Dr HB Lo Integrative GP

Chronic disease · Crohn’s & colitis · Conversation prep

Crohn’s & colitis: how to weigh the next step in your treatment

This tool prepares you to have the escalation conversation with your gastroenterologist or GP as an informed equal. It does not tell you what to escalate to, or whether to escalate at all — that is a decision you make together with your specialist.

Type it how you’d say it to a friend — what you’ve been on, how you’ve been feeling lately, what your doctor’s said about the next step.

Free text. The more you tell me, the more specific I can be. Nothing you type leaves your device.

Tell me a bit more — what are you on now, and what’s your doctor said about the next step?

Just to check — is the bleeding happening right now, or is it something to discuss with your gastro?

Dr HB Lo · Integrative GP
Crohn’s & colitis — escalation conversation guide · generated · clinical content last checked 2026-06-09 (draft, pending clinical sign-off)
Your escalation conversation guide drhblo.com/tools

In your words

The one thing to know

The shape of the decision

The IBD treatment ladder
general — your gastro tailors the order
  1. 5-ASA / aminosalicylates central in UC · limited role in Crohn’s
  2. Corticosteroids to settle a flare short-term only, not a maintenance drug
  3. Immunomodulators azathioprine · mercaptopurine · methotrexate
  4. Biologics / advanced therapies anti-TNF · ustekinumab · vedolizumab · JAK inhibitors — PBS criteria apply (see below)

An ordered list of the four general rungs of IBD treatment, from gentlest to strongest: first, 5-ASA aminosalicylates, central in ulcerative colitis and of limited role in Crohn’s; second, corticosteroids, used short-term only to settle a flare and not as a maintenance drug; third, immunomodulators such as azathioprine, mercaptopurine and methotrexate; fourth, biologics and advanced therapies including anti-TNF, ustekinumab, vedolizumab and JAK inhibitors, for which PBS access criteria apply. This is a general order your gastroenterologist tailors — it is not a recommendation of what you should do.

Rungs and their contents come from Crohn’s & Colitis Australia — Medication for IBD and Biologics for IBD. This is a general map, not a path you should follow — your gastro places you on it and decides the order with you.

The honest bit

The other side of the same numbers. Treating early isn’t free. Stepping up means stronger medicines with real trade-offs — immunomodulators and biologics raise infection risk and need ongoing blood monitoring, and not everyone needs the aggressive path. The PROFILE result was for newly-diagnosed Crohn’s; it doesn’t automatically apply to long-standing disease or to ulcerative colitis. And in Australia, which biologic you can even access is gated by PBS rules, not just by what’s best on paper — most biologics require you to have already failed or not tolerated steroids plus an immunomodulator first. (CCA — Biologics for IBD; PBS access context, AURORA/ANZIBD.)

The questions to bring to your appointment

  • Which strategy are you making for me — climb slowly (step-up), or treat harder early (top-down) — and why that one?
  • What’s my real chance this next step helps me, in numbers — and what are the chances of the main side effects?
  • How fast do you think we should move, and what are we waiting to see before we step up?
  • What does the PBS path look like for me — what do I need to have tried before a biologic is on the table?
  • What happens to me if we don’t step up — what’s the risk of leaving things as they are?

Email yourself the one-page escalation conversation guide — the ladder, the trade-offs, and the questions to bring to your appointment.

You’ll get a clean printable: the step-up vs top-down framing, the treatment ladder, the honest trade-offs, and the questions to ask your gastro — on one page you can hand over.

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I’ll also send the occasional drhblo email. Unsubscribe anytime.

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This is the general map. The full Crohn’s & Colitis decision kit walks your exact situation — the real remission and risk numbers for each option, the PBS access path, and a question worksheet you fill in with your gastro. → See the kit

Weighing the escalation decision itself? Try the questions-to-ask generator. Want the real “X in 100” numbers for a specific option? Try the risk-numbers tool. Prepping for the gastro appointment? Try consult prep.