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Crohn's Disease — RACP Adult Medicine MCQ

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EasyGastroenterology & HepatologyCrohn's DiseaseRACP Adult Medicine

A 40-year-old woman presents with Crohn's disease of the terminal ileum. She has had a previous ileocolic resection and now has recurrent disease at the anastomosis with stricturing. She is a smoker. After optimising anti-TNF therapy, what is the single most important modifiable risk factor to address?

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Correct answer: E — Smoking cessation

Smoking is the most important modifiable risk factor for Crohn's disease. It increases the risk of disease recurrence, surgical recurrence (especially post-ileocolic resection), stricturing behaviour, and need for immunosuppression. Smoking cessation reduces post-operative recurrence by approximately 50%. It should be prioritised alongside optimising medical therapy. ECCO guidelines strongly recommend smoking cessation for all patients with Crohn's disease.

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