• Compare and contrast the signs and symptoms of ulcerative colitis (UC) and Crohn’s disease (CD)
• Select an appropriate drug regimen for patients with CD or UC
• Utilize current treatment guidelines to develop a treatment plan for a patient case

• Inflammatory bowel disease (IBD)
• Crohn’s disease (CD)
• Ulcerative colitis (UC)
• Irritable Bowel Sydrome (IBS) is NOT a category of IBD

IBD Introduction

Crohn’s Disease

• Transmural inflammation (all layers)
• Affects any part of the GIT from mouth to anus
• Prevalence: 4-9 per 100K; Incidence: 20-50 per 100K (increasing)

IBD Introduction

Ulcerative Colitis

• Mucosal inflammation
• Confined mainly to rectum & colon
• Prevalence: 3-15 per 100K; Incidence: 80-120 per 100K (stable)

IBD Introduction

Age

• Can affect any age group
• Bimodal age of onset (peak incidence occurring in the 2^nd and 3^rd decades with a 2^nd peak between 60-80 years of age)

IBD Etiology

• Many Theories
• No Single Causative Factor
• Likely an Interplay of Many Things

IBD Etiology

Theories Include

• Psychosomatic
• Social
• Metabolic
• Vascular
• Genetic
• Allergic
• Autoimmune
• Immune-mediated factors

IBD Etiology

Likely an Interplay of

• Genetics
• Intestinal flora
• Environmental factors
• Immune response

IBD Etiology

Likely an Interplay of… Genetics

• NOD2/CARD15 variants associated with ileal CD (don't memorize)
• Several other genes are being identified

IBD Etiology

Likely an Interplay of… Intestinal flora

• Mycobacterium avium paratuberculosis and Escherichia coli
• Higher concentrations of flora in GI mucosa

IBD Etiology

Likely an Interplay of… Environmental factors

• IBD more common in N.America and Northern Europe (becoming more common in Asia-Pacific area recently)
• Smoking (protective effect for UC, worsens CD)

IBD Clinical signs and symptoms

• Diarrhea with or without rectal bleeding
• Abdominal tenderness or pain
• Weight loss
• UC more likely to present with 
• blood in stool, 
• rectal urgency, 
• or tenesmus (feel like you always need to pee)

Intestinal Complications

Crohn’s Disease

(6)

• Fissures, fistulas (a tract from the intestine to another location)
• Linear clefts
• Strictures --> obstruction
• Cobblestone appearance
• Skip lesions
• Intra-abdominal and perianal abscesses

Intestinal Complications

Ulcerative Colitis

(4)

• Crypt abscesses
• Continuous pattern of inflammation
• Toxic megacolon (more common with UC, but can occur with CD; 10% vs. 2.3%)
• Medical emergency, it can kill people

IBD Extra-intestinal Complications

(6)

• Related to systemic inflammation
• Joint-related complications
• Cutaneous manifestations
• Ocular inflammation
• Hepatic primary sclerosing cholangitis (PSC)
• Malabsorption

IBD Extra-intestinal Complications

Joint-related complications

• Ankylosing spondylitis
• Scroilitis (in hip)
• Peripheral arthritis of large or small joints

IBD Extra-intestinal Complications

Cutaneous manifestations

(3)

• Erythema nodosum
• Pyroderma gangrenosum
• Aphthous ulcers

IBD Extra-intestinal Complications

Hepatic primary sclerosing cholangitis (PSC)

(6)

• Progressive inflammation and destruction of bile ducts
• Fatigue, 
• itching, 
• jaundice
• Progress to ESLD, 
• transplant or death in 12-18 years

IBD Extra-intestinal Complications

Malabsorption

(4)

• Anemia
• Cholelithiasis (formation of gallstones)
• Nephrolithiasis
• Metabolic bone diasease

IBD Diagnosis

(4)

• Endoscopy and Imaging
• Imaging, scope, and biopsy can confirm diagnosis and differentiate between CD and UC
• Scopes
• Imaging (helpful to determine location of disease and intra-abdominal complications)

IBD Diagnosis

Scopes

(4)

• Upper endoscopy
• Colonoscopy
• Proctosigmoidoscopy
• Video-capsule endoscopy

IBD Diagnosis

Imaging (helpful to determine location of disease and intra-abdominal complications)

(3)

• Ultrasonography
• CT scan
• MRI

IBD

Determining Disease Activity

(4)

