Crohn's Disease: The Complete Guide to Medical Management

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

Chapter 23: Medical Management of Severe Crohn’s Disease (continued)

Themistocles Dassopoulos, MD; Theodore M. Bayless, MD

The CDAI system has several limitations, including high interobserver variability and lack of accuracy in patients with stenosing CD or concomitant irritable bowel syndrome (IBS). Several randomized controlled trials of biologic agents in active CD have hinted at the limitations of the CDAI. Post hoc analyses showed that subjects in the placebo arms with normal C-reactive protein (CRP) levels had pronounced improvements in their CDAI scores. These findings suggest that concomitant conditions such as IBS, short bowel syndrome, cholerrheic diarrhea, small bowel bacterial overgrowth, and partial…