Noninvasive Imaging in CD

CE / CME

Interactive Case Challenge 2: Integrating Noninvasive Imaging in Crohn’s Disease Management 

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Physicians: maximum of 0.50 AMA PRA Category 1 Credit

ABIM MOC: maximum of 0.50 Medical Knowledge MOC point

Released: March 20, 2025

Expiration: March 19, 2026

Activity

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Case History



John Burns is a 35-year-old man with a 10-year history of CD. He presents for follow-up because of worsening symptoms. During the past 2 months, he has experienced increase abdominal pain, occasional bloating, intermittent diarrhea (2-3 loose nonbloody stools daily), fatigue, and a 5-lb weight loss that he attributes to dietary changes.  


Today, Mr Burns states that the pain in his abdomen has been gradually increasing. The pain is intermittent and crampy. He believes that it has just been localized to the right lower area. The pain is worse after meals, but there is no vomiting or diarrhea when it occurs. Mr Burns also states that his daily activities have been affected by his fatigue.



He is currently receiving infliximab 5 mg/kg every 8 weeks and azathioprine 150 mg/day. 



  • Past medical history: 

    • Diagnosed with CD at age 25 

    • Initial disease location: terminal ileum (Montreal classification L1) 

    • Complications: no history of strictures, fistulas, or perianal disease 

    • Past treatments: prior corticosteroid use for flare management 




Vitals: afebrile; blood pressure: 120/78 mm Hg; heart rate: 78 beats/min, BMI: 24 kg/m2 



  • Recent laboratory findings: 

    • C-reactive protein (CRP): 12 mg/L  

    • Fecal calprotectin: 450 µg/g  

    • Hemoglobin: 12.8 g/dL  

    • Albumin: 3.9 g/dL  

    • Liver function tests: normal 

    • White blood cell count: 7.2 x 109/L 



What is the most appropriate next step to assess his disease activity?