Ulcerative colitis and Crohn's disease

Question 1

Describe ulcerative colitis

Answer 1

• Inflammation of the submucosa ONLY in the colon (and ONLY affects that one cell layer)
• ulcerations may cover the entire surface of the colon

Question 2

Sx of ulcerative colitis

Answer 2

• diarrhea, bleeding, severe pain
• loss of nutrition, anemia-starvation is a risk
• colon can become ‘still’ from scarring and burst, leading to peritonitis

Question 3

Describe Crohn’s disease

Answer 3

• inflammatory disease which can cover the entire digestive system
• tends to be separate, isolated regions of inflammation
• fistulas may form ; the intestinal wall may also be breached
• may also be associated with severe skin inflammation

Question 4

Describe IBD

Answer 4

• Infl. bowel disease

- no cure, only Tx with are variably effective

Question 5

Treatment of IBD

Answer 5

• surgical removal of the colon can eliminate ulcerative colitis, but cannot always eliminate Crohn’s disease (b/c it can be all through the GI tract)
• IBD’s are typical relapsing/remitting inflammatory diseases

Question 6

List 3 Tx goals for IBD’s

Answer 6

1) treat the acute outbreak
2) induce and retain remission
3) treat complications

Question 7

What is the 1st line tx for IBD? Describe its usefulness

Answer 7

5- Amino salycilic acid (5ASA)

• good for mild to moderate UC. Less useful in CD and severe UC
• does NOT work by COX inhibition (like ASA)
• unknown MOA

Question 8

What is the response rate to 5ASA Tx?

Answer 8

60-80%

Question 9

How is 5ASA released?

Answer 9

released in colon in Sulfasalzine by bacteria (N=N)

Question 10

What’s another potential Tx option for IBD?

Answer 10

Glucocorticoids: stress hormone that suppress the immune system

Question 11

Describe usefulness of glucocorticoids in IBD

Answer 11

• useful for acute tx of moderate to severe disease
• not useful in maintaining remission
• LOTS of side effects

Question 12

SE’s of glucocorticoids used for IBD

Answer 12

• weight gain
• moon face
• stress and emotional responses (anxiety, anger, etc)
• steroid-dependent diabetes
• increased risk of infection (suppresses immune system)

Question 13

Can immunosuppressants be useful for IBD?

Answer 13

Yes. Used for severe crohn’s disease

Question 14

Describe IS Tx of IBD

Answer 14

• Thiopurine derivatives (DNA synthesis inhibitors)
• Mercaptopurine and azothiopurine
• may take weeks to months to work (not for acute use)

Question 15

What type of drug is only used for the MOST serious cases of UC and CD? (last line tx)

Answer 15

Cyclosporine

Question 16

Name a TNFa inhibitor

Answer 16

Infliximab