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Histology in CD
Interactive Case Challenge 3: Evolving Role of Histology in Crohn’s Disease Management 

Released: March 18, 2025

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Case History and Presentation 
Mr Smith missed his 3-month appointment because of worsening symptoms and not being able to leave his house from urgency. He finally returns today, 5 months later, for a follow-up appointment. Mr Smith reports persistent symptoms despite the increased adalimumab dosing. He continues to experience abdominal pain, averaging 4-5 loose stools daily, with occasional urgency. His energy levels remain low, and he notes feeling fatigued throughout the day. Although his weight has remained stable, he expresses frustration over ongoing discomfort and lack of symptom relief. He wishes he would have reported back earlier. TDM was performed and found adalimumab trough level of 12.1 mcg/mL and no antidrug antibodies detected.  

What is the next best step in the management of Mr Smith’s CD?