Define IBD
group of inflammatory conditions of the colon and small intestine
Major types of IBD
ulcerative colitis and Crohn's disease
ulcerative colitis characteristics
mucosal inflammation confined to the rectum and colon with superficial ulcerations
when UC is limited to the descending colon and rectum, it is called
distal disease and can be treated with topical (rectal) treatment
in UC, inflammation limited to the rectum is called
proctitis
characteristics of moderate UC
characterized by >4 stools/day with minimal signs of toxicity
characteristics of severe UC
≥ 6 bloody stools/day with evidence of toxicity (fever, tachycardia, anemia, elevated ESR)
characteristics of fulminant UC
>10 stools/day and severe symptoms (continuous bleeding, abdominal pain, distension)
characteristics of Crohn's disease
characterized by deep, transmural (through the bowel wall) inflammation that can affect any part of the GI tract
in Crohn's disease, what part of the GI tract like likely affected
ileum and colon
symptoms of Crohn's disease
chronic diarrhea (nocturnal), abdominal pain and weight loss
pattern of Crohn's disease
non-continuous, "cobblestone" appearance
pattern of UC
continuous
location of Crohn's disease
entire GI tract (especially ileum and colon)
location of UC
colon (especially the rectum)
depth of Crohn's disease
transmural
depth of UC
superficial
True or false. Fistulas/strictures are common in Crohn's disease.
True
True or false. Fistulas/strictures are common in UC.
False. They are uncommon
Smoking is a ____ for Crohn's disease
risk factor
Smoking is a ____ measure for UC
protective
How is IBD diagnosed
colonoscopy with tissue biopsy
What class of medications are used for maintenance therapy in most patients with distal UC or mild extensive disease
aminosalicylates
What medication is used for mild Crohn's disease
oral budesonide ≤ 3 months, after this course, discontinue treatment or change to thiopurine or methotrexate
What medications are used for moderate to severe Crohn's disease
anti-TNF agents (humira, remicade, cimzia), thiopurines, methotrexate, IL receptor antagonist (stelara)
What medications are used for refractory to standard treatment in Crohn's disease
Entyvio, Tysabri
What medication is used for mild UC
mesalamine (5-ASA) rectal and/or oral preferred
What medications are used for moderate to severe UC
anti-TNF agents (humira, remicade, simponi), thiopurines, cyclosporines, IL receptor antagonist (stelara)
What medications are used for refractory to standard treatment for UC
entyvio, xeljanz
Brand name for budesonide used for CD
Entocort EC
Brand name for budesonide used for UC
Uceris
How is budesonide metabolized
undergoes extensive first-pass metabolism, decreases systemic exposure than other oral steroids
Rectal steroids are indicated for
UC only
Brand name for hydrocortisone rectal
Cortenema, Cortifoam
Primary aminosalicylate used for UC
mesalamine
Sulfasalazine is used less commonly due to the
many side effects associated with the sulfapyridine component
Brand name for sulfasalazine
Azulfidine
Azathioprine is metabolized to
mercaptopurine
What test should be considered before starting azathioprine
TPMT genetic testing
Brand name for azathioprine
Azasan, Imuran
Brand name of ustekinumab
Stelara
MOA of Stelara
interleukin receptor antagonist that binds to and interferes with IL-12 and IL-23
Brand name of tofacitinib
Xeljanz
(can use in moderate-severe UC)
Brand name of ozanimod
Zeposia
MOA of Zeposia
sphingosine 1-phosphate receptor modulator that blocks lymphocytes from exiting the lymph nodes, reducing lymphocytes in the periphery
(can use in moderate-severe UC)
Brand name for natalizumab
Tysabri
(available through REMS)
Brand name of vedolizumab
Entyvio
Discontinue Entyvio and Tysabri is no benefit by
week 14