How should I approach the monitoring and management of a patient with Crohn's disease who is in remission?

Monitoring and management of a patient with Crohn's disease in remission should include:

• Discuss maintenance treatment options: Engage the patient and their family in discussions about managing the disease during remission, including the choice between no treatment and maintenance therapy, explaining risks of relapse and potential side effects of treatments. Document the patient's preferences in their medical records.
• Maintenance therapy: Consider azathioprine or mercaptopurine monotherapy to maintain remission, especially if these were used to induce remission or if the patient has adverse prognostic factors. Methotrexate may be considered if thiopurines are contraindicated or not tolerated.
• Follow-up and symptom monitoring: Arrange regular follow-up appointments in primary care, tailored to clinical judgement and specialist advice. Educate the patient on symptoms that may indicate relapse (e.g., unintended weight loss, abdominal pain, diarrhoea, general ill-health) and ensure they know how to access healthcare promptly if these occur.
• Smoking cessation: Encourage and support smoking cessation as smoking increases the risk of relapse.
• Colorectal cancer surveillance: Ensure the patient is aware of the need for colonoscopic surveillance if they have Crohn's colitis affecting more than one segment of the colon and symptoms started 10 or more years ago. The frequency of surveillance is determined by specialist teams based on disease severity and duration.
• Assess and manage osteoporosis risk: Evaluate risk factors such as dietary calcium intake, extent of disease, and history of small bowel resection, and manage accordingly.
• Provide information and support: Offer patient education about the lifelong nature of Crohn's disease, potential relapses, treatment aims, and available support resources such as Crohn's and Colitis UK.

These steps ensure comprehensive monitoring and management to maintain remission and promptly identify and treat relapses or complications.

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