GI: Crohns Disease

Question 1

Why can Crohns disease cause secondary osteoporosis?

Answer 1

Reduced absorption of dietary vitamins and minerals.

Question 2

What is fistulating Crohn’s disease?

Answer 2

When there is the formation of a fistula between the intestine and adjacent structures, such as the perianal skin, bladder, and vagina. It occurs in about 1/4 patients, mostly when the disease involves the ileocolonic area.

Question 3

What common harmful lifestyle factor can make Crohn’s worse?

Answer 3

Smoking

Question 4

In the treatment of acute Crohn’s, what is used to induce remission in patients with a first presentation or a single inflammatory exacerbation of Crohn’s in a 12-month period?

Answer 4

A corticosteroid (either prednisolone or methylprednisolone or intravenous hydrocortisone).

Question 5

Acute Crohns: In patients with distal ileal, ileocaecal or right-sided colonic disease, in whom a conventional corticosteroid is unsuitable or contra-indicated, what can be considered and why?

Answer 5

Budesonide can be considered, it is less effective but may cause fewer side-effects than other corticosteroids as the systemic exposure is limited.

Aminosalicylates (sulfasalazine and mesalazine) are an alternative option. But less effective.

Question 6

When would add-on treatment be used in Acute Crohn’s?

Answer 6

If there are two or more inflammatory exacerbations in a 12-month period, or if the corticosteroid dose cannot be reduced.

Question 7

Acute Crohn’s: What can be added to a corticosteroid or budesonide to induce remission?

Answer 7

Azathioprine or mercaptopurine can be added.

Azathioprine or mercaptopurine [unlicensed indications] can be added to a corticosteroid or budesonide to induce remission. In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, methotrexate can be added to a corticosteroid.

Question 8

Acute Crohn’s: Add-on treatment: In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, what can be added to a corticosteroid?

Answer 8

Methotrexate

Question 9

Under specialist supervision, monoclonal antibody therapies with what are options for the treatment of severe, active Crohn’s disease, following inadequate response to conventional therapy?

Answer 9

Adalimumab: anti-TNF

Infliximab: anti-TNFa

Question 10

How does adalimumab work?

Answer 10

anti TNF

Question 11

How does infliximab work?

Answer 11

Anti TNF

Question 12

Acute Crohn’s. add-on treatment: what is a recommended treatment option for moderate to severely active Crohn’s disease when therapy with adalimumab and infliximab is unsuccessful or not tolerated?

Answer 12

Vendolizumab:
monoclonal antibody that binds specifically to the α4β7 integrin, which is expressed on gut homing T helper lymphocytes and causes a reduction in gastrointestinal inflammation.

Question 13

How does Vendolizumab work?

Answer 13

monoclonal antibody that binds specifically to the α4β7 integrin, which is expressed on gut homing T helper lymphocytes and causes a reduction in gastrointestinal inflammation.

Question 14

In the maintenance of remission in Crohn’s, what drugs used as unlicensed monotherapy can maintain remission when previously used to induce remission?

Answer 14

Azathio and mercaptopurine

Question 15

What are the symptoms of Crohn’s relapse?

Answer 15

Weight loss, abdominal pain, diarrhoea and general ill-health.

Question 16

Methotrexate should only be used in patients to maintain remission if what?

Answer 16

If methotrexate was needed to induce remission or if they are intolerant of or not suitable for azathioprine or mercaptopurine.

Question 17

What drugs should not be used for the maintenance of remission in Crohn’s?

Answer 17

Corticosteroids or budenoside.

Question 18

What drug is licensed for the relief of diarrhoea associated with Crohn’s disease?

Answer 18

Colestyramine but also loperamide and codeine.