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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, on;y 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
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 (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
