IBD Therapy

Question 1

what are the therapeutic strategies for IBD

Answer 1

Lifestyle advice
Drugs
Surgery

Question 2

What lifestyle advice is given to those with IBD

Answer 2

Stop smoking - smoking aggravates crohns and worsens disease outcome. Higher chance of reoccurrence after surgery.

Diet- not implicated in pathogenesis but can influence symptoms

Question 3

What type of drugs are used to treat IBD

Answer 3

All anti-inflammatory effects

Taylor drugs to mild, moderate and severe relapses

Question 4

What drugs are used to treat UC

Answer 4

5 ASA (mesalazine)
Steroids (acute flare)
Immunosuppressants (long term)
Anti-TNF therapy

Question 5

What drugs are used to treat Crohn’s disease

Answer 5

Steroids (acute flare)
Immunosuppressants (long term)
Anti-TNF therapy

Question 6

How do 5 ASA’s work

Answer 6

Topical effect
Anti-inflammatory
reduces risk of colon cancer
side effects: diarrhoea, idiosyncratic nephritis (check renal function before starting therapy)

Question 7

How is 5ASA delivered

Answer 7

Orally

• prodrugs -metabolised as they move through the tract
• pH dependent release
• delayed release

Topical

• suppositories
• enemas

Question 8

Most common 5 ASA drugs in use now

Answer 8

Mezavant
Mesalazine
Asacol (pH release)
Pentasa (delayed release)

Question 9

Which 5ASA is released in the duodenum, jejunum, ilieum and colon

Answer 9

Pentasa

Question 10

Suppositories and enemas have the same mucosal adherence true/false

Answer 10

False - suppositories have better adherence that enemas

Question 11

What corticosteriods are used in IBD

Answer 11

Prednisolone oral/topical
Budesonide
Short course of high dose reducing over 6-8 weeks

Question 12

What side effects are caused by corticosteroids

Answer 12

• avascular necrosis (death of bone due to lack of blood)
• osteoperosis
• Acne
• thinning of skin
• weight gain
• diabetes
• hypertension
• neuropsychiatric problems
• cataracts
• growth failure

Question 13

Immunosuppressive drugs

Answer 13

azathioprine/mercaptopurine

methotrexate

Question 14

What are some features of azathioprine

Answer 14

• Slow onset of action (16 weeks)
• Avoid co-prescribing with allopurinol (for gout) as it inhibits the pathway of aaa metabolism
• regular blood monitoring required

Question 15

Side effects of Azathioprine

Answer 15

Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer

Question 16

What anti-TNF drugs are used

Answer 16

antibodies to TNF

• chimeric (IV infliximab)
• humanised (S/c adalimumab)
• promotes apoptosis of activated T cells

Question 17

What is TNF

Answer 17

Tumour necrosis factor - pro inflammatory cytokine

Question 18

What safety considerations are there for Anti-TNF therapy

Answer 18

• Infusion reactions -allergic type response
• Infections (persistent cough/colds etc)
• Check patients haven’t been previously exposed to TB as it reactivated latent TB
• Risk of developing lymphoma and solid tumours

Question 19

When should anti-TNF be used

Answer 19

when as part of a long term strategy including immunosuppression, surgery and supportive therapy

Question 20

What surgery is used in IBD

Answer 20

Emergency
-failure to respond to medical therapy, small bowel obstruction, abscess, fistulae

Elective
-failure to respond to medical therapy, dysplasia of colon mucosa

Question 21

What is the IBD therapy pyramid

Answer 21

Smoking cessation 
5ASA 
Steroids if required 
Immunosuppressants 
Anti-TNF