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Identify patients at diagnosis with a poor prognosis. Such patients are likely to have two or more of the following at diagnosis: perianal disease, weight loss 5kg,stricturing behavior, need for steroids at diagnosis, age 40 years. These patients are suitable for early immunomodulator (thiopurine or methotrexate) therapy and/or biological therapy. Biological (anti-TNF) therapy is best continued once started, because it reduces 12 month hospitalization and surgeryrates and because response is rarely regained. Failure to consider surgery is a common cause of lack of response to anti-TNF therapy. © 2010 Blackwell Publishing Ltd.

Original publication





Book title

Inflammatory Bowel Disease: Translating basic science into clinical practice

Publication Date



469 - 480