• Location –
• Guides choice of drug therapy (some formulations are active in only certain parts of the GIT)
• Severity
• Disease classification

Crohn's Disease 

Severity and Classification

(4)

• Crohn’s disease activity index (CDAI)
• 150-219: mild-moderate
• 220-450: mod-severe
• > 450: severe

Ulcerative Colitis

Severity and Classification

Big Slide

(6)

• Truelove and Witts Severity Index
• Mild: < 4 stools/day with or without blood; no systemic signs; normal ESR
• Moderate: > 4 stools/day; limited systemic signs
• Severe: > 6 bloody stools/day + systemic toxicity
• Anemia, fever, tachycardia, elevated ESR
• Fulminant disease: > 10 stools/day with continuous bleeding, abd tenderness/distension, colonic dilation, systemic toxicity

Ulcerative Colitis

Severity and Classification

Levels

(5)

• Truelove and Witts Severity Index
• Mild
• Moderate:
• Severe:
• Fulminant disease

Ulcerative Colitis

Severity and Classification

Mild

(3)

• < 4 stools/day with or without blood;
• no systemic signs;
• normal ESR

 FYI

Ulcerative Colitis

Severity and Classification

Moderate

(2)

• > 4 stools/day;
• limited systemic signs

Ulcerative Colitis

Severity and Classification

Severe

(5)

• > 6 bloody stools/day + systemic toxicity
• Anemia, 
• fever, 
• tachycardia, 
• elevated ESR

Ulcerative Colitis

Severity and Classification

Fulminant Disease

(5)

• > 10 stools/day with continuous bleeding, and 
• tenderness/distension, 
• colonic dilation, 
• systemic toxicity

FYI

Crohn's Disease Activity Index

(Picture needed)

IBD

Treatment Goals

Big Slide

(8)

• Induction and maintenance of remission (improve QoL)
• Secondary goals
• Reduce long-term use of corticosteroids
• Minimize risk of colorectal cancer
• If initial induction therapy works  maintenance; if it doesn’t, another approach is tried until symptoms are controlled
• Maintenance drugs should be tapered to the lowest effect dose to minimize adverse effects
• Mucosal healing (not universally applied in practice, difficult to confirm via scoring systems, but can be visualized via scope)
• Associated with lower complication rates, fewer hospitalizations, reduced need for surgery

IBD

Treatment Goals

Induction and maintenance of remission

(improve QoL)

(8)

• Secondary goals
• Reduce long-term use of corticosteroids
• Minimize risk of colorectal cancer
• If initial induction therapy works 
• --> maintenance; 
• If it doesn’t, 
• Another approach is tried until symptoms are controlled
• Maintenance drugs should be tapered to the lowest effect dose to minimize adverse effects

IBD

Treatment Goals

Secondary goals

(2)

• Reduce long-term use of corticosteroids
• Minimize risk of colorectal cancer

IBD

Treatment Goals

Mucosal healing 

(7)

• Not universally applied in practice,
• Difficult to confirm via scoring systems,
• But can be visualized via scope
• Associated with 
• lower complication rates, 
• fewer hospitalizations, 
• reduced need for surgery

IBD Treatment

Big Slide

(9)

• Aminosalicylates
• Corticosteroids
• Immunomodulators
• Thiopurines
• Other immunosuppressants (cyclosporine, tacrolimus, methotrexate)
• Biologics (Infliximab, adalimumab, certolizumab pegol, natalizumab)
• Antibiotics
• Adjuvant therapies (omega-3’s, probiotics, nicotine)
• Surgery

IBD Treatment

Drug Class Options

(7)

• Aminosalicylates
• Corticosteroids
• Immunomodulators
• Biologics 
• Antibiotics
• Adjuvant therapies
• Surgery

IBD Treatment

Options:  Immunomodulators

(5)

• Thiopurines
• Other immunosuppressants
• Cyclosporine,
• Tacrolimus,
• Methotrexate

IBD Treatment

Options:  Biologics

(4)

• Infliximab,
• Adalimumab,
• Certolizumab pegol,
• Natalizumab

IBD Treatment

Options:  Adjuvant therapies

(3)

• Omega-3’s,
• Probiotics,
• Nicotine

IBD Treatment

Aminosalicylates (anti-inflammatory)

Big Slide

(8)

