- output stomas. C Patients with pouchitis: consider offering multistrain probiotics to prevent pouchitis. C Insufficient evidence regarding prebiotics for pouchitis. C Show 2 more Patients with Clostridioides difficile infection, antibiotic therapy: As per ACG 2021 guidelines, consider administering oral vancomycin (125 mg QID for a minimum of 14 days) in patients with IBD and C. difficile infection. B As per AGA 2017 guidelines, consider administering vancomycin rather than metronidazole for the treatment of C. difficile infection in patients with IBD. C Show 2 more Patients with Clostridioides difficile infection, withholding immunosuppressive therapy: https://web.pathway.md/diseases/recFEepjgYMnE2bAn 22/28 6/23/23, 3:37 AM Crohn's disease Pathway As per ACG 2021 guidelines, do not hold immunosuppressive IBD therapy during anti-C. difficile infection treatment in the setting of disease flare, and consider escalating therapy if there is no symptomatic improvement with treatment of C. difficile infection. D As per AGA 2017 guidelines, consider postponing the escalation of corticosteroids and other immunosuppression agents during acute C. difficile infection until therapy for C. difficile infection has been initiated. Decide on withholding or continuing immunosuppression in patients with IBD with C. difficile infection on an individual basis. C Patients with Clostridioides difficile infection, fecal microbiota transplantation: As per ACG 2021 guidelines, consider performing fecal microbiota transplantation in patients with IBD and recurrent C. difficile infection. B As per HIS/BSG 2018 guidelines: Offer fecal microbiota transplantation in patients with IBD and recurrent C. difficile infection. Counsel patients about a small but recognized risk of exacerbating IBD. B Do not offer fecal microbiota transplantation for the treatment of IBD. Insufficient evidence to recommend fecal microbiota transplantation for any other gastrointestinal or non- gastrointestinal disease apart from C. difficile infection. D As per AGA 2017 guidelines, offer a referral for fecal microbiota transplantation in patients with IBD and recurrent C. difficile infection. B 11. Preventative measures Routine immunizations: provide annual vaccination against influenza in all adult patients with IBD. Administer the non-live trivalent inactivated influenza vaccine, and not the live inhaled influenza vaccine, in patients on immunosuppressive therapies and their household contacts. B Show 7 more Healthy diet: advise following the principles of healthy dietary patterns and avoidance of individual nutritional triggers. Adjust the diet accordingly if particular clinical problems are still present during the remission phase. B Show 2 more Breastfeeding: advise breastfeeding as it is the optimal food for infants and reduces the risk of IBD. B 12. Follow-up and surveillance Therapeutic drug monitoring: As per ECCO 2020 guidelines: Insufficient evidence to recommend for or against proactive therapeutic drug monitoring in patients with CD in clinical remission under anti-TNF treatment. I Insufficient evidence to recommend for or against reactive therapeutic drug monitoring in patients with CD lost response to an anti-TNF agent. I https://web.pathway.md/diseases/recFEepjgYMnE2bAn 23/28 6/23/23, 3:37 AM Crohn's disease Pathway As per AGA 2017 guidelines, consider obtaining reactive therapeutic drug monitoring to guide treatment changes in adult patients with active IBD treated with anti-TNF agents. C Show 4 more Serial laboratory assessment: Consider measuring fecal calprotectin and fecal lactoferrin as an adjunct to monitor disease activity in patients with CD. E Consider obtaining serial CRP level measurements as an adjunct to monitor disease activity and response to therapy in selected patients with CD, recognizing that this test is relatively nonspecific to CD inflammation. E Serial imaging assessment: As per ACG 2018 guidelines, consider obtaining periodic cross-sectional imaging (CT enterography, MR enterography) to monitor response to