Inflammatory Bowel Disease (IBD)

These flashcards cover key concepts, symptoms, treatments, and classifications related to Inflammatory Bowel Disease (IBD), particularly focusing on Crohn's Disease.

What is Inflammatory Bowel Disease (IBD)?

IBD refers to diseases of chronic or remitting/relapsing intestinal inflammation.

What are the two sub-types of IBD?

Ulcerative colitis (UC) and Crohn's disease (CD).

What characterizes Ulcerative Colitis (UC)?

It is a mucosal inflammatory condition confined to the rectum and colon.

What is Crohn’s disease (CD)?

A transmural inflammation of the GI tract that can affect any part, from the mouth to the anus.

What autoimmune response is associated with IBD?

Inappropriate T-cell response to intestinal flora.

What is a significant etiological factor in IBD related to infection?

Loss of tolerance to or altered normal flora.

What lifestyle factor is noted to affect IBD?

Western diet, low in fiber and high in sugar.

What medication type may trigger disease flares in IBD?

NSAIDs (nonsteroidal anti-inflammatory drugs).

How does nicotine impact Crohn's disease (CD)?

It worsens CD but is protective for UC.

What psychological factors can influence IBD?

Mental health changes such as stress, anxiety, and depression.

What antibodies are associated with Crohn's disease?

Anti–Saccharomyces cerevisiae antibodies (ASCA).

What antibodies are associated with Ulcerative Colitis?

Perinuclear antineutrophil cytoplasmic antibodies (pANCA).

What are the general characteristics of Crohn's Disease (CD)?

It is a chronic transmural inflammatory disease with discontinuous lesions, often causing fistulas and malabsorption.

What is a common clinical presentation of Crohn's Disease?

Chronic diarrhea, abdominal pain, fever, and weight loss.

What is a common complication of Crohn's disease?

Fistula formation between structures such as the colon and bladder.

What does a CDAI score indicate?

Crohn’s Disease Activity Index score is used to assess therapeutic outcomes.

What is the CDAI score indicating symptomatic remission?

A CDAI score <150.

What does a CDAI score of 220–450 indicate?

Moderate to severe Crohn's disease.

What is considered severe/fulminant disease in CD?

CDAI score >450, with persistent symptoms despite treatment.

What is the mechanism of action (MOA) of corticosteroids?

They modulate the immune system and inhibit cytokine production.

What are some adverse effects of corticosteroids?

Increased appetite, insomnia, GI upset, hypertension, and osteoporosis.

What should be monitored when using corticosteroids?

Adrenal suppression and immunosuppression.

What is the efficacy of oral mesalamine in Crohn's disease?

It has not been consistently demonstrated to be effective compared to placebo.

What are the management steps for mild symptomatic Crohn's disease?

Begin budesonide for 4-8 weeks and taper if effective.

What is the recommendation for moderate to severe Crohn's disease?

The AGA suggests corticosteroids for induction of remission.

What is the recommended initial dose of Methotrexate?

15 mg to 25 mg once weekly IM or SQ.

What is the recommendation regarding thiopurines in moderate to severe CD?

They are recommended for maintenance of remission but not for induction.

What is the role of TNF-α in IBD?

It induces proinflammatory cytokines and enhances leukocyte migration.

Which medication is a TNF-α antagonist?

Infliximab (Remicade).

What is the significance of the SONIC trial?

It compared infliximab, azathioprine, and their combination for CD treatment.

What is the AGA's recommendation for anti-TNF therapies?

They recommend anti-TNF drugs for induction and maintenance of remission.

What is Ustekinumab?

A non-TNF biologic that blocks IL-12 and IL-23 activity.

What is the contraindication for Natalizumab?

Risk of progressive multifocal leukoencephalopathy (PML).

What is the effect of combination therapy in Crohn’s disease?

Combining infliximab with thiopurines may be more effective than monotherapy.

How should patients be monitored when on Ustekinumab?

Regular screening for TB before and during treatment.

What should be done if induction therapy fails with TNF-α antagonists?

Consider using alternatives such as ustekinumab or vedolizumab.

What dietary factors are associated with IBD?

A low fiber, high sugar Western diet may exacerbate IBD.

What kind of genetic testing might be needed before using thiopurines?

Thiopurine methyltransferase (TPMT) testing.

What is a key clinical feature of moderate–severe Crohn’s disease?

Significant weight loss and abdominal pain.

What action should be taken if a patient experiences symptoms flare after tapering steroids?

Restart budesonide or prednisone.

What is a common symptom associated with the distal portion of Crohn's disease?

Malabsorption of vitamin B12.

What is the standard route for administering Infliximab?

It is given as an IV infusion.

What types of infections pose risks with TNF-α antagonists?

Serious infections including TB and opportunistic infections.

What is the typical long-term maintenance approach for Crohn's disease?

Continue biologic therapy combined with thiopurines if remission is maintained.

What happens during the first line of treatment if steroids were used?

Consider no maintenance therapy or a transition to thiopurines.

How is severe Crohn's disease defined in terms of CDAI score?

CDAI score exceeding 450.

What is the importance of dietary control in managing IBD?

Dietary factors influence disease activity and symptomatology.

Which type of biological therapy is recommended for naïve patients with moderate to severe CD?

Anti-TNFa drugs for induction of remission.

What should be considered before starting corticosteroid therapy?

Patient history of infections and other comorbidities.

What clinical signs suggest a need for surgical intervention in Crohn’s disease?

Significant peritoneal signs and cachexia.

What is the implication of findings from the SONIC trial?

Combination therapy is superior for achieving remission.

What role does psychological support play in managing IBD?

It can help manage flares associated with stress and anxiety.

What is the primary goal in managing moderate to severe Crohn's disease?

Achieve and maintain remission through appropriate therapy.

In which demographic is Crohn's disease typically diagnosed?

It can be diagnosed at any age but often between 15 and 35 years.

What are common symptoms of IBD?

Diarrhea, abdominal pain, and urgency.

What is an immune system involvement in Crohn's disease?

Autoimmune response triggering inflammation.

What are common complications associated with Crohn's disease?

Fistulas and bowel obstruction.

What is a characteristic feature of granulomas in Crohn’s disease?

They may be found in the affected areas but not in UC.

What systemic view does IBD take into account?

Genetics, immune response, and environmental factors.

What is the AGA's standpoint on the role of corticosteroids in long-term management?

They recommend against their use for maintaining remission.

What should be done if IBD symptoms become severe in a patient?

Consider hospitalization and initiation of intravenous therapy.

What monitoring is required when using Methotrexate?

Monitor for liver function and blood counts.

How is azathioprine dosed in treating IBD?

It is typically dosed as per body weight and TPMT levels.

What class of medications is avoided in active Crohn's disease?

5-aminosalicylates (mesalamine).

How is the induction of remission approached in IBD?

Through corticosteroids, biologics, or combination therapies.

What is the typical management approach for acute flares of Crohn's disease?

Short course of systemic steroids.

What dietary changes may support IBD management?

Increasing fiber intake and reducing processed foods.

What are the long-term risks associated with thiopurines?

Increased risk of malignancy.

What initial diagnosis method is commonly used for Crohn's disease?

Endoscopy or colonoscopy with biopsy.

What are essential components of a comprehensive treatment plan for IBD?

Medication, diet, and psychological support.

What is the importance of vaccination in patients on immunosuppressive therapy?

To reduce the risk of infections.

What is indicated if a patient does not respond to correct IBD therapy?

Re-evaluate diagnosis and consider alternative therapies.