IBD and diverticulitis

Question 1

what inhibits beta glucuronidase?

Answer 1

calcium glucarate

Question 2

Th2 mnemonic

Answer 2

Ah-choo! Two! (antibodies, allergies)

Question 3

diet triggers for IBD

Answer 3

diet (high fat & sugar, processed foods),

Question 4

IBD and SDH

Answer 4

42% of IBS had at least one SDH

Question 5

lifestyle factors to reduce risk of IBD?

Answer 5

Physical activity
Breastfeeding
Bed sharing
Tea consumption
 High levels of folate
High levels of vitamin D
 H pylori infection

Question 6

early life factors and CD

Answer 6

lower with BF

higher with maternal smoking in utero

Question 7

Diet to decrease IBD risk

Answer 7

Fiber
Fruit
Vegetables
High n-3 FA

Question 8

Diet factors that increase IBD risk

Answer 8

Animal Protein
Heme iron, Sulfur
Refined sugars
High-fat (trans)
emulsifiers

Question 9

Diet, Microbiome and IBD

Answer 9

animal fat, milk fat, iron, emulsifiers - IBD flares
high sugar - leads to IP, AIEC
high fat diet - dysbiosis, ileitis
maltodextrin - AIEC and biofilms
iron, red meat - mitigated by resistant starches

Question 10

low FODMAP diet and IBD

Answer 10

helps with Sx

Question 11

eating rainbow and IBD

Answer 11

flavones and resveratrol decreased IBD

Question 12

best alcohol for microbiome diversity

Answer 12

red wine

Question 13

How do probiotics help with IBD

Answer 13

Inhibit Pathogenic Bacteria
Improve Epithelial Function
Immunoregulation

Question 14

should you use prebiotics in CD?

Answer 14

No but yes for UC

Question 15

“Reinoculate” for IBD

Answer 15

Probiotics
•Prebiotics
•Short chain fatty acids

Question 16

“Repair” strategies for IBD

Answer 16

• Omega 3 Fatty Acids
• Immunoglobulin/protein
• Boswellia
• Vitamin D
• Curcuminoids
• L-Glutamine

Question 17

L-glutamine doses

Answer 17

2 - 4 g/d in divided dosages for wound healing and
general intestinal support
• 10 - 30 g/d in divided dosages for critically ill and
advanced disease

Question 18

other botanicals for IBD

Answer 18

Bioflavonoids: 
quercetin
rutin
wheatgrass
ginger
turmeric
green tea
boswellia

Question 19

Nutraceuticals for IBD

Answer 19

Whey protein with concentrated immunoglobulins:
• Serum Bovine-derived immunoglobulins
• Glutamine
• Larch (Arabinogalactans): 
butyrate

Question 20

Artemisia absinthium (worm wood)

Answer 20

Induction of remission mild to

moderate disease in CD

Question 21

Nutraceuticals for IBD

Answer 21

whey protein with concentrated Igs
Serum Bovine-derived immunoglobulins
Glutamine
Larch (Arabinogalactans)
vit D
butyrate

Question 22

alternative Tx for IBD

Answer 22

helminths

LDN

Question 23

“Rebalance” for IBD

Answer 23

• Mindfulness-Based Interventions
• Stress Management
• Hypnotherapy
• Relaxation Training
• Acupuncture

Question 24

Risk factors for diverticular disease

Answer 24

Age • DD in patients younger than 50 years is a more virulent disease and is more
predominant in men
• Incidence increases steeply with age, beginning at age 40 years
Diet DD is associated with a history of low-fiber diet
Gender Incidence is more predominant in men before 65 years of age, and more
predominant in women after 65 years of age
Geography • Most common in industrialized nations
• Less common in Asian countries, where it tends to be right-sided
Medication use • Chronic NSAID use doubles the risk for DD and quadruples risk of perforation
• Opioids and corticosteroids increase risk of perforation
• Calcium channel blockers reduce risk of perforation
Obesity Striking increase in incidence among the obese, especially before age 40 years
Physical activity Risk of developing DD is inversely proportionate to activity level
Smoking Contradictory findings

Question 25

protective factors for diverticulitis

Answer 25

``` BMI 18-25 • Red meat <4/week • ≥ 23 g fiber/day • Exercise 2 hrs/week • No smoking ```

Question 26

diverticulitis Tx - with abx?

Answer 26

Omitting antibiotics in the treatment of uncomplicated acute diverticulitis did not result in more complicated diverticulitis, recurrent diverticulitis or sigmoid resections at long-term follow up.

Question 27

diverticulitis Diet

Answer 27

This systematic review and GRADE assessment conditionally recommend the use of liberalized diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. • It also strongly recommends a high dietary fiber diet aligning with dietary guidelines, with or without dietary fiber supplementation, after the acute episode has resolved

Question 28

diverticulitis Tx

Answer 28

fiber probiotics rifaximin Kefir and exercise, stress reduction

Question 29

DD and age

Answer 29

increased! DD in patients younger than 50 years is a more virulent disease and is more predominant in men • Incidence increases steeply with age, beginning at age 40 years Gender Incidence is more predominant in men before 65 years of age, and more predominant in women after 65 years of age Geography • Most common in industrialized nations • Less common in Asian countries, where it tends to be right-sided Medication use • Chronic NSAID use doubles the risk for DD and quadruples risk of perforation • Opioids and corticosteroids increase risk of perforation • Calcium channel blockers reduce risk of perforation Obesity Striking increase in incidence among the obese, especially before age 40 years Physical activity Risk of developing DD is inversely proportionate to activity level Smoking Contradictory findings

Question 30

DD and diet

Answer 30

associated with a history of low-fiber diet

Question 31

DD and age

Answer 31

increased! DD in patients younger than 50 years is a more virulent disease and is more predominant in men • Incidence increases steeply with age, beginning at age 40 years

Question 32

DD and geography

Answer 32

Most common in industrialized nations | • Less common in Asian countries, where it tends to be right-sided

Question 33

DD and meds

Answer 33

Chronic NSAID use doubles the risk for DD and quadruples risk of perforation • Opioids and corticosteroids increase risk of perforation • Calcium channel blockers reduce risk of perforation

Question 34

DD and obesity

Answer 34

Striking increase in incidence among the obese, especially before age 40 years

Question 35

DD and physical activity

Answer 35

Physical activity Risk of developing DD is inversely proportionate to activity level

Question 36

DD and smoking

Answer 36

Smoking Contradictory findings

Question 37

meds that increase IBD

Answer 37

ocp NSAIDs

Question 38

appy and tonsillectomy adn IBD

Answer 38

increase

Question 39

vit deficiency that can cause IBD

Answer 39

D

Question 40

IBD higher in urban or rural?

Answer 40

urban

Question 41

does H pylori infection increase or decrease IBD

Answer 41

decrease

Question 42

does smoking increase or decrease IBD

Answer 42

increase