Severe to fulminant Crohn's disease represents a critical end of the disease spectrum. Hospitalized patients in this category present with a constellation of acute findings that require prompt, structured inpatient management aimed at controlling the inflammatory burden.
This protocol applies to hospitalized patients with severe to fulminant Crohn's disease presenting with one or more of the following features:
In this inpatient setting, intravenous corticosteroid therapy serves as the cornerstone of the initial approach — used to control the acute inflammatory burden while steroid-sparing treatment options are concurrently evaluated. The complete regimen, sequencing, and additional management steps are in the full protocol.
Control of inflammatory burden in severe to fulminant disease.
DOI: 10.14309/ajg.0000000000003465;
For hospitalized patients presenting with severe to fulminant CD, intravenous corticosteroids may be used to control inflammatory burden while evaluating steroid-sparing treatment options.
Individuals with severe/fulminant disease have persistent symptoms despite the introduction of conventional corticosteroids and/or advanced therapies or present with high fevers, evidence of intestinal obstruction, significant peritoneal signs such as involuntary guarding or rebound tenderness, cachexia, or evidence of an abscess usually requiring hospitalization.
Intravenous corticosteroids, dosed at methylprednisolone 40–60 mg/d or equivalent, are effective for severe to fulminant disease in the hospitalized patient.
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