Inflammatory Bowel Disease

IBD - What is it and common symptoms

IBD is not the same as IBS

• distinguish each

Anatomy of large intestine

IBD - Epidemiology and risk factors

What are some agents that can cause IBD flares?

Pathophysiology of IBD

Structure of the wall of GI - Ulcerative colitis

Ulcerative colitis Pathophysiology

UC - Diagnosis

Assessment of disease severity - UC

• Gold standard to assess and diagnosis severity of the disease is through an endoscope

  • After use UCEIS Scale

What is ulcerative colitis?

Maintenance therapy for UC

Treatment concepts

• remission is confirmed by clinical diagnosis

  • combination of symptoms and the appearance of the lining of the gut with colonoscopy and endoscopy

Aminosalicylates → Active ingredient: 5-ASA

Aminosalicylate Agents (4)

• Sulfasalazine contains a sulfone group

  • avoid in sulfa allergy patients

  • the other 3 agents are okay to give instead

• If patient allergic to salicylates, then all 4 agents are C/I

Mesalamine

• Know the brand names

All of the above

Alternative therapy to mesalamine: Corticosteroids for Induction/Maintenance of IBD

• KNOW: there are two different brand names for budesonide with different indications

Budesonide

• Class

• ADRs and DDI

• Formulations

Cyclosporin

• MOA

• Indication

• PK

Exam question on which increase v decrease Cyclosporin: CYP3A4 Inducers and Inhibitors

UC: Treatment algorithm

• Proctitis

• Left sided colitis

• Pancolitis - affects the entire colon; extent of the disease

Ulcerative Colitis Induction, Maintenance, and Refractory for each type of UC

Crohn’s disease presentation and what is it

Crohn’s disease Diagnosis

Assessment of disease severity

Crohn’s Disease: Corticosteroids Induction/Maintenance

Thiopurines: Azathiopurines and 6-Mercaptopurine for Crohn’s disease

TNF Inhibitor: Infliximab for Crohn’s Disease

TNF Inhibitors: Moderate-Severe disease

• Just know the bolded parts

IL-Inhibitors for Crohn’s Disease

Integrin Inhibitors

JAK Inhibitors

Crohn’s disease: Treatment algorithm

Crohn’s Disease: Treatment algorithm for Moderate-Severe Disease Mod-High risk disease

CD: Tx algorithm for Severe or fulminant disease and Severe + Fistulizing disease

CD: Post operative

CD: Tx alorithm summary

• Mild

• Moderate

• Severe

• Fulminant

Antimicrobial agents: Crohn’s disease

Disease modifiers

Treatment goals for UC and CD