Crohn's Disease: The Complete Guide to Medical Management

Gary R. Lichtenstein, MD, FACP, FACG, AGAF

Chapter 27: Management of Steroid-Unresponsive Crohn’s Disease (continued)

Saratchandra I. Reddy, MD, MPH; Robert Burakoff, MD, MPH, FACF, FACP

In the patient with persistent symptoms suggestive of refractory Crohn’s disease, additional evaluation may be necessary to exclude other conditions that may be responsible for the symptoms (Table 27-1). Before attributing symptoms to refractory CD, it is necessary to rule out infection with bacterial and parasitic pathogens. Enteric infections may contribute to flares of otherwise controlled disease or can mimic clinical inflammatory bowel disease (IBD). Clostridium difficile infection has also been associated with exacerbations of IBD. In 1 series of patients with IBD flares, 19% of…