IBD Overview


Background

Pathophysiology

Therapeutics - Overview

  1. Inflammation control
  2. Pharmacotherapy
  3. Other

Follow-Up

  1. Remission
  2. Flares can be managed outpt by increasing dose in step wise approach
 

CROHN'S DISEASE


Inflammation of entire GI tact from mouth to anus of entire wall
“Skip lesions” are characteristic due to segmental inflammation
Clinical Features
  • Abdominal cramps and pain,
  • Diarrhea, occasionally bloody
  • Fever
  • Perianal fissures
  • Fistula formation
  • Abscesses
  • Rectal prolapse
 

ULCERATIVE COLITIS


Chronic inflammatory disease of rectum and colon only
Symptoms similar to Crohn’s
  • Major finding is bloody diarrhea
Increased risk of toxic megacolon
Risk of colon cancer increased 30-fold
 

TREATMENT OF FULMINANT COLITIS


  • NPO
  • Fluid resuscitation
  • Replace electrolytes
  • NG Suction
Steroids
  • Hydrocortisone 300 mg daily OR (100mg IV q6h)
  • Methylprednisolone 48 mg daily OR (30-40mg IV q12h)
  • Prednisolone 60 mg daily
Broad-spectrum antibiotics
  • Vancomycin : 250-500 mg orally four times daily for 10-14 days
    -- and--
  • Metronidazole : 250-500 mg orally/intravenously every 6-8 hours for 10-14 days


A 30-year-old male presents to your office with a 3-week history of nausea, weight loss, diarrhea, and hematochezia. He states that he has had similar episodes twice in the past and was treated at the local urgent care clinic for infectious diarrhea, with resolution of his symptoms. Your initial laboratory workup is negative for enteric pathogens and you refer the patient for colonoscopy and esophagogastroduodenoscopy with small bowel follow-through. The patient is found to have multiple noncontiguous transmural ulcerations throughout both the small and large intestines. Which one of the following initial management strategies is most likely to induce remission in this patient?

A) Laparotomy with colectomy
B) Metronidazole (Flagyl)
C) Prednisone
D) Infliximab (Remicade)