Patient handout

Crohn's Disease

PRODUCTION

1. Your condition

This handout is for crohn's disease. Your care team identified this based on: chronic diarrhea ± rectal bleeding.

Other reasons your team may use this plan: rlq abdominal pain + weight loss; perianal pain / fistula / abscess; elevated fecal calprotectin / crp / iron deficiency.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
budesonide	9 mg PO daily × 8-12 weeks	PO	daily	AGA 2021 — first-line induction for mild ileocolonic CD; lower systemic effects than prednisone

Plan: Crohn's disease severity-driven induction + maintenance — ACG 2018+2024 + AGA 2021 + ECCO 2023/2024

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — In remission — continue maintenance

If you have:

Stable bowel pattern (≤3 BMs/day, formed or soft, no blood)
No abdominal pain
Normal energy and appetite
Calprotectin <250 (if measured)

Do this:

Take maintenance therapy as prescribed (do not skip biologic)
No NSAIDs
Smoking cessation
Keep IBD clinic appointments
Annual labs and surveillance per IBD plan

YELLOW — Caution — early flare, contact IBD team within 24-48 hours

If you have:

Increased BM frequency (>4-5/day) for >3 days
New or worsening abdominal pain
Visible blood in stool
Low-grade fever (37.5-38.5°C)
Weight loss or anorexia
New joint pain or skin lesions

Do this:

Continue maintenance therapy
Hydrate and rest
Contact IBD team within 24-48 hours
Stool sample for C. diff if available
Clinic visit may include calprotectin, CRP, possible budesonide or steroid course

Call your provider if:

Symptoms worsening despite home measures
Fevers >38.5°C
Weight loss >5%
Severe joint/skin/eye involvement

RED — Medical alert — go to ED now

If you have:

Severe abdominal pain or rigid abdomen (perforation)
Vomiting + obstipation (obstruction)
Massive bleeding from rectum
High fever >39°C with shaking chills
Severe dehydration / lightheaded
Perianal abscess with fever

Do this:

Call 911 / go to nearest ED immediately
Bring updated medication list
Notify IBD team of admission

Call your provider if:

Any red zone symptom — ED now, do not wait

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

CDAI ≥450 OR Harvey-Bradshaw ≥9 OR fever + tachycardia + rapid weight loss (ACG 2018)
CT shows abscess >3-5 cm in CD (ACG 2018)
Bilious/feculent vomiting + obstipation + dilated bowel on imaging (ACG 2018)
Perianal pain, fluctuance, or new fistula tract (ACG 2018)
No improvement after 3-5 days of IV methylprednisolone (ACG 2018)

5. Follow-up

q2-4w during induction, q3mo first year maintenance, q6mo stable remission; postop colonoscopy 6-12mo (Rutgeerts); annual comprehensive review; preconception counselling

6. Sources

Guideline: ACG 2018 Crohn + ACG 2024 update + AGA 2021 Moderate-Severe CD + ECCO 2023/2024 + BSG 2024 IBD + SONIC (NEJM 2010) + ADVANCE/MOTIVATE/FORTIFY (Lancet 2022) + SELECT-CD (NEJM 2023) + SEQUENCE (Lancet 2024) + GALAXI 1/2/3 (Lancet 2024)