{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 14, Ep 2 of 3: Crohn Complete","html":"","width":"100%","height":180,"duration":1151,"description":"Episode two of the IBD chapter takes Crohn disease from phenotype through complete medical management. It runs the Montreal classification into risk stratification and the top-down versus step-up decision, then walks Crohn-specific induction, immunomodulators, and biologic positioning. It closes with the phenotype-specific algorithms for perianal disease, strictures, and post-operative recurrence.\n \nTopics covered\n\nMontreal classification and phenotype drift\nTop-down versus step-up risk stratification\nCrohn-specific induction and steroids\nThiopurines and methotrexate\nBiologics by mechanism and safety\nPerianal Crohn algorithm\nStricturing disease and bowel preservation\nPost-operative recurrence and Rutgeerts score\n \n \nKey decisions\n\nBudesonide 9 mg is induction for mild-to-moderate ileal or right-colonic disease but fails as maintenance beyond six months and does not treat left-sided colonic disease.\nThe high-risk stacked phenotype (young age, deep ulcers, perianal fistula, steroid requirement, smoking) starts biologic plus immunomodulator combination, not step-up.\nTPMT genotype or activity is mandatory before thiopurines, with NUDT15 testing added in Asian, Hispanic, and Native American patients; hepatosplenic T-cell lymphoma clusters in young men on thiopurine plus anti-TNF.\nPerianal Crohn sequence is non-negotiable: drain the abscess and place setons first, then start biologic; dose-optimized infliximab on an undrained abscess is the wrong move.\nPost-operative high-risk patients start prophylactic anti-TNF within four weeks; smoking cessation is the single modifiable factor that meaningfully reduces recurrence.\nRutgeerts scope at six to twelve months is universal regardless of risk, and the middle grade or higher triggers escalation.\nIn pregnancy the dominant threat is active disease, not medication: continue most drugs, stop methotrexate and JAK inhibitors.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}