2023 RxPrep Ch. 74 Irritable Bowel Disease (IBD)

Irritable Bowel Disease (IBD)

Group of inflammatory conditions of the colon & small intestines

Types of IBD

- Ulcerative Colitis

- Crohn's Disease

Classic symptom of IBD

Bloody Diarrhea

IBS vs IBD

Similar symptoms, but IBD is more serious and involves inflammation

Ulcerative Colitis (UC)

Mucosal inflammation confined to the rectum & Colon with superficial ulcerations

Distal disease

when UC is limited to rectum and colon

Proctitis

inflammation of the rectum

Describe the organization of the GI tract

- Mouth

- Esophagus

- Stomach

- Small intestine (Duodenum, Jejunum, Ileum)

- Large Intestine (Cecum, Ascending, Transverse, Descending, Sigmoid, Rectum, Anus)

UC classification

- Mild: < 4 stools

- Moderate: > 4 stools/day

- Severe: > 6 bloody stools/day

- Fulminant: > 10 stools/day * severe symptoms

Crohn's Disease

Deep, transmural inflammation that can affect any part of GI tract

CD vs UC

- Location: Anywhere in GI for CD, Only Large intestine for UC

- Depth: Deep in CD, Superficial in UC

- Pattern: Noncontinuous in CD, Continuous in UC

- Fistulas/Strictures: common in CD

Diagnosis of IBD

colonoscopy with tissue biopsy

Lifestyle modifications for IBD

- Smaller, more frequent meals (low fat/dairy)

- Plenty of water

- Avoid alcohol & Caffeine

- Identify & avoid triggers

UC

Induction of Remission (treating flares)

- 5-ASA ± steroids

- Anti-TNF agents

- Ustekinumab

- Tofacitinib

- Vedolizumab

- Cyclosporine IV

CD

Induction of remission (treating flares)

- Steroids ± (Thiopurine or MTX)

- Anti-TNF agent ± Thiopurine

- Ustekinumab

CD

Maintenance of Remission

Mild

- PO Budensonide

Mod-Severe

- Anti-TNF agents

- Thiopurines

- MTX

- IL receptor antagonist

- Ustekinumab

Refractory

- Integrin receptor antagonists

UC

Maintenance of Remission

Mild

- Mesalamine

Mod-Severe

- Anti-TNF agents

- Thiopurines

- Cyclosporine

- IL receptor antagonist

- Jak Inhibitor

Refractory

- Integrin receptor antagonists

List the Aminosalicylates

- Mesalamine (Pentasa)

- Sulfasalazine

List the Thiopurines

- Azathioprine

- Mercaptopurine

List the Anti-TNF agents

- Adalimumab (Humira)

- Infliximab (Remicade)

- Certolizumab (Cimzia)

List the IL-12/23 receptor antagonists

- Ustekinumab (Stelara)

List the Janus Kinase inhibitors

Tofacitinib (Xeljanz)

List the Integrin receptor antagonists

- Vedolizumab (Entyvio)

- Natalizumab (Tysabri)

If steroids are used longer than ______ weeks, they should be tapered.

2 weeks

Aminosalicylates

MOA & Side effects:

- Topical anti-inflammatory effect in the GI tract

- Abdominal pain, Nausea, HA, Flatulence, Belching

Thiopurines

MOA & Side effects:

- Immunosuppressive agents

- NVD, Rash, Elevated LFTs,

MTX

MOA:

DHFR inhibitor (immunosuppressant)

Cyclosporine

MOA:

Calcineurin inhibitor (Immunosuppresant)

Anti-TNF agents

MOA:

- Bind and inhibits TNF⍺, preventing induction of proinflammatory cytokines

Integrin receptor antagonists

MOA & Side effects:

- Bind to subunits of integrin molecules, preventing inflammatory cells from migrating into GI tissue

- Infusion reactions, HA, Fatigue, Arthralgia, PML