Gastroenterologist for Crohn's Disease Management
Patients with Crohn's disease should be referred to a gastroenterologist for specialized evaluation and management. 1
Primary Specialist
Gastroenterologists are the primary specialists for diagnosing, treating, and monitoring Crohn's disease, as they possess expertise in inflammatory bowel disease management, endoscopic procedures, and advanced therapeutic decision-making. 1
Gastroenterologists coordinate the comprehensive assessment required for Crohn's disease, including determination of disease location (ileal, colonic, or ileocolonic), behavior (inflammatory, stricturing, or penetrating), and severity (mild, moderate, or severe). 1
The gastroenterologist performs or orders essential diagnostic procedures including ileocolonoscopy with biopsies, cross-sectional imaging (MRI enterography preferred as first-line), and biomarker monitoring (fecal calprotectin and serum CRP). 1
Multidisciplinary Team Involvement
Colorectal surgeons experienced in inflammatory bowel disease should be involved early for patients with stricturing or penetrating disease, perianal fistulizing disease, or those requiring surgical assessment for complications. 1
Patients with perianal Crohn's disease specifically require management through an IBD multidisciplinary team (MDT) that includes both gastroenterology and colorectal surgery, with examination under anesthesia by an experienced colorectal surgeon. 1
Radiologists with expertise in cross-sectional enterography play a critical role in disease assessment, as shared understanding between gastroenterologists and radiologists regarding imaging goals improves therapeutic decision-making for strictures, penetrating complications, and disease extent. 1
When Additional Specialists Are Needed
Oral medicine specialists should evaluate patients with suspected orofacial granulomatosis or oral Crohn's disease manifestations, as gastroenterologists miss approximately 50% of oral lesions compared to dentist examination. 1
Nutritional support specialists may be required for patients with severe disease, stricturing complications, or malnutrition, particularly when gastrostomy tube feeding or exclusive enteral nutrition is considered. 1
Common Pitfalls to Avoid
Do not delay referral to gastroenterology for patients with suspected Crohn's disease, as early diagnosis and risk stratification are essential for preventing complications—nearly one-third of patients present with complicated disease at diagnosis, and up to 50% require surgery within 10 years. 2
Avoid referring to general surgeons without IBD expertise for perianal disease or complex strictures, as specialized surgical assessment is critical for optimal outcomes. 1
Do not attempt to manage moderate-to-severe Crohn's disease in primary care alone, as the therapeutic armamentarium includes biologics (anti-TNF agents, vedolizumab, ustekinumab, risankizumab), immunomodulators, and treat-to-target strategies requiring gastroenterology expertise. 1, 3, 2