Intended for healthcare professionals

Practice Guidelines

Management of Crohn’s disease: summary of updated NICE guidance

BMJ 2019; 367 doi: (Published 01 November 2019) Cite this as: BMJ 2019;367:l5940
  1. Rui Martins, technical analyst in health economics1,
  2. Chris Carmona, senior technical analyst1,
  3. Bruce George, consultant colorectal surgeon2,
  4. Jenny Epstein, consultant paediatric gastroenterologist3
  5. on behalf of the Guideline Committee
  1. 1National Institute for Health and Care Excellence, London, UK
  2. 2Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
  3. 3Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK
  1. Correspondence to R Martins rui.martins{at}

What you need to know

  • This guideline update focuses on maintaining remission in people with ileocolonic Crohn’s disease who have had complete macroscopic resection within the last three months

  • Consider azathioprine in combination with up to three months’ postoperative metronidazole after complete macroscopic resection of ileocolonic Crohn’s disease

  • Do not offer biologics to maintain remission after surgery

  • Mercaptopurine and aminosalicylates are no longer recommended to maintain remission after surgery

Crohn’s disease is a chronic inflammatory disease that mainly affects the gastrointestinal tract. Approximately 115 000 people are living with Crohn’s in the UK. There is no known cure, so the aim of medical treatment is to induce or maintain absence of symptoms (remission). If symptoms are refractory to medication, surgical resection may be required. Post-surgical recurrence is common, with approximately 20-40% of patients requiring reoperation within 10 years.12

This article summarises recent recommendations from the update of the National Institute for Health and Care Excellence (NICE) guideline for the management of Crohn’s disease in children, young people, and adults.3 The focus of this update is on maintaining remission in people with Crohn’s disease after surgery. It does not cover people who have had surgery and are not in remission—for example, people who have active disease at other sites.

All other areas of the guideline, such as induction of remission and surgery, remain …

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