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Crohn's Disease Flare — UKMLA MCQ

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MediumGastroenterologyCrohn's Disease FlareUKMLAMRCGP AKTPARAMRCP Part 1PSA

A 25-year-old man with known Crohn's disease affecting the terminal ileum presents with increased stool frequency (6 times/day), abdominal cramps, and fatigue. He is currently taking mesalazine granules. Inflammatory markers (CRP, faecal calprotectin) are significantly elevated. According to NICE NG129, what is the most appropriate initial treatment to induce remission of this flare-up?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Start oral prednisolone

NICE NG129 recommends monotherapy with a conventional glucocorticosteroid (e.g., oral prednisolone) to induce remission in people with a first presentation or single inflammatory exacerbation of Crohn's disease in a 12-month period. Mesalazine is generally not recommended for inducing remission in Crohn's (more role in UC). Azathioprine is a maintenance therapy. Infliximab is for severe active disease or failure of conventional therapy. Loperamide manages symptoms but doesn't treat inflammation.

Reference: NICE NG129: Crohn's disease: management