General Measures Additional therapies depend on location of disease:

• Oral lesions: Hydrocortisone and carboxymethyl-cellulose or topical sucralfate for aphthous ulcers, cheilitis, and/or granulomatous sialadenitis.
• Gastroduodenal CD: No clinical trials, although the slow-release form of mesalamine may be of benefit, as it is partially released in the proximal small bowel. Case reports detail success with anti-TNF therapies. Otherwise, symptomatic relief may be obtained from proton pump inhibitors, H2-receptor antagonists, and/or sucralfate.
• Ileitis: Patients often require supplementation of fat-soluble vitamins, as well as iron, B₁₂, and/or folate, and calcium to prevent bone loss.
• Treatment toxicity: Pancreatitis, bone marrow toxicity, lymphoma, nonmelanoma skin cancer, infections (TB, histoplasmosis, others), malignancy

• Peritonitis: Bowel rest and antibiotic therapy (7–10 days parenteral antibiotics, followed by 2–4 week course of PO ciprofloxacin and metronidazole); surgery as indicated:
  • Consider holding steroids, which mask sepsis.
• Abscess: Antibiotics, percutaneous drainage, or surgery with resection of affected segments.
• Small bowel obstruction: IV hydration, NG suction, TPN for malnutrition, with resolution typically in 24–48 hours. Surgery for nonresponders.