• Sulfasalazine: combo of sufapyridine and mesalamine
• Associated with anemia secondary to reduced folate absorption (may administer with folic acid 1 mg po qday)
• Dose-related toxicities: nausea, vomiting, diarrhea, headache, arthralgias
• Idiosyncratic reactions: hepatotoxicity, bone marrow suppression, pancreatitis, pneumonitis, interstitial nephritis
• Mesalamine (better adverse effect profile than sulfasalazine)
• Multiple dosage forms (po, pr as suppositories and enemas), targeted delivery; can use multiple dosage forms in combination (topical + oral)
• Topical therapy results in a more rapid symptom response
• Exacerbation of colitis may occur in up to 4% of patients during initiation (may not be recognized in pts also receiving steroids)

IBD Treatment

Aminosalicylates (anti-inflammatory)

Overview

(6)

• Sulfasalazine
• Mesalamine
• Olsalazine
• Balsalazide
• Exacerbation of colitis may occur in up to 4% of patients during initiation 
• May not be recognized in pts also receiving steroids

IBD Treatment

Aminosalicylates (anti-inflammatory)

Sulfasalazine

(6)

• Combo of sufapyridine and mesalamine
• Associated with anemia secondary to reduced folate absorption
• may administer with folic acid 1 mg po qday
• Dose-related toxicities: 
• Idiosyncratic reactions: 
• Not primary choice for therapy due to amount of side effects

IBD Treatment

Aminosalicylates (anti-inflammatory)

Sulfasalazine: Dose Related Toxicities

(5)

• Nausea,
• Vomiting,
• Diarrhea,
• Headache,
• Arthralgias

IBD Treatment

Aminosalicylates (anti-inflammatory)

Sulfasalazine: Idiosyncratic Rxns

(5)

• Hepatotoxicity,
• Bone marrow suppression,
• Pancreatitis,
• Pneumonitis,
• Interstitial nephritis

IBD Treatment

Aminosalicylates (anti-inflammatory)

Mesalamine

(6)

• Better adverse effect profile than sulfasalazine
• Multiple dosage forms 
• Po, pr as suppositories and enemas, 
• targeted delivery; 
• can use multiple dosage forms in combination (topical + oral)
• Topical therapy results in a more rapid symptom response

IBD Treatment

Aminosalicylates Table

(doses are fyi)

IBD Treatment

Aminosalicylates:

Sulfasalazine Brand

Azulfidine

IBD Treatment

Aminosalicylates: Sulfasalazine

Azulfidine

(8)

• Formulation  
• Tablet,
• Induction dose
• EC tab1-1.5 g qid    
• Maintenance dose
• 500 mg tid-qid         
• Site of Action
• Colon

doses fyi 

IBD Treatment

Aminosalicylates: Mesalamine

Brands

(6)

• Canasa
• Rowasa
• Asacol
• Lialda
• Pentasa **
• Apriso

IBD Treatment

Aminosalicylates: Mesalamine

Canasa

(8)

• Formulation  
• Suppository
• Induction dose         
• 1 g qhs          
• Maintenance dose    
• 1 g qhs
• Site of Action
• Rectum

 doses fyi 

IBD Treatment

Aminosalicylates: Mesalamine

Rowasa

(8)

• Formulation  
• Enema           
• Induction dose         
• 4 g qhs
• Maintenance dose    
• 4 g qhs
• Site of Action
• Rectum, descending colon

doses fyi  

IBD Treatment

Aminosalicylates: Mesalamine

Asacol

(8)

• Formulation  
• Tablet
• Induction dose         
• 800-1600 mg TID
• Maintenance dose    
• 800 mg BID or 400 mg QID
• Site of Action
• Distal ileum, colon

doses fyi  

IBD Treatment

Aminosalicylates: Mesalamine

Lialda

(8)

• Formulation  
• Tablet
• Induction dose         
• 2.4-4.8 g/day
• Maintenance dose    
• 2.4 g/day
• Site of Action
• Distal ileum, colon

 doses fyi 

IBD Treatment

Aminosalicylates: Mesalamine

Pentasa**

(9)

• Formulation  
• Capsule
• Induction dose         
• 1 g qid
• Maintenance dose    
• 1 g qid
• Site of Action
• Small bowel, colon
• WORKS ALONG THE ENTIRE GUT

doses fyi  

IBD Treatment

Aminosalicylates: Mesalamine

Apriso

(8)

• Formulation  
• Capsule
• Induction dose         
• --
• Maintenance dose    
• 1.5 g q/day
• Site of Action
• Distal ileum, colon

doses fyi  

IBD Treatment

Aminosalicylates:

