MRCP2-1915

MRCP2-1915

A 32-year-old woman presents with symptoms of iron deficiency anaemia. She has a history of Crohn’s disease and took azathioprine for up to 2 years during her late 20s, but her symptoms have been stable over the past few years on no regular medication. Her bowels are open 3-4 times per day with loose motion. She has no regular periods as she currently uses the progesterone-releasing IUD for contraception.

The only other history of note is epigastric pain for which her GP has prescribed a PPI. On examination, her BP is 112/80 mmHg, pulse is 75/min and regular. She looks pale. Abdomen is soft and non-tender and her BMI is 22.

Investigations reveal a haemoglobin level of 94 g/l (normal range 135 – 175 g/l) and a mean corpuscular volume of 76 fl (normal range 80 – 100 fl). Her barium follow-through shows a gastroduodenal stricture, confirmed to be ulcerated on endoscopy, with biopsy appearance typical of active Crohn’s disease.

What is the most important step in managing this patient?