therapy in selected patients with small bowel CD. E As per AGA 2018 guidelines: Consider obtaining cross-sectional enterography in disease monitoring paradigms when small bowel disease or penetrating disease complications are present. B Prefer MR enterography over CT enterography, when possible, for estimating response to medical treatment in asymptomatic patients with CD, as its multiparametric nature permits evaluation of multiple imaging parameters reflecting inflammation and avoids radiation. B Postoperative imaging (early): Obtain any of the following modalities as the initial imaging of a suspected complication after proctectomy, coloproctectomy or colectomy with pouch or other anastomosis: MRI of the pelvis without and with IV contrast CT of the abdomen and pelvis with IV contrast CT of the pelvis with IV contrast. B Postoperative imaging (late): Obtain postoperative endoscopic monitoring at 6-12 months after surgical resection in patients with surgically-induced remission of CD not receiving pharmacological prophylaxis. B Consider obtaining postoperative endoscopic monitoring at 6-12 months after surgical resection in patients with surgically-induced remission of CD receiving pharmacological prophylaxis. C Endoscopic surveillance, ileocolonscopy: As per ASCRS 2020 guidelines, obtain endoscopic surveillance at regular intervals in patients with long-standing Crohn's colitis involving at least one-third of the colon or > 1 segment. B Show 3 more As per ACG 2018 guidelines: Do not use narrow-band imaging during colorectal neoplasia surveillance examinations for CD. D Insufficient evidence to recommend routine use of chromoendoscopy in patients with IBD undergoing surveillance colonoscopy if the endoscopist has access to high-definition white https://web.pathway.md/diseases/recFEepjgYMnE2bAn 24/28 6/23/23, 3:37 AM Crohn's disease Pathway light endoscopy. I As per ASCRS 2015 guidelines: Obtain endoscopic surveillance of the large bowel in patients with long-standing CD of the ileocolon or colon. B Perform biopsies of suspicious lesions (mass, ulcer) identified in patients with Crohn's, especially when considering small-bowel strictureplasty. B Endoscopic surveillance (video capsule endoscopy): Consider performing small bowel capsule endoscopy for the assessment of CD extent and for monitoring and guiding the "treat-to-target" strategy. C Use activity scores (such as the Lewis score and the CECDAI) to facilitate prospective small- bowel capsule endoscopy follow-up of patients for longitudinal assessment of small bowel CD and its response to medical therapy (using mucosal healing as an endpoint). B Cervical cancer surveillance: obtain annual cervical cancer screening in female patients with IBD on immunosuppressive therapy. B Skin cancer surveillance: Obtain screening for melanoma in patients with IBD independent of the use of biologic therapy. B Obtain screening for non-melanoma squamous cell cancer in patients with IBD receiving immunomodulators (6-mercaptopurine or azathioprine), particularly > 50 years of age. B 13. Quality improvement Documentation: document the type of IBD in the medical record, along with the location and level of activity. E References 1. Stephan C Bischoff, Palle Bager, Johanna Escher et al. ESPEN guideline on Clinical Nutrition in inflammatory bowel disease. Clin Nutr. 2023 Jan 13;42 3 352 379. Open 2. Adamina M, Bonovas S, Raine T et al. ECCO guidelines on therapeutics in Crohn's disease: surgical treatment. J Crohns Colitis. 2019 Nov 19. pii: jjz187. Open 3. Steinhart AH, Panaccione R, Targownik L et al. Clinical Practice Guideline for the Medical Management of Perianal Fistulizing Crohn's Disease: The Toronto Consensus. Inflamm Bowel Dis. 2019 Jan 1;25 1 1 13. Open 4. Strong S, Steele SR, Boutrous M et al. Clinical Practice Guideline for the Surgical Management of Crohn's Disease. 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The Medical Management of Paediatric Crohn's Disease: an ECCO ESPGHAN Guideline Update. J Crohns Colitis. 