IBS/IBD - Bach

Alarm symptoms for IBS

fever, rectal bleeding, unintentional weight loss, anemia, family history of colon cancer, persistent severe pain

What are the 4 types of IBS? How are they classified?

1. Constipation predominant

2. Diarrhea predominant

3. Mixed (>25% C, >25% D)

4. Unsubtyped

Classified by bristol stool form scale 1-7

higher number = higher water content —> diarrhea

lower number = low water content —> constipation

What is the general order of drug treatments for IBS-D?

Loperamide —> eluxadoline OR rifaximin —> alosetron

What is the general order of drug treatments for IBS-C?

Bulk-forming laxative —> Osmotic laxative —> secretagogues

Which medications are used to treat pain in IBS?

Antidepressants (imipramine, nortriptyline, amitriptyline, duloxetine)

OR

Antispasmodics (hyoscyamine, dicyclomine, scopolamine, atropine)

Which lab values decrease in UC?

HCT, HgB, albumin

What lab values increase in UC?

WBC, CRP, ESR, p-ANC

Categories of disease extent in UC?

Proctitis (just rectum), proctosignmoiditis (rectum, sigmoid colon), left-sided disease/distal disease(splenic flexure, descending), pancolitis (extensive disease)

Which drugs are exclusive to UC and not Crohn’s?

Aminosalicylates, golimumab, S1Ps (ozanimod, etrasimod), cyclosporine, tofacitinib

Which drugs are exdclusive to Crohn’s and not UC?

Natalizumab, methotrexate, certolizumab (NMC —> No More Crohn’s)

Which aminosalicylates require hepatic caution? Renal? Which is approved for secretory diarrhea?

hepatic: mesa, balsa, olsala, balsalazide (all except sulfasalazine)

renal: ALL

Which corticosteroid has low systemic activity and can be used for up to 8 weeks for IBD flare up?

Budesonide

What warnings exist for thiopurines (including BBW) and what monitoring do they require?

Warnings: malignancy, pancreatitis, infection, thrombocytopenia, leukopenia, hepatotoxicity

Patients should have their baseline TPMT activity taken prior to therapy

Which agents are reserved for severe UC? What about fulminant?

4-12 weeks prednisone, 8 weeks budesonide, thiopruines, SP1s, antibodies, JAK inhibitors

Fulminant: medrol, hydrocortisone, infliximab, IV cyclosporines

Which IBD treatment should be always avoided in pregnancy and breastfeeding?

Methotrexate (stop 3 months prior to conception)