MRCP2-3756
A 32-year-old man with a history of Crohn’s disease presents to the Emergency Department (ED) with complaints of abdominal pain. He was diagnosed with Crohn’s disease at the age of 26 after presenting to his General Practitioner (GP) with persistent symptoms of diarrhea, weight loss, and abdominal pain. At the time of diagnosis, he was noted to have an elevated C-reactive protein (CRP) and fecal calprotectin. He has been managed by a dedicated gastroenterology service and has been on a maintenance dose of Infliximab for the past year. He has started a new job as a air flight controller and has been experiencing increased stress due to the COVID-19 pandemic. His current medications include paracetamol as required and Infliximab every 8 weeks. He denies any rectal bleeding or changes in bowel habits. This is his third presentation to the hospital within the past year.
On examination, his abdomen is tender in the right lower quadrant with no rebound tenderness. Bowel sounds are present. A pregnancy test, urine dip, and routine blood tests are unremarkable. A recent CT scan of his abdomen showed mild inflammation in the terminal ileum, consistent with his known Crohn’s disease. A recent colonoscopy showed mild inflammation in the cecum and ascending colon.
What is the most appropriate management choice for this patient?