European doctors have released updated guidelines for treating Crohn’s disease, a serious digestive condition that causes inflammation in the gut. The new recommendations suggest that older medications aren’t as helpful as once thought, and that newer biologic drugs (made from living cells) work better. The guidelines also emphasize that surgery performed early in the disease might prevent long-term problems, and that special diets like the Mediterranean diet can help keep symptoms under control. Doctors are encouraged to work as teams and involve patients in treatment decisions to get the best results.

The Quick Take

  • What they studied: How to best treat Crohn’s disease using the latest medical evidence and expert recommendations from European specialists
  • Who participated: This is a review of existing research and expert opinions, not a study with patients. It summarizes what works best based on many previous studies
  • Key finding: Newer biologic medications (especially TNF antibodies and IL-23 antibodies) work better than older drugs, and surgery early in the disease may prevent serious complications better than taking medications for years
  • What it means for you: If you have Crohn’s disease, talk to your doctor about whether newer medications or early surgery might be right for you. These guidelines suggest your doctor should involve you in decisions and monitor your progress regularly

The Research Details

This is a clinical guideline document, not a traditional research study. European Crohn’s and Colitis Organization experts reviewed all available scientific evidence about treating Crohn’s disease and created updated recommendations based on what works best. They looked at drug treatments, surgical options, and nutritional approaches. The guidelines were designed to help doctors make better decisions and involve patients in choosing their treatment plan.

The experts used a ’treat-to-target’ approach, which means doctors should set specific goals for treatment and adjust medications if those goals aren’t being met. This is different from the old way of just giving medications and hoping they work.

Guidelines like these help doctors across Europe provide consistent, high-quality care. They summarize years of research so doctors don’t have to search through hundreds of studies. By following evidence-based guidelines, patients are more likely to get treatments that actually work and avoid treatments that don’t help much.

This guideline comes from a respected European organization that specializes in inflammatory bowel diseases. The recommendations are based on reviewing scientific evidence, though the document notes that some comparisons between newer drugs are limited because there aren’t many head-to-head studies. The guidelines were updated in 2024, so they reflect current knowledge. However, guidelines are general recommendations—your individual situation may be different.

What the Results Show

The guidelines recommend moving away from older medications like 5-aminosalicylates (which don’t work well for Crohn’s) and corticosteroids (which should only be used briefly during flare-ups). Instead, doctors should use newer biologic medications that target specific parts of the immune system.

TNF antibodies (medications like infliximab and adalimumab) remain the first-line treatment for most patients because they work well and have been used for many years. However, if these stop working, IL-23 antibodies (like risankizumab) appear to be more effective than other options.

The guidelines also emphasize that surgery shouldn’t be avoided just because it’s an operation. Early surgery in selected patients may actually prevent long-term complications and the need for lifelong medications. When surgery is performed, doctors should use minimally invasive techniques (smaller cuts) whenever possible.

Nutritional therapy received more attention in these guidelines than in previous versions. Exclusive enteral nutrition (a special liquid diet) can help children and motivated adults. Mediterranean-style diets may help maintain remission (periods without symptoms).

The guidelines stress the importance of multidisciplinary teams—meaning gastroenterologists, surgeons, nutritionists, and other specialists should work together. Patient involvement in treatment decisions is emphasized as important for better outcomes. Proper preparation before surgery (reducing steroid use and correcting malnutrition) is highlighted as particularly important for success.

These 2024 guidelines represent a significant shift from older approaches. Previous guidelines relied more heavily on conventional medications like 5-aminosalicylates and thiopurines, which are now de-emphasized. The new guidelines give much more weight to biologic medications and recognize surgery as a viable early option rather than a last resort. The increased focus on nutrition is also new.

This is a guideline document based on reviewing existing research, not original research itself. Some comparisons between newer medications are limited because there aren’t many direct comparison studies. The guidelines are general recommendations and may not apply perfectly to every individual patient. Individual factors like age, disease severity, and personal preferences should guide treatment decisions with your doctor.

The Bottom Line

If you have Crohn’s disease: (1) Work with a team of specialists rather than seeing just one doctor (high confidence). (2) Ask your doctor about newer biologic medications rather than older drugs like 5-aminosalicylates (high confidence). (3) Discuss whether early surgery might be right for you, especially if medications aren’t working well (moderate confidence). (4) Consider Mediterranean-style eating patterns to help maintain remission (moderate confidence). (5) Make sure your doctor regularly checks whether your treatment is working and adjusts it if needed (high confidence).

These guidelines are most relevant for people with Crohn’s disease and their doctors. They’re particularly important for people newly diagnosed or those whose current treatment isn’t working well. People with ulcerative colitis (a related condition) should consult separate guidelines. If you have Crohn’s disease, share these guidelines with your doctor to discuss whether your current treatment aligns with current best practices.

Biologic medications typically take 2-4 weeks to start working and may take 8-12 weeks to show full benefit. Dietary changes may help within weeks to months. If you’re considering surgery, recovery typically takes 2-6 weeks depending on the type of procedure. Regular monitoring (every 3-6 months) helps determine if treatment is working.

Want to Apply This Research?

  • Track your Crohn’s symptoms daily using a simple scale (1-10 for pain, number of bowel movements, presence of blood). Also note what you eat and how you feel afterward to identify trigger foods. Share this data with your doctor at appointments to help evaluate whether your current treatment is meeting the ’treat-to-target’ goals.
  • Work with your doctor to establish specific treatment goals (like reducing bowel movements to a certain number per day or eliminating blood in stool). Use the app to monitor progress toward these goals. If goals aren’t being met after 8-12 weeks, discuss with your doctor whether your medication needs adjustment. Try incorporating Mediterranean diet elements (olive oil, fish, vegetables, whole grains) and track how they affect your symptoms.
  • Set monthly reminders to review your symptom trends. Create a summary report every 3 months to share with your doctor showing your symptom patterns, medication adherence, and dietary observations. This supports the ’treat-to-target’ approach by providing concrete data for treatment decisions.

This summary describes clinical guidelines for Crohn’s disease treatment, not a specific research study. These are general recommendations from European experts and should not replace personalized medical advice from your own doctor. Treatment decisions should be made based on your individual situation, disease severity, and personal preferences in consultation with your healthcare team. If you have Crohn’s disease, discuss these guidelines with your gastroenterologist to determine which approaches are right for you. Do not change your medications or treatment plan without talking to your doctor first.