Crohn's

Question 1

Fecal cal pro should be considered to help differential IBD vs IBS

Answer 1

strong, moderate evidence

Question 2

In patient at high risk for colorectal neoplasia, chromoendoscopy should be used during colonoscopy to increase diagnostic yield for detection of dysplasia, especially compared w/ standard-definition white light endoscopy

Answer 2

conditional, low evidence

Question 3

There is insufficient evidence to recommend universal chromoendoscopy for surveillance

Answer 3

conditional, moderate evidence

Question 4

Narrow-band imaging shouldn’t be used during surveillance exams for Crohn’s

Answer 4

conditional, very low evidence

Question 5

Endoscopists sufficiently trained/comfortable w/ chromoendoscopy may forgo random surveillance biopsies and rely on target biopsies alone

Answer 5

conditional, very low evidence

Question 6

NSAIDs may exacerbate disease activity and should be avoided

Answer 6

strong, low evidence

Question 7

Cigarettes exacerbate disease and should be avoided

Answer 7

strong, low evidence

Question 8

Use of abx shouldn’t be restricted in CD to prevent flares

Answer 8

conditional, very low evidence

Question 9

Assessment and management of stress, depression, and anxiety should be included as part of comprehensive care for the CD patient

Answer 9

strong, very low evidence

Question 10

Sulfasalazine is effective for symptoms of colonic CD that is mild to moderate

Answer 10

conditional, low evidence

Question 11

PO mesalamine has not shown benefit compared to placebo w/ active CD and shouldn’t be used

Answer 11

strong, moderate evidence

Question 12

Ileal release budesonide 9mg daily should be used for induction of symptomatic remission for patients w/ mild-to-moderate ileocecal CD

Answer 12

strong, low evidence

Question 13

Flagyl is not more effective than placebo for luminal inflammatory CD and shouldn’t be used as primary therapy

Answer 13

conditional, low evidence

Question 14

Cipro has shown similar efficacy to mesalamine in active luminal CD but not more than placebo and shouldn’t be used

Answer 14

conditional, very low evidence

Question 15

PO steroid are effective and can be used for short-term use for signs and symptoms of moderate to severely active CD

Answer 15

strong, moderate evidence

Question 16

Conventional steroids don’t consistently achieve mucosal healing and should be used sparingly

Answer 16

weak, low evidence

Question 17

Azathioprine and 6-MP aren’t more effective than placebo to induce short-term symptomatic remission and shouldn’t be used in this manner

Answer 17

strong, low evidence

Question 18

Thiopurines are effective and should be considered for use for steroid sparing in Crohn’s disease

Answer 18

strong, low evidence

Question 19

Thiopurine methytransferase (TPMT) testing should be considered before initial use of thiopurines

Answer 19

strong, low evidence

Question 20

Methotrexate up to 25mg weekly is effective in patients w/ steroid-dependent CD and for maintaining remission

Answer 20

conditional, low evidence

Question 21

Anti-TNF agents should be used to treat CD resistant to steroids

Answer 21

strong, moderate evidence

Question 22

Anti-TNF agents should be given for CD refractory to thiopurines or methotrexate

Answer 22

strong, moderate evidence

Question 23

Combo of infliximab w/ immunomodulators isn’t more effective than w/ either alone in naive patients

Answer 23

strong, high evidence

Question 24

Anti-integrin (vedolizumab) +/- immunomodulator is effective and should be considered for induction in patients w/ moderate- to severe-CD

Answer 24

strong, high evidence

Question 25

Natalizumab is effective and should be considered for induction in patients w/ active CD

Answer 25

strong, high evidence

Question 26

Natalizumab should be used for maintenance of natalizumab-induced remission of CD only if serum antibody to JC is negative. JC testing should be repeated every 6 months and treatment stopped if positive.

Answer 26

strong, moderate evidence

Question 27

Ustekinumab should be given for moderate-to-severe Crohn's disease patients who failed previous treatment w/ corticosteroids, thiopurines, methotrexate, or anti-TNF inhibitors or who have no prior exposure to anti-TNF inhibitors

Answer 27

strong, high evidence

Question 28

Cyclosporin, mycophenolate, and tacro shouldn't be used for CD

Answer 28

strong, moderate evidence

Question 29

IV steroids should be used for severe or fulminant CD

Answer 29

conditional, moderate evidence

Question 30

Anti-TNF can treat severely active CD

Answer 30

strong, moderate evidence

Question 31

Infliximab may be administered to treat fulminant CD

Answer 31

conditional, low evidence

Question 32

Infliximab is effective for perianal fistulas in CD

Answer 32

strong, moderate evidence

Question 33

Infliximab may be effective for enter-cutaneous and rectovaginal fistulas in CD

Answer 33

strong, moderate evidence

Question 34

Adalimumab and certolizumab peg may be effective in treating perianal fistulas in CD

Answer 34

strong, low evidence

Question 35

Thiopurines may be effective and should be considered in fistulizing CD

Answer 35

strong, low evidence

Question 36

Tacro can be given for short-term treatment of perianal and cutaneous fistulas in CD

Answer 36

strong, moderate evidence

Question 37

Abx may be effective in treating simple perianal fistulas

Answer 37

strong, moderate evidence

Question 38

Addition of abx to infliximab is more effective than infliximab alone in treating perianal fistulas

Answer 38

strong, moderate evidence

Question 39

Abscess drainage should be done before treatment for fistulizing CD w/ anti-TNF

Answer 39

conditional, very low evidence

Question 40

Setons increase efficacy of infliximab and should be considered for perianal fistulas

Answer 40

strong, moderate evidence

Question 41

Once remission is induced w/ steroids, a thiopurine or methotrexate should be considered

Answer 41

strong, moderate evidence

Question 42

Patients who are steroid dependent should be started on thiopurines or methotrexate with or without anti-TNF therapy

Answer 42

strong, moderate evidence

Question 43

PO 5-ASA not effective for maintenance

Answer 43

strong, moderate evidence

Question 44

Steroids not effective for maintenance of medically induced remission in CD and shouldn't be used long-term

Answer 44

strong, moderate evidence

Question 45

Budesonide shouldn't be used to maintain remission of CD beyond 4 months

Answer 45

strong, moderate evidence

Question 46

Anti-TNF should be used to maintain remission of anti-TNF-induced remission

Answer 46

strong, high evidence

Question 47

Combining azathioprine/6-MP or methotrexate w/ anti-TNF should be considered due to the potential for immunogenicity

Answer 47

strong, moderate evidence

Question 48

Vedolizumab should be used to maintain remission of vedolizumab-induced remission

Answer 48

conditional, moderate evidence

Question 49

Natalizumab should be considered to maintain remission of natalizumab-induced remission if JC negative

Answer 49

conditional, moderate evidence

Question 50

Ustekinumab should be used to maintain remission of ustekinumab-induced remission

Answer 50

conditional, moderate

Question 51

All patients w/ CD should quit smoking

Answer 51

conditional, very low evidence

Question 52

Imidazole abx at doses b/w 1 and 2g/day can be used after small intestinal resection in CD to prevent recurrence

Answer 52

conditional, low evidence

Question 53

Thiopurines may be used to prevent clinical and endoscopic recurrence and are more effective than mesalamine (but not severe)

Answer 53

strong, moderate evidence

Question 54

Anti-TNF agents should be started within 4 wks of surgery in high-risk CD patients

Answer 54

conditional, low evidence