GASTROENTEROLOGY ARTICLE OF THE WEEK
October 10, 2002
Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002;347:417-429.
1. Enviromental triggers for IBD
a. NSAID use may flare Crohn’s
b. Smoking decreases the risk of symptomatic Crohn’s
c. Smoking decreases the risk of symptomatic U.C.
d. Appendectomy reduces risk of U.C.
2. Epidemiology of IBD
a. first degree relatives have an absolute risk of 7% for development of IBD
b. Risk of developing IBD among first-degree relatives is 4 to 20 times higher
than the general population
c. Contribution of genetic predisposition is more important in ulcerative colitis
than Crohn’s disease
d. Probably a single gene is involved
e. NOD2, a gene within chromosome 16 may be linked to increased
predisposition to developing Crohn’s Disease
True or False
3. Maintenance therapy with 5-ASA is effective in maintaining remission in U.C. and Crohn’s Disease.
4. Methotrexate is effective in corticoscteroid-dependent Crohn’s disease and in maintaining remission of Crohn’s. It should be given by IM injection.
5. Corticosteroids are useful in maintaining remission in U.C.
6. Homozygotes for variant NOD2 have a 20-fold or higher risk for Crohn’s disease, most people with Crohn’s disease are homozygote for variant NOD2
7. Anti Saccharomyces cerevisiae Ab are present in >50% of Crohn’s patients; pANCA antibodies are present in >70% of U.C. patients.
8. Infliximab is a useful agent to treat refractory ulcerative colitis.
9. Oral budesonide is a useful alternative for patients with distal colonic disease who dislike the systemic effects of corticosteroids.
10. Cyclosporine may play a role in hospitalized patients with severe ulcerative colitis who have not responded as expected to 5-7 days of IV corticosteroids.
11. ASA preparations that deliver the ASA exclusively to the colon include
a. Pentasa (mesalamine)
b. Asacol (mesalamine)
c. Dipentum (olsalazine)
d. Colazal (balsalazide)
e. Sulfasalazine
12. Antibiotics in IBD
a. antibiotics are useful in treating refractory ulcerative colitis
b. metronidazole can control large bowel, but not small bowel, Crohn’s disease
c. ciprofloxacin is as effective as metronidazole in Crohn’s disease
d. low dose metronidazole is effective for perineal Crohn’s disease