IBD Flashcards
what is crohns
Crohn disease (CD) is an inflammatory bowel disease (IBD)
how does CD differe from UC
CD is not limited to the colon but can manifest anywhere in the gastrointestinal tract
what are features of CD
Clinical features commonly include diarrhea, weight loss, and abdominal pain
what are treatment aims for CD
induce and maintain remission
how are acute flares treated?
managed with corticosteroids but steroid-sparing regimes (e.g., thiopurine analogs, biologics) may also be used
how is remission induced in mild to moderate CD treated?
Oral systemic corticosteroids
(prednisone)
Consider sulfasalazine
how is remission induced in severe cd
IV systemic corticosteroids (e.g., IV methylprednisolone) PLUS infliximab
how is remission induce in moderate to severe CD (monotherapy)
A biologic (e.g., anti-TNF-α antibodies, ustekinumab, or vedolizumab) is preferred.
Consider methotrexate (IV or subcutaneous).
how is remission induce in moderate to severe CD (monotherapy)
Oral systemic corticosteroids (e.g., prednisone) PLUS an immunomodulator (e.g., azathioprine) OR anti-TNF-α antibodies (e.g., infliximab)
Steroid-sparing regime: anti-TNF-α antibodies (e.g., infliximab) PLUS an immunomodulator (e.g., thiopurine analogs, methotrexate)
how is remission maintained in mild to moderate CD
aymptomatic patient and/or low risk of progression of CD: supportive therapy as needed
High risk of progression of CD or continued inflammation: Consider anti-TNF-α antibodies.
how is remission maintained in moderate to severe CD
Taper and discontinue corticosteroids.
Continue non-steroid agents that resulted in remission.
what lifestyle advice can be given for CD
smoking cessation
how is chrohns disease mediated
Mediated by dysfunctional IL-23-Th17 signaling
how is uc mediated
mediated by th2 cells
what is UC
chronic mucosal inflammation of the rectum, colon
what are UC
bloody diarrhea, abdominal pain, and fecal urgency
what diagnostic techniques for IBD
elevated inflammatory markers (e.g., ESR, CRP) and elevated fecal calprotectin
what is the first line treatment to induce remission in UC (mild to moderate)
5-ASA mesalamine
what is the first line treatment to induce remission in UC if patient does not tolerate 5-ASA
Corticosteroids may be added in patients who do not tolerate 5-ASA therapy or do not achieve remission with 5-ASA monotherapy
what is the first line treatment to induce remission in UC (moderate to severe)
Oral corticosteroids (e.g., budesonide MMX or prednisone)
OR anti-TNF therapy (e.g., infliximab, adalimumab, golimumab) with or without azathioprine
OR integrin receptor antagonist (e.g., vedolizumab)
OR JAK3 inhibitor (e.g., tofacitinib)
what is the first line treatment to induce remission in UC (acute severe)
Intravenous corticosteroids (e.g., methylprednisolone)
Consider cyclosporine or infliximab for patients who do not achieve remission after 3–5 days of systemic corticosteroids.
when should systemic cortcosteroids be used?
Systemic corticosteroids should only be used for induction of remission.
when should steroid sparing agents be used?
Steroid-sparing agents are preferred for maintenance of remission
what is remission
absence of active disease
where can chrons disease affect
mouth to anus
where is ulceritis colitis
colon and rectum
what is mild IBD
fewer than 4 bowel movements
what is moderate ibd
4-6 bowel movements
what is severe ibd
6+ bowel movements
does mild and moderate ibd include anaemia
no
does severe ibd include anaemia
yes
are aminosalicyates preparations interchangeable
no
what is the active component of Aminosalicylates
5-ASA (mesalazine) is the active component
is * 5-ASA (mesalazine) stable in acidic conditions? what can be done
- 5-ASA is unstable in acidic conditions
oral preparations are formulated to withstand the acidic conditions of the stomach
what is the aim of suppositores in IBD
reach rectum
what is the aim of foam enemas in IBD
reach rectum and sigmoid colon
what is the aim of liquid enemas in IBD
reach rectum and rectosigmoid colon
is ciclosporin used in both ibd diseases
only used in UC not crohns
when is ciclosporin used in UC
acute severe active UC unresponsive to IV steroids after 72hrs or if symptoms worsen on steroids
what happens if there is no response to ciclosporin
coleoctomy
what monitoring needs to be done on ciclosporin
BP, Mg, K, lipids, FBC, Ur and Cr, LFTs before and during therapy
when is infliximab used
used to induce remission in severe UC when ciclosporin is contraindicated
what is infliximab contraindicated in
heart failure
when are vedolizumab, ustekinumab etc used
when anti tnf alpha agents cannot be tolerated
when is methotrexate used
maintain remission and used when thiopurines are not tolerated
what do you need to take with methotrexate
folic acid
