GI: Crohns Disease Flashcards
Why can Crohns disease cause secondary osteoporosis?
Reduced absorption of dietary vitamins and minerals.
What is fistulating Crohn’s disease?
When there is the formation of a fistula between the intestine and adjacent structures, such as the perianal skin, bladder, and vagina. It occurs in about 1/4 patients, mostly when the disease involves the ileocolonic area.
What common harmful lifestyle factor can make Crohn’s worse?
Smoking
In the treatment of acute Crohn’s, what is used to induce remission in patients with a first presentation or a single inflammatory exacerbation of Crohn’s in a 12-month period?
A corticosteroid (either prednisolone or methylprednisolone or intravenous hydrocortisone).
Acute Crohns: In patients with distal ileal, ileocaecal or right-sided colonic disease, in whom a conventional corticosteroid is unsuitable or contra-indicated, what can be considered and why?
Budesonide can be considered, it is less effective but may cause fewer side-effects than other corticosteroids as the systemic exposure is limited.
Aminosalicylates (sulfasalazine and mesalazine) are an alternative option. But less effective.
When would add-on treatment be used in Acute Crohn’s?
If there are two or more inflammatory exacerbations in a 12-month period, or if the corticosteroid dose cannot be reduced.
Acute Crohn’s: What can be added to a corticosteroid or budesonide to induce remission?
Azathioprine or mercaptopurine can be added.
Azathioprine or mercaptopurine [unlicensed indications] can be added to a corticosteroid or budesonide to induce remission. In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, methotrexate can be added to a corticosteroid.
Acute Crohn’s: Add-on treatment: In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, what can be added to a corticosteroid?
Methotrexate
Under specialist supervision, monoclonal antibody therapies with what are options for the treatment of severe, active Crohn’s disease, following inadequate response to conventional therapy?
Adalimumab: anti-TNF
Infliximab: anti-TNFa
How does adalimumab work?
anti TNF
How does infliximab work?
Anti TNF
Acute Crohn’s. add-on treatment: what is a recommended treatment option for moderate to severely active Crohn’s disease when therapy with adalimumab and infliximab is unsuccessful or not tolerated?
Vendolizumab:
monoclonal antibody that binds specifically to the α4β7 integrin, which is expressed on gut homing T helper lymphocytes and causes a reduction in gastrointestinal inflammation.
How does Vendolizumab work?
monoclonal antibody that binds specifically to the α4β7 integrin, which is expressed on gut homing T helper lymphocytes and causes a reduction in gastrointestinal inflammation.
In the maintenance of remission in Crohn’s, what drugs used as unlicensed monotherapy can maintain remission when previously used to induce remission?
Azathio and mercaptopurine
What are the symptoms of Crohn’s relapse?
Weight loss, abdominal pain, diarrhoea and general ill-health.