HOW DO YOU EVALUATE AND TREAT MID-PROXIMAL SMALL BOWEL CROHN’S DISEASE?

The Montreal classification defines L4 Crohn’s disease (CD) as any disease location proximal to the terminal ileum, which anatomically includes L4-esophagogastroduodenal (EGD), L4-jejunal, and L4-proximal ileal involvement. This chapter will focus on L4-jejunal and L4-proximal ileal disease. L4 disease prevalence is about 15%-it is more common to have L4-EGD disease than L4-jejunal or proximal ileal disease.¹ The vast majority of patients with L4 disease have evidence of CD in other locations, mostly in the terminal ileum.