Olsalazine Brand

Dipentum

IBD Treatment

Aminosalicylates:

Dipentum

(9)

• Formulation  
• Capsule
• Induction dose         
• 1-3 g/day
• Maintenance dose    
• 500 mg bid
• Site of Action
• Colon
• Rarely used

doses fyi  

IBD Treatment

Aminosalicylates:

Balsalazide Brand

Colazal

IBD Treatment

Aminosalicylates:

Colazal

(9)

• Formulation  
• Capsule
• Induction dose         
• 2.25 g tid
• Maintenance dose    
• --
• Site of Action
• Colon
• Rarely used

doses fyi  

IBD Treatment

Corticosteroids

Overview

(6)

• Utilized for the induction of remission
• Acute adverse effects
• Chronic ADRs: 
• Inability to taper steroids is an indication for immunomodulator or biologic therapies
• Budesonide
• Topical Corticosteroids

IBD Treatment

Corticosteroids

Acute adverse effects

(5)

• Hyperglycemia
• Fluid retention
• Hypertension
• Insomnia
• Mood changes

IBD Treatment

Corticosteroids

Chronic ADRs:

(6)

• Osteoporosis,
• Thinning of skin,
• Cataracts,
• Weight gain,
• Fat redistribution
• NOT recommended for maintenance therapy

IBD Treatment

Corticosteroids

Budesonide

(6)

• Extensive first-pass metabolism, 10-15% systemic absorption
• Effects localized to GIT, with limited systemic toxicity
• 35% lower incidence of ADRs vs. other steroids
• Typically used 1st line alone or in combination with aminosalicylates for induction or maintenance of remission in mild-mod CD involving the ileum or ascending colon
• 2 week overlap when switching from po prednisone to budesonide
• New XR formulation, Uceris, has approval for UC

Less toxic 

IBD Treatment

Corticosteroids

Topical Corticosteroids

• Topical corticosteroids less effective than aminosalicylates for mild-mod UC
• Limited to descending colon and rectum
• Reserved for pts unresponsive to aminosalicylates

IBD Treatment

Corticosteroids

Table

IBD Treatment

Corticosteroids

Drugs and Brands

(11)

• Prednisone   
• Hydrocortisone         
• Solu-Cortef
• Cortenema
• Cortifoam
• Anusol-HC
• Methylprednisolone
• Solu-Medrol
• Budesonide   
• Entocort EC
• Uceris

IBD Treatment

Corticosteroids

Prednisone Table

IBD Treatment

Corticosteroids

Hydrocortisone Brands

(4)

• Solu-Cortef
• Cortenema
• Cortifoam
• Anusol-HC

IBD Treatment

Corticosteroids

Hydrocortisone: Solu-Cortef Table

IBD Treatment

Corticosteroids

Hydrocortisone: Cortenema Table

IBD Treatment

Corticosteroids

Hydrocortisone: Cortifoam Table

IBD Treatment

Corticosteroids

Hydrocortisone: Anusol-HC Table

IBD Treatment

Corticosteroids
Methylprednisone Brand

IBD Treatment

Corticosteroids
Methylprednisone: Solu-Medrol Table

IBD Treatment

Corticosteroids

Budesonide Brands Table

• Entocort EC
• Uceris

IBD Treatment

Corticosteroids

Budesonide: Entocort EC Table

IBD Treatment

Corticosteroids

Budesonide: Uceris Table

IBD Treatment

Immunomodulators

(10)

• Thiopurines inhibit purine synthesis --> 
• anti-proliferative effect 
• and induction of apoptosis in T-cells
• Used to maintain remission – 
• effects are delayed weeks to months
• Reserved for patients whose 
• disease has not responded to other therapies 
• or who are dependent on corticosteroids
• Used in combination with acute therapies
• These take some time to work

IBD Treatment

Immunomodulators

Thiopurines: Drugs

(2)

• Azathioprine
• And 6-mercaptopurine

IBD Treatment

Immunomodulators

Used in combination with acute therapies: Drugs

(3)

• Aminosalicylates,
• Corticosteroids,
• Biologics

IBD Treatment

Thiopurines ADRs

(2)

• Dose-Related
• Idiosyncratic

IBD Treatment

Thiopurines ADRs: Dose-Related

(6)

• Nausea
• Malaise
• Infections
• Hepatitis
• Myelosuppression
• Requires Monitoring

IBD Treatment

Thiopurines ADRs: Dose-Related

Myelosuppression Monitoring

(4)

