Inflammatory Bowel Disease

Question 1

What diseases does inflammatory bowel disease include?

Answer 1

Crohn’s disease and ulcerative colitis

Question 2

What’s the difference between Crohn and UC?

Answer 2

Crohn can affect any part of the GI tract.

UC is restricted to colon

Question 3

What is it called when UC involves the entire colon?

Answer 3

Ulcerative pancolitis

Question 4

What is it called when UC involves the rectum and sigmoid colon?

Answer 4

Ulcerative proctosigmoiditis

Question 5

What is it called when the UC is limited to rectum?

Answer 5

Ulcerative proctitis

Question 6

Does surgery cure UC and CD?

Answer 6

Colectomy cures UC
CD can still recur after surgery

Question 7

What are the pharmacological choices for IBD?

Answer 7

1. Aminosalicylates
2. Corticosteroids
3. Immunomodulators
4. Biologic response modifiers
5. Antibiotics
6. Antidiarrheals
7. Opioid analgesics

Question 8

What are the three drugs under the 5-aminosalicyic acid (5-ASA) class?

Answer 8

1. Mesalamine
2. Sulfasalazine
3. Olsalazine

Question 9

What is mesalamine?

Answer 9

One 5-ASA molecule

Question 10

What is olsalazine?

Answer 10

Two 5-ASA molecules linked

Question 11

What is sulfasalazine?

Answer 11

A sulfapyridine linked to 5-ASA

Question 12

5-ASA can be administered ________ or _________.

Answer 12

Orally
Rectally

Question 13

What are the different types of mesalamine drugs?

Answer 13

Salofalk, Pentasa, Asacol, Mezavant

Question 14

Which 5-ASA drug releases in the small bowel?

Answer 14

Salofalk and Pentasa

Question 15

Which 5-ASA drugs releases primarily in the colon?

Answer 15

Sulfasalazine
Olsalazine
Asacol
Mezavant

Question 16

What 5-ASA compound is good for mild-moderate UC? What is it effective for?

Answer 16

All oral 5-ASA (irrespective of oral or rectal) is equally effective

Effective for induction of remission and prevention of relapse.

Question 17

What 5-ASA compound is good for mild colonic CD?
What is it effective for?

Answer 17

Sulfasalazine
Effective only for induction of remission of mild colonic CD
Nothing else works

Question 18

Of the 5-ASA options, which is the least favourable agent?

Answer 18

Sulfasalazine

Question 19

Why is sulfasalazine the least favourable?

Answer 19

Many adverse effects caused by the sulfapyridine moiety like: nausea, headache, rash, hemolytic anemia, hepatotoxicity, reversible oligospermia

Question 20

Can you take 5-ASA agents fi you have sulfa allergy?

Answer 20

No sulfasalazine

Question 21

When do corticosteroids come into play?

Answer 21

Induction of remission for patients with CD and UC if:
- Allergic to sulfa and you have Crohn’s
- Unresponsive to 5-ASA
- Moderate to severe Crohn’s
- Severe UC

Question 22

Do we ever use corticosteroid for maintenance of CD and UC?

Answer 22

No

Question 23

What is the corticosteroid therapy and dose for moderate to severe exacerbation of CD or UC?

Answer 23

Oral prednisone 40-60mg/day