Wk 10 IBD lewis

What is Crohn’s disease most common in?

Women (teenagers)

What is ulcerative colitis most common in?

Men (20 year olds)

What is the etiology of IBD?

Inflammation d/t infectious (pro-inflammatory bacteria, diet), genetic (1st degree relatives, monozygotic twins), environment (microflora of GI tract), immunologic (cytokines, TNF-a), psychologic (stress, anxiety, depression), too hygienic of environment , diets in fruits and vegetables

How does smoking affect IBD?

Protective in UC, harmful in CD

What meds can cause IBD?

NSAIDs, antibiotics, oral contraceptives, isotretinoin

What is common in Crohn’s but rare in UC?

Fever, malaise, tenderness, abdominal mass, internal fistulas, linear ulcers, illeal involvement, strictures, cobblestone appearance, discontinuous/ patchy pattern, usually affects small intestine, affects all layers of bowel wall

What is more common in UC than Crohn’s?

Rectal bleeding, rectal involvement, continuous distribution, usually affects colon, only affects inner layer of bowel

What are complications of UC?

Hemorrhoids, fissures, perirectal abscess, toxic megacolon, colonic hemorrhage, colonic stricture, colorectal cancer (risks: young age of onset, severe inflammation, family hx, primary sclerosis cholangitis)

Which IBD has a higher risk of colorectal cancer?

Ulcerative colitis

What are complications of CD?

Small bowel stricture, access, fistula formations (connect parts of GI tract together), nutritional deficiencies (vitamin B12, A-D, folate, iron)

What are extra intestinal manifestations of IBD?

Hepatobillary complications (liver/ gallbladder problems not related to disease severity), ocular complications, dermatologic complications, arthritis, anemia, VTE, osteoporosis

What are lab tests for IBD?

low Hg/HCT, high WBC, ESR, CRP

What is Pancolitis?

Entirety of colon

What is proctosignoiditis?

Rectum and sigmoid colon

What is proctitis?

Confined to rectal area

What is extensive UC?

Extends proximal to splenic flexure

What is distal UC?

Limited to areas distal to splenic flexure (left-sided)

What is ilocoloitis CD?

Most common form of CD, affects terminal ileum

What are poor prognostic factors of UC?

Age <40 at diagnosis, extensive colitis, severe endoscopic disease, hospitalization for colitis, elevated CRP, low serum albumin

What are poor prognostic factors for CD?

Age <40 at diagnosis, smoking, extra-intestinal manifestations, perianal disease, stenotic/penetrating behavior, need for systemic corticosteroids, severe lesions, elevated CRP

What are goals of therapy?

No rectal bleeding, abdominal pain, higher quality of life, prevent complications. Low fecal calprotein, CRP, ESR, better imaging

What are non pharm management of Crohn’s?

Try special diet, avoid: sugary/ carbonated drinks, avoid popcorn, fruit skins, veggies, nuts, seeds cookies. Drink water, eat small meals, keep food diary

What drugs are used to treat IBD?

Aminosalicylates, corticosteroids, immunosuppresive agents/ immunomodulators, antimicrobials (metronidazole, ciprofloxacin)

What are TNF-a inhibitors?

Infliximab (Remicade), Adalimumab (Humira), Golimumab (Simponi), Certolizumab (Cimzia)

What are sphingosine 1-phospate modulators?

Ozanimod (Zeposia), Etrasimod (Velsipty)

What are interleukin inhibitors?

Ustekinumab (Sterlara), Risankizumab (Skyrizi), Mirikizumab (Omvoh), Guselkumab (Tremfya)

What are integrin receptor antagonist?

Vedolizumab (Entyvio), Natalizumab (Tysabri)

What are JAK inhibitors?

Tofacitinib (Xejanz), updacitinib (Rinvoq)

What should be started in IBD? (Top-down approach)

Biologics

When is surgery implicated in UC?

Maxed out on medicine management, have chance of cancer. Protolectomy/ colectomy can cure UC

When is surgery implicated in CD?

Pts with complications, fistulas, strictures. Resections of small intestine may cause (malabsorption, high rate of recurrence).

What is given after surgically induced remission of CD if low risk of recurrence?

3 month course of metronidazole & ileocolonoscopy after 6-12 months

What is given after surgically induced remission of CD if high risk of recurrence?

Anti-TNF or AZA/6MP & 3 months of metronidazole ileocolonsocpy after 6-12 months