• CBC
• Q wk x 1 mo,
• Q 2wk x 2 mo,
• Then q mo

IBD Treatment

Thiopurines ADRs: Idiosyncratic

(4)

• Fever
• Rash
• Arthralgias
• Pancreatitis

Thiopurines - TPMT

(4)

• Thiopurine S-methyltransferase (TPMT) – enzyme involved in the metabolism of the drug
• Polymorphisms in TPMT are common and affect the accumulation of toxic metabolites associated with myelosuppression and hepatotoxicity
• Genotypically or phenotypically assessed BEFORE initiating therapy
• Low to absent enzyme activity = highest risk of myelosuppression (avoid this med)

IBD Treatment

Other Immunomodulators: Drugs

(3)

• Cyclosporine infusions
• Tacrolimus
• Methotrexate

IBD Treatment

Other Immunomodulators: Cyclosporine Infusions

(7)

• Severe to fulminant UC unresponsive to 3-5 days of steroids
• ADRs: 
• nephrotoxicity, 
• neurotoxicity, 
• hypertension, 
• electrolyte abnormalities
• Monitor drug levels

IBD Treatment

Other Immunomodulators: Tacrolimus

(5)

• CD – fistulas and disease unresponsive to corticosteroids or infliximab; 
• not studied for maintenance therapy
• Fistula management
• ADRs similar to cyclosporine
• Monitor drug levels

IBD Treatment

Other Immunomodulators:

Methotrexate

• Induction and maintenance of remission in CD
• Steroid-sparing effect
• Not effective for UC
• ADRs: 
• hepatic fibrosis, 
• pneumonitis, 
• bone marrow suppression

IBD Treatment

Other Immunomodulators: Methotrexate
monitoring

• CBC, liver, renal function 
• on initiation 
• and q1-2 mo. during therapy
• CXR and PFTs 
• at baseline 
• and periodically thereafter

 Monitoring is important

IBD Treatment

Biologic Therapies Overview

Big Slide

(6)

• Infliximab (IV), adalimumab (SQ), certolizumab (SQ) target TNF-a (blocks inflammatory cascade)
• Indications
• Mod-severe CD refractory to other therapies
• Fistulas caused by CD (* Not many options)
• Natalizumab targets alpha 4 integrin (a molecule on leukocytes that mediates adhesion to endothelial receptors and migration into the intestine)
•  --> Last Line
• Reserved for CD pts who do not respond to, or tolerate, other therapies including pts who develop TNF-a antibodies
• Infliximab studied in combo with azathiopine for CD and UC

Very effective and expensive but there are lots of toxicities involved

IBD Treatment

Biologic Therapies Overview

Infliximab (IV), adalimumab (SQ), certolizumab (SQ

(4)

• Target TNF-a (blocks inflammatory cascade)
• Indications
• Mod-severe CD refractory to other therapies
• Fistulas caused by CD (*not many options)

IBD Treatment

Biologic Therapies Overview

Natalizumab

(6)

• Targets alpha 4 integrin 
• A molecule on leukocytes that mediates adhesion to endothelial receptors and migration into the intestine
• --> last line
• Reserved for CD pts who 
• Do not respond to, or tolerate, other therapies 
• Including pts who develop TNF-a antibodies

IBD Treatment

Biologic Therapies Overview

Infliximab

Studied in combo with azathiopine for CD and UC

IBD Treatment

Biologic Therapies: Infliximab
General

(9)

• 2 hour IV infusion
• Primary non-responders (up to 30%)
• Of those who do respond
• 30% become intolerant to the drug
• 40% experience infliximab-resistant disease within the first year (secondary non-responders)
• Infusion related rxns
• Secondary Non-responders
• Infusion related rxns
• Serum sickness

IBD Treatment

Biologic Therapies: Infliximab

Also indicated for:

(2)

• Mild-mod, extensive UC refractory to other therapies
• Severe UC without the need for immediate hospitalization

IBD Treatment

Biologic Therapies: Infliximab

Secondary non-responders

(8)

• If antibodies undetectable and low levels of drug present, 
• increase dosage to regain response 
• OR substitute another TNF-a antagonist 
• adalimumab, 
• certolizumab
• If antibodies are detected, 
• pts may still respond to adalimumab 
• or certolizumab but with a response rate 8-15% lower than that of pts who are naïve to biologic therapy

IBD Treatment

Biologic Therapies: Infliximab

Infusion-related reactions: Pre-Treat With

(3)

• APAP,
• Diphenhydramine,
• +/- corticosteroids

IBD Treatment

Biologic Therapies: Infliximab

Serum-sickness reactions

(2)

• May occur if infusions are separated by long periods rather than dosed on a scheduled basis
• Adherence is important!

