IBD vs IBS

Question 1

What are new changes to induction/maintenance meds for Crohns? Think A’s

Answer 1

Avoid 5-ASA, Antibiotics, Alternative tx

Question 2

What meds classes are used to treat crohns?

Answer 2

1. Start with Sulfalazine if mild, unless severe then steroids
2. Thiopurines (except in high risk, not for maintenance)
3. Methotrexate
4. Biologics! vedolizumab, ustekinumab

Question 3

IBS guidelines treatment pharm?

Answer 3

1. Antispasmodics
2. Antidepressants (SSRI and TCA)
3. Eluxadoline (mu agonist)
4. Lubiprostone (C type)
5. Linaclotide (constella- c)

Question 4

IBS tx non pharm 4 + 1 test

Answer 4

1. TTG or endosymal IgA (NO CRP/fecal calprotectin)
2. FODMAP trial
3. pysllium
4. Peppermint/probiotics
5. CBT/hypno therapy
6. colonoscopy if > 50 OR alarm features

No more : loperamide, cholestyramine, osmotic laxatives

Question 5

Chronic diarrhea workup? How is chronic defined?

Answer 5

4 weeks
hgb
ferritin
TSH
TTG
Cdiff
stool O and P
Calprotectin (rule out IBD)
FIT
Other causes: Breath hydrogen (lactose), capsule endoscopy, fecal elastase (fat malabsorption), MRI abdo (pancreatitis)

Question 6

How do you dx IBS?

Answer 6

ROME criteria:
Abdominal pain at least 1x per week for 3 months with 2 of the following:
1. Pain with defecation
2. Change in stooo freq
3. Change in stool appearance
Other ssx: N, V, HA, anorexia, arthralgis
Comorbid with anxiety and depression in kids

Non pharm- CBT!!!