IBD

Question 1

UC:
What therapy is superior for induction of remission in mild to moderately active ulcerative colitis compared with oral or topical therapies alone?

Answer 1

Combined mesalamine therapy (oral and topical)

Question 2

Crohn

Tx of mild to moderate disease (NO fever or abdominal tenderness, <10% weight loss)

Answer 2

• Budesonide or mesalamine (for limited, mild ileocolonic disease) for remission
• 6MP, azathioprine, or MTX for maintenance

Question 3

Crohn

Tx of moderate to severe disease (fever, >10% weight loss, anemia, abdominal pain, nausea, vomiting)

Answer 3

• prednisone for remission induction
• 6MP, azathioprine, or MTX for maintenance
• Anti-TNF antibodies in glucocorticoid refractory disease (infliximab, adalimumab, certolizumab); ustekinumab and vedolizumab for disease refractory to anti-TNF antibodies

Question 4

Crohn
Tx of severe to fulminant disease (despite oral glucocorticoids, high fever, cachexia, vomiting, rebound tenderness, obstruction, or abscess)

Answer 4

• IV glucocorticoid for remission
• Anti-TNF antibodies in glucocorticoid refractory disease (infliximab, adalimumab, certolizumab); ustekinumab and vedolizumab for disease refractory to anti-TNF antibodies
• surgical intervention if pt has extremely toxic disease or does not benefit from medications

Question 5

Crohn

Tx of fistula

Answer 5

azathioprine, 6MP, anti-TNF antibodies

Question 6

UC

Tx of mild disease (<4 BMs a day; occasional blood in stool; normal vital signs, hemoglobin, and ESR)

Answer 6

5-ASA agents: mesalamine for pancolitis (combined oral and topical) and topical sulfasalazine for proctitis or left-sided colitis

Question 7

UC

Tx of moderate disease

Answer 7

• prednisone or budesonide for remission induction

- maintenance therapy with a 5-ASA agent (topical and oral), 6-MP, or azathioprine

Question 8

UC

Tx of severe disease: >6 BMs a day; bleeding, fever, pulse rate >90/min, ESR>30, anemia

Answer 8

• IV glucocorticoids followed by anti-TNF antibody

- surgery for refractory disease and toxic megacolon

Question 9

Persons with chronic inflammatory bowel disease or who are immunocompromised are most susceptible to severe travelers’ diarrhea or complications, and prophylaxis with ***should be provided to these patients.

Answer 9

fluoroquinolones preferred, such as ciprofloxacin