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