You need to do biopsies BEFORE starting steroids!

• A. True
• B. False
• C. Depends
• D. Not required

Answer: (A)

Before starting immunosuppressive therapy like steroids, obtaining tissue biopsies is essential because histology and microbiology guides the diagnosis and rules out mimics before therapy is given. Steroids can suppress inflammation and alter mucosal appearance, masking infections or other conditions such as intestinal tuberculosis or fungal enteritis, and can blur histologic features that would steer specific management. By taking biopsies from the involved small intestine (and any accessible sites), you can use histology, special stains, cultures, and molecular tests to confirm or refine the diagnosis, differentiate Crohn's disease from infections or other inflammatory conditions, and choose the safest, most effective treatment approach. Skipping biopsy risks misdiagnosis and potentially worsening an occult infection or other pathology, so performing biopsies first is the better approach.