IBD Treatment

Biologic Therapies: Infliximab

ADRs

(7)

• Lupus
• Hemolytic anemia
• Demyelinating syndrome (MS, optic neuritis, Guillaine-Barre syndrome)
• Hepatosplenic T-cell lymphoma (rare, but serious)
• Worsening heart failure (dose-related), all TNF-a inhibitors are contraindicated in pts with NYHA class III and IV HF (Bad heart failue, Don't use)
• Predispose patients to infection (all TNF-a inhibitors)
• Pre-screen for tuberculosis and hepatitis B and C

IBD Treatment

Biologic Therapies: Natalizumab

(6)

• Contraindicated with other immunosuppressants, TNF-a antagonists, and patients with underlying hepatic injury
• ADRs similar to TNF-a antagonists
• Progressive multifocal leukoencephalopathy (rare, but fatal ADR associated with use)
• Fatal viral disease characterized by progressive damage or inflammation of the white matter of the brain at multiple locations
• Restricted access TOUCH prescribing program
• So they can monitor more closely 

IBD Treatment

Antibiotics

• Metronidazole +/- ciprofloxacin
• Perianal CD
• Pouchitis – inflammation of the pouch created after colectomy in UC
• Mixed results for both CD and UC (alone and combo) (not routinely recommended)
• Rifaximin
• Augmentin
• Bactrim
• Tetracycline
• Treat toxic megacolon

IBD Treatment

Adjunctive Therapy

(7)

• Omega-3 fatty acids – studied, not effective
• Probiotics
• Based on animal studies
• Reduced bifidobacteria in CD
• Reduced lactobacilli in UC
• Study design for induction/maintenance limits application, likely safe? Theoretical r/o infection if given with immunosuppressants, but not clinically reported
• Transdermal nicotine – conflicting evidence for UC, may be helpful for attenuating disease exacerbation in pts who would like to quit smoking

IBD Treatment

Surgery

(5)

• Up to 1/3 of pts with CD require major abdominal surgery within 5 years of diagnosis
• Not curative for CD; used for active disease, associated with high recurrence of symptoms
• Colectomy in UC is curative
• But it can cause other complications
• Not many go to this

IBD Treatment

Surgery: Indications Overview in regards to curativeness

(4)

• Crohn’s Disease
• Not curative
• Ulcerative Colitis
• Colectomy-curative

IBD Treatment

Surgery Indications: Crohn’s Disease

(6)

• Intractable hemorrhage
• Perforation
• Obstruction
• Abscess
• GI cancer
• Disease refractory to medical therapy

IBD Treatment

Surgery Indications: Ulcerative Colitis

(6)

• Excessive hemorrhage
• Perforation
• Cancer
• Severe colitis
• Toxic megacolon
• Disease unresponsive to conventional medical therapy

IBD Treatment

Top-Down vs. Step-Up Treatment

Top-Down

(7)

• May be in future
  
• Early immunomodulator therapy or biologic agents
• Early aggressive interventions in CD may result in 
• early mucosal healing 
• & altered disease progression 
• potentially leading to reduced structural damage
• Requires further study

IBD Treatment

Top-Down vs. Step-Up Treatment

Step-Up

(3)

• What we do now
  
• Current practice guidelines
• Escalating approach to drug therapy

IBD

Health Maintenance Overview

• Colorectal cancer (CRC)
• Osteoporosis (10-14%)
• Vaccines
• VTE prophylaxis for those with acute illness admitted to the hospital

IBD

Health Maintenance

Colorectal Cancer

(8)

• Similar risk in UC (8%) and CD (7%) patients
• Risk factors: 
• family history, 
• extensive colitis, 
• long disease duration (10+ years), 
• presence of PSC --> 5x the risk of CRC in UC pts
• Routine screening recommended
• UC pts receiving at least 1.2 g mesalamine/d have a 77% lower risk of developing CRC

Diagrams at the endo the slides

Highlighted areas that need to be known

IBD

Treatment Goals

Overciew of the 2 main Goals

• Induction and maintenance of remission
• Improve QOL
• Mucosal healing
• Not universally applied in practice
• Difficult to confirm via scoring systems
• Can be visualized via