NICE has today (Wednesday 10 October) published guidance on the role of new and established treatments for the management of Crohn´s disease in adults and children.

Crohn's disease is a chronic inflammatory condition that mainly affects the gastrointestinal tract (gut). It can develop at any age but most commonly starts between the ages of 15 and 30, with around a third of patients diagnosed before the age of 21. The disease affects slightly more women than men. Its cause is unknown, but it is around twice as common in smokers. There are currently around 115,000 people living with Crohn's disease in the UK and between 3000 and 6000 new cases are diagnosed each year. An estimated 5% of patients have severe disease, but the proportion of people with moderate Crohn's disease is unclear. The condition can lead to delay of growth and puberty in children, as well as affecting fertility and sexual relationships in adults.

Common symptoms of Crohn's disease include:

• recurring diarrhoea
• abdominal pain and cramping (the pain is often worse after eating)
• blood and mucus in faeces
• extreme tiredness
• weight loss

There may be long periods that last for weeks or months where there are mild or no symptoms, followed by periods where symptoms are particularly upsetting, which are known as flare-ups.

In the last decade, there have been a number of new drugs licensed for the conditionⁱ. Glucocorticosteroids can be offered to induce remission in people with Crohn's disease and azathioprine or mercaptopurine can be offered as maintenance treatment. The new guidance covers the use of these drugs in the care pathway for Crohn's disease.

Aimed at all healthcare professionals involved in the management of Crohn's disease, recommendations include:

• Offer monotherapy with a conventional glucocorticosteroid (prednisolone, methylprednisolone or intravenous hydrocortisone) to induce remission in people with a first presentation or a single inflammatory exacerbation of Crohn's disease in a 12 month period.
• Discuss with people with Crohn's disease, and/or their carer if appropriate, options for managing their disease when they are in remission, including both no treatment and treatment. The discussion should include the risk of inflammatory exacerbations (with and without drug treatment) and the potential side effects of drug treatment. Record the person's views in their notes.
• Offer azathioprine or mercaptopurine as monotherapy to maintain remission when previously used with a conventional glucocorticosteroid or budesonide to induce remission.
• Consider surgery as an alternative to medical treatment early in the course of the disease for people whose disease is limited to the distal ileum (small intestine), taking into account the following:
  
  - benefits and risks of medical treatment and surgery
  
  - risk of recurrence after surgery
  
  - individual preferences and any personal or cultural considerations.

Record the person's views in their notes.

• Offer adults, children and young people, and/or their parents or carers, age-appropriate multidisciplinary support to deal with any concerns about the disease and its treatment, including concerns about body image, living with a chronic illness, and attending school and higher education.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: "Crohn's disease is affecting increasing numbers of people in England including children and young people. Its symptoms can be painful and unpleasant, and have a significant negative impact on quality of life. Therefore it is important that there are clear, evidence-based guidelines in place that can help improve the care offered to people with Crohn's disease."

Professor John Mayberry, Consultant Physician and Honorary Professor, University Hospitals of Leicester NHS Trust and chair of the guideline development group said: "Chairing the guideline development group on Crohn's disease was one of the most stimulating experiences of my professional career. It was a privilege to work with such a talented group of people who shared common ideals and approached their work with open minds. Our common wish was to ensure that people with Crohn's disease have excellent care and treatment, based on the very best available evidence, and that such an approach to care becomes universal."

Andy Player, patient/carer member of the guideline development group said: "Any Crohn's patient reading these guidelines should be confident that the best evidence has been picked over, discussed and debated to produce robust recommendations on the treatment of their condition. As someone with Crohn's disease who took part in this process, I was impressed by how the discussion of every recommendation had the interests of each and every Crohn's patient at its heart."

The new NICE clinical guideline on Crohn's disease can be found from 00:01hrs on Wednesday 10 October at: www.nice.org.uk/CG152

Ends

Notes to Editors

References

i. These include drugs in the following categories: corticosteroids, immunomodulators (azathioprine, mercaptopurine and methotrexate) and aminosalicylates.

About the clinical guideline

1. The new NICE clinical guideline on Crohn's disease can be found from 00:01hrs on Wednesday 10 October at: www.nice.org.uk/CG152

Embargoed copies are available on request; please contact the press office.

2. Further details on clinical guideline development

Related NICE guidance

Incorporated guidance

This guideline incorporates the following NICE guidance:

3. Infliximab (review) and adalimumab for the treatment of Crohn's disease. NICE technology appraisal guidance 187 (2010). Available at: www.nice.org.uk/guidance/TA187

Other related NICE guidance

4. Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas. NICE clinical guideline 118 (2011). Available at: www.nice.org.uk/guidance/CG118

5. Extracorporeal photopheresis for Crohn's disease. NICE interventional procedure guidance 288 (2009). Available at: www.nice.org.uk/guidance/IPG288

6. Medicines adherence. NICE clinical guideline 76 (2009). Available at: www.nice.org.uk/guidance/CG76

7. Irritable bowel syndrome in adults. NICE clinical guideline 61 (2008). Available at: www.nice.org.uk/guidance/CG61

8. Smoking cessation services. NICE public health guidance 10 (2008). Available at: www.nice.org.uk/guidance/PH10

9. Varenicline for smoking cessation. NICE technology appraisal guidance 123 (2007). Available at: www.nice.org.uk/guidance/TA123

10. Brief interventions and referral for smoking cessation. NICE public health guidance 1 (2006). Available at: www.nice.org.uk/guidance/PH1

11. Nutrition support in adults. NICE clinical guideline 32 (2006). Available at: www.nice.org.uk/guidance/CG32

12. Leukapheresis for inflammatory bowel disease. NICE interventional procedure guidance 26 (2005). Available at: www.nice.org.uk/guidance/IPG126

13. Fertility. NICE clinical guideline 11 (2004). Available at: www.nice.org.uk/guidance/CG11

14. Wireless capsule endoscopy for investigation of the small bowel. NICE interventional procedure guidance 101 (2004). Available at: www.nice.org.uk/guidance/IPG101

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
• Commissioning Outcomes Framework - NICE develops the potential indicators for the COF, the scheme starting in 2013, which will help measure the health outcomes and quality of care commissioned by Clinical Commissioning Groups.

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.