TRATAMIENTO

Question 1

INDICACIONES GENERALES

Answer 1

Régimen…
Hidratación, electrolitos
Profilaxis TVP, excepto hemorragia masiva
Analgesia paracetamol + opioides

Question 2

No usar

Answer 2

AINE

Antiespasmódicos, antidiarreicos?

Question 3

ATB

Answer 3

• RS 2011: La terapia con antibióticos puede inducir la remisión en la EC y la CU activa, aunque el número diverso de los antibióticos probados significa que los datos son difíciles de interpretar
  
  • AGA guidelines: “anti-mycobacterial therapy has no role in the treatment of patients with CD”
  • Indicación en lesiones perianales o supurativas

Recomendación ATB (ceftriaxona + metronidazol) PUC:

    - Antecedentes epidemiológicos (viajes, contactos afectados)
    - Infección demostrada por C.difficile u otro enteropatógeno
    - T°> 38,5°C
    - Megacolon tóxico
    - Complicación supurativa/ enfermedad perianal
    - Falta respuesta 3er día

Question 4

Etapas del tratamiento EII

Answer 4

Inducción de remisión
Mantención de remisión
Manejo quirúrgico

Question 5

Tratamientos estudiados en induccion

Answer 5

Aminosalicilatos
Sulfasalazina, mesalamina, otros
Tópicos (supositorios, espuma, enema), orales
Corticoides

Anti TNF-alfa
Ciclosporina
Metrotrexato

Question 6

Rectal 5-aminosalicylic acid for induction of remission in ulcerative colitis

Answer 6

RS 2010: Superior a placebo y corticoides tópicos
Rectal 5-ASA should be considered a first-line therapy for patients with mild to moderately active distal UC
The optimal total daily dose of 5-ASA remain to be determined

Question 7

5 ASA sistémicos en CU

Answer 7

RS 2011: Efectivos

DOSIS > 2gr /día

Question 8

Aminosalicylates for induction of remission or response in Crohn’s disease

Answer 8

(RS 2010):
Sulfasalazina efecto modesto comparado con placebo
Inferior a corticoides en L/M
Mesalamina/olsalazina no son superior a placebo
Inferior a corticoides
Datos insuficientes
The existing data show little benefit for 5-aminosalicylates

Question 9

AMINOSALICILATOS: Efectos Adversos

Answer 9

Sulfasalazina (hasta 50%)

• Comunes
  
  • Cefalea (1/3), dosificación gradual
  • Anorexia /náuseas
  • Fiebre / Rash (si ocurre reiniciar gradual)
  • Alt recuento espermático, reversible
• Raro; pancreatitis, agranulocitosis (

Question 10

Traditional corticosteroids for induction of remission in Crohn’s disease

Answer 10

RS 2008:
Corticosteroids are effective for induction of remission in patients with CD, particularly when used for more than 15 weeks
further study is required to determine whether corticosteroids are more effective in patients with certain phenotypes or when administered intravenously

Question 11

Oral budesonide for induction of remission in ulcerative colitis

Answer 11

(RS 2010)
There is no evidence to recommend the clinical use of oral budesonide for the induction of remission in active ulcerative colitis.
Mesalamine is superior to budesonide for the treatment of active ulcerative colitis

Question 12

Budesonide for induction of remission in Crohn’s disease

Answer 12

(RS 2008)
Budesonide is more effective than placebo or mesalamine for induction of remission in Crohn’s disease.
short-term efficacy with budesonide is less than with conventional steroids, likelihood of adverse events and adrenal suppression is lower

Question 13

Manejo Crisis EII leve

Answer 13

• 5-ASA
  
  • tópico (sólo hasta ángulo esplénico)
    
    • proctitis (sup)
    • PS (enema)
  • oral
    
    • Sulfasalazina >2gr
    • Mesalamina 2,4-4,8gr
• respuesta 1-2 semanas

Question 14

Manejo Crisis EII Moderada

Answer 14

Prednisona 40-60mg

respuesta 1-2 semanas

Question 15

Manejo Crisis EII Grave

Answer 15

Hospitalización
Corticoides ev (100mg c 8hrs, o MP 20 mg cada 8 hrs)
(estudio CMV)
respuesta 3 días

Question 16

Manejo Crisis si hay respuesta inicial

Answer 16

Tratamiento de mantención :

• 5-ASA
• Azatioprina (respuesta 3 meses) 2,5 mg/Kg/día
• Mercaptopurina 1-1,5 mg/Kg/día
• Decalaje corticoides

Question 17

Manejo Crisis si no hay respuesta inicial

Answer 17

Leve: manejo como moderada
Moderada: manejo como severa
Severa:

• Estudio CMV
• Qx
• Anti TNF-alfa ((infliximab 5mg/Kg ev, semanas 0-2-6, luego c/8))
• Ciclosporina
• Metrotrexato

Question 18

Anti TNF-alfa en CU refractaria

Answer 18

Effective and safe therapies for the induction and maintenance of long-term remission and prevention of treatment by colectomy for patients with refractory ulcerative colitis
clinical remission (p,0.00001), steroid-free remission (p = 0.01), endoscopic remission (p,0.00001) and a decrease in frequency of colectomy (p = 0.03)

Question 19

Anti TNF-alfa en Crohn refractaria

Answer 19

Infliximab, adalimumab and certolizumab are effective as both induction and maintenance therapy in moderate to severe Crohn’s disease in adults
Including patients with fistulas
The safety profile was acceptable.

Question 20

Indicación Quirúrgica

Answer 20

Ausencia de respuesta a tratamiento
CU 20-30%
Crohn 50% a los 10 años
Efectos adversos con tratamientos
Estenosis/perforaciones
Lesiones supurativas
Displasia/cancer