Crohn disease

Also known as: Crohn's · IBD · inflammatory bowel disease

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United StatesACG/AGA/AASLD

Current

ACG Clinical Guideline: Management of Crohn's Disease in Adults

American College of Gastroenterology (ACG) · 2025

This ACG guideline covers diagnosis and management of Crohn's disease in adults, developed with GRADE methodology and emphasising shared decision-making between clinician and patient.

The guideline notes that diagnosis and treatment of Crohn's disease have changed substantially since the previous ACG practice guideline. source
Recommendations are graded using the GRADE system for quality of evidence and strength of recommendation. source

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EuropeUEG/EASL

Current

ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment

ECCO (European Crohn's and Colitis Organisation) · 2024

A panel of 46 experts assembled by ECCO used GRADE methodology to update European recommendations on drug treatment of Crohn's disease, covering conventional agents, immunomodulators and biologics.

The guideline recommends against 5-aminosalicylates for inducing or maintaining remission in Crohn's disease. source
It gives strong recommendations for anti-TNF agents for both induction and maintenance, and discusses combination therapy and later de-escalation. source

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US vs EU key differences

Both sides now reject 5-ASA in Crohn's disease: the 2024 ECCO therapeutics guideline recommends against 5-ASA for induction at any disease location, matching the 2025 ACG recommendation against oral mesalamine for induction or maintenance in mildly to moderately active disease. source
The 2025 ACG guideline suggests against requiring failure of conventional therapy before starting advanced therapy, moving US practice away from an obligatory step-up sequence. source
ECCO retains an explicit place for budesonide as induction therapy in mild-to-moderate disease confined to the ileum and ascending colon, citing its better side-effect profile than systemic corticosteroids. source
ECCO draws a drug-specific distinction the US guideline does not: thiopurine co-therapy is strongly recommended with infliximab, but adalimumab monotherapy is preferred over combination therapy in biologic-naive patients. source
Regulatory availability differs: ECCO flags certolizumab pegol as only weakly recommended and not EU-approved, whereas it remains a licensed option in the United States. source

What changed recently

US2018 → 20252025-06-01
The 2025 ACG guideline moves away from the 2018 step-up model, suggesting against requiring failure of conventional therapy before starting advanced therapy and endorsing early treat-to-target management with therapy chosen by phenotype and prior exposure. It also recommends combination infliximab plus a thiopurine over either agent alone in biologic- and immunomodulator-naive patients.
source ↗curation confidence 90%
EU2020 → 20242024-10-01
The 2024 ECCO therapeutics update adds strong recommendations for the newer agents risankizumab (maintenance) and upadacitinib (induction and maintenance) in moderate-to-severe Crohn's disease, broadening options beyond anti-TNF and older biologics. It also restructures the guidance into actionable practice points alongside the GRADE recommendations carried over from 2020.
source ↗curation confidence 90%

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