Crohn's Disease — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyCrohn's DiseaseRACP Adult Medicine

A 28-year-old woman with Crohn's disease involving the terminal ileum presents with a perianal fistula. She has failed metronidazole and ciprofloxacin. What is the most appropriate next-line treatment?

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Correct answer: B — Adalimumab

Anti-TNF therapy (infliximab or adalimumab) is the treatment of choice for perianal fistulising Crohn's disease that has failed antibiotics. The ACCENT II trial demonstrated fistula healing with infliximab. Azathioprine may be added as combination therapy. Surgical assessment with examination under anaesthesia and seton placement is also important. Mesalazine has no role in perianal Crohn's disease.

Reference: eTG – 2025 – Gastrointestinal; ECCO – 2024 – Crohn's Disease Guidelines