Step-Up vs. Top-Down Approach in Crohn’s Disease
Fig. 48.1 Inflammation (left panel) and fibrostenosis (right panel) The progression from early to late disease is accompanied by a change in mucosal cytokine profiles. Early CD is characterized by…
Surgical Management of Crohn’s Disease and Ulcerative Colitis
Fig. 50.1 CT image of isolated small bowel Crohn’s disease (arrows). This image clearly demonstrates the segmental nature CD and the hyper-enhancement of the mesenteric blood vessels and thickened bowel…
Environmental Factors in the Epidemiology of Inflammatory Bowel Disease
Possible causes for change over time • Before 1970 – Retrospective data – Hospital based – Cross-sectional studies – Unclear definitions – Pre-endoscopic period • After 1970 – Early endoscopic period – Defined populations – Prospective registration – GP/hospital based • After…
Extraintestinal Manifestations: Autoimmune Hepatitis
Gender Female +2 HLA DR3 or DR4 +1 AP:AST (or ALT) ratio >3 <1.5 −2 +2 Immune disease Thyroiditis, colitis, others +2 γ-Globulin or IgG level above normal >2.0 1.5–2.0…
Optimal Management of Fistulizing Crohn’s Disease
Induction Maintenance Minimal evidence Investigational No role IFX or ADA IFX or ADA CZP Spherical carbon adsorbent Steroids aAntibiotics b6-MP Tacrolimus Stem cells Aminosalicylates – bAZA Cyclosporine – – –…
Sulfasalazine and 5-Aminosalicylates for Ulcerative Colitis
Fig. 38.1 Chemical structures of sulfasalazine and 5-ASA derivatives [2, 3] Mechanism of Action Sulfasalazine has been suggested to exert its clinical effects through anti-inflammatory, immunosuppressive, and bacteriostatic mechanisms. Downregulation…
Objective Assessment of Endoscopic Disease Activity and Mucosal Healing
Benefits of mucosal healing Unresolved issues of mucosal healing Decreased clinical relapse How much mucosal healing is required to impact outcomes? Decreased hospitalizations Can mucosal healing be achieved in most…
Biologic Therapy of Ulcerative Colitis: Natalizumab, Vedolizumab, Etrolizumab (rHUMab Beta 7), Anti-MAdCAM
Fig. 45.1 Tc-99 m HMPAO WBC scintigraphy in a patient with ulcerative colitis (left) whole-body image and (right) a detail of the abdomen. Rapid migration of lymphocytes from the peripheral…
Management and Prevention of Infectious Diseases in IBD Patients
Drug Risk of Infection Comments Corticosteroids • Serious infections OR 2.21 (1.46–3.34) from TREAT registry of Crohn’s disease patients [7, 19] • Independently associated with serious infections [28] • Infections reported: fungal [10],…
Leukocytapheresis Therapy of Inflammatory Bowel Disease
Fig. 49.1 Scanning electron photomicrographs of carriers that have adsorbed leukocytes during leukocytapheresis. (a) The Adacolumn is filled with cellulose acetate beads as leukocytapheresis carriers that selectively adsorb granulocytes, monocytes/macrophages,…