2020 Oct 7;jjaa161. Open 14. Bruining DH, Zimmermann EM, Loftus EV Jr et al. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. Radiology. 2018 Mar;286 3 776 799. Open 15. Joseph D Feuerstein, Edith Y Ho, Eugenia Shmidt et al. AGA Clinical Practice Guidelines on the Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn's Disease. Gastroenterology. 2021 Jun;160 7 2496 2508. Open 16. Stephan C Bischoff, Johann Ockenga, Ahad Eshraghian et al. Practical guideline on obesity care in patients with gastrointestinal and liver diseases Joint ESPEN/UEG guideline. Clin Nutr. 2023 Apr 10;42 6 987 1024. Open 17. Mullish BH, Quraishi MN, Segal JP et al. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology BSG and Healthcare Infection Society HIS guidelines. Gut. 2018 Nov;67 11 1920 1941. Open 18. Lamb CA, Kennedy NA, Raine T et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019 Dec;68 Suppl 3):s1-s106. Open 19. Nguyen GC, Loftus EV Jr, Hirano I et al. American Gastroenterological Association Institute Guideline on the Management of Crohn's Disease After Surgical Resection. Gastroenterology. 2017 Jan;152 1 271 275. Open 20. Grace L Su, Cynthia W Ko, Premysl Bercik et al. AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020 Aug;159 2 697 705. Open https://web.pathway.md/diseases/recFEepjgYMnE2bAn 26/28 6/23/23, 3:37 AM Crohn's disease Pathway 21. Vanessa J Kumpf, Jose Eduardo de Aguilar-Nascimento, Jose Ignacio Diaz-Pizarro Graf et al. ASPEN FELANPE Clinical Guidelines. JPEN J Parenter Enteral Nutr. 2017 Jan;41 1 104 112. Open 22. Colleen R Kelly, Monika Fischer, Jessica R Allegretti et al. ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections. Am J Gastroenterol. 2021 Jun 1;116 6 1124 1147. Open 23. Axel U Dignass, Christoph Gasche, Dominik Bettenworth et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015 Mar;9 3 211 22. Open 24. Expert Panel on Gastrointestinal Imaging: Angela D. Levy, MD, Peter S. Liu et al. ACR Appropriateness Criteria Anorectal Disease. ACR. 2021. Open 25. Feuerstein JD, Nguyen GC, Kupfer SS et al. American Gastroenterological Association Institute Guideline on Therapeutic Drug Monitoring in Inflammatory Bowel Disease. Gastroenterology. 2017 Sep;153 3 827 834. Open 26. Relling MV, Gardner EE, Sandborn WJ et al. Clinical Pharmacogenetics Implementation Consortium guidelines for thiopurine methyltransferase genotype and thiopurine dosing. Clin Pharmacol Ther. 2011 Mar;89 3 387 91. Open 27. Francis Ha, Hanan Khalil. Crohn's disease: a clinical update. 2015 Nov;8 6 352 9.2015 Nov;8 6 352 9. Open 28. E V Loftus Jr. Crohn's disease: why the disparity in mortality?. 2006 Apr;55 4 447 9.2006 Apr;55 4 447 9. Open 29. Brian Veauthier, Jaime R Hornecker. Crohn's Disease: Diagnosis and Management. Am Fam Physician. 2018 Dec 1;98 11 661 669. Open 30. Joana Torres, Saurabh Mehandru, Jean-Fr d ric Colombel et al. Crohn's disease. Lancet. 2017 Apr 29;389 10080 1741 1755. Open 31. Tun GS, Cripps S, Lobo AJ. Crohn's disease: management in adults, children and young people - concise guidance . Clin Med Lond). 2018 Jun;18 3 231 236. Open 32. E V Loftus, Jr. Crohn's disease: why the disparity in mortality?. Gut. 2006 Apr; 55 4 447 449. Open 33. Francis Ha and Hanan Khalil. Crohn s disease: a clinical update. Therap Adv Gastroenterol. 2015 Nov; 8 6 352 359. Open 34. Kathryn A. Myers, MD, EdM et al. Does This Patient Have Clubbing?. JAMA. 2001;286 3 341 347. Open 35. Anand Padmanabhan, Laura Connelly-Smith, Nicole Aqui et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019 Jun;34 3 171 354. Open 36. Jean-Fr d ric Colombel, William J Sandborn, Paul Rutgeerts et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the CHARM trial. Gastroenterology. 2007 Jan;132 1 52 65. Open 37. Brian G Feagan, William J Sandborn, Christopher Gasink et al. Ustekinumab as Induction and Maintenance Therapy for Crohn's Disease. N Engl J Med. 2016 Nov 17;375 20 1946 1960. Open https://web.pathway.md/diseases/recFEepjgYMnE2bAn 27/28 6/23/23, 3:37 AM Crohn's disease Pathway https://web.pathway.md/diseases/recFEepjgYMnE2bAn 28/28