Inflammatory Bowel Diseases

Ashwin N. Ananthakrishnan MD, MPH, Assistant Professor of Medicine, Harvard Medical School; Director, Crohn’s and Colitis Center, Massachusetts General Hospital, Boston, MA, USA.Ramnik J. Xavier MD, Kurt Isselbacher Professor of Medicine, Harvard Medical School; Chief of Gastroenterology, Massachusetts General Hospital; Institute Member, Broad Institute of MIT and Harvard, Boston, MA, USA.Daniel K. Podolsky MD, President, University of Texas Southwestern Medical Center; Professor of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA.

“This is a valuable book that everybody taking care of IBD patients should have. It is very concise but at the same time very complete” Henrique Fernandez, MD, FACP, Parkview Medical Center on behalf of Doody’s

• Preface ixSection I Pathogenesis and Clinical Features 11 Epidemiology and Pathogenesis 3Clinical Take Home Messages 3Epidemiology 3Pathogenesis 6Genetics 6Microbiome 8Environmental Triggers 9Case Studies and Multiple Choice Questions 12References 13Answers to Questions 152 Clinical Features and Diagnosis of Crohn’s Disease 17Clinical Take Home Messages 17Clinical Features 19Disease Course and Natural History 20Diagnosis 21History and Physical Examination 21Laboratory Investigations 22Serologic Markers 23Endoscopy 23Histology 25Imaging Studies 25Case Studies and Multiple Choice Questions 27References 28Answers to Questions 313 Clinical Features and Diagnosis of Ulcerative Colitis 33Clinical Take Home Messages 33Clinical Features 34Disease Course and Natural History 35Diagnosis 35History and Physical Examination 36Laboratory Investigations 36Serologic Markers 37Endoscopy 37Histology 39Imaging Studies 40Differential Diagnosis (UC and CD) 40Case Studies and Multiple Choice Questions 44References 45Answers to Questions 474 Extraintestinal Manifestations of Inflammatory Bowel Diseases 49Clinical Take Home Messages 49Arthritis and Arthropathy 50Metabolic Bone Disease 51Cutaneous Manifestations 52Hepatobiliary Manifestations 53Ophthalmologic Manifestations 55Renal Complications 55Thromboembolic and Cardiovascular Complications 56Case Studies and Multiple Choice Questions 57References 58Answers to Questions 61Section II Therapeutic Agents 635 Aminosalicylates 65Clinical Take Home Messages 65Efficacy in Ulcerative Colitis 66Efficacy in Crohn’s Disease 68Safety 68Multiple Choice Questions 70References 71Answers to Questions 736 Corticosteroids 75Clinical Take Home Messages 75Efficacy in Ulcerative Colitis 76Efficacy in Crohn’s Disease 77Safety 78Case Studies and Multiple Choice Questions 80References 81Answers to Questions 837 Immunomodulators 85Clinical Take Home Messages 85Thiopurines 85Efficacy in Ulcerative Colitis 87Efficacy in Crohn’s Disease 88Safety 89Methotrexate 90Efficacy in Ulcerative Colitis 90Efficacy in Crohn’s Disease 91Safety 91Calcineurin Inhibitors 91Efficacy in Ulcerative Colitis 91Efficacy in Crohn’s Disease 93Case Studies and Multiple Choice Questions 94References 95Answers to Questions 998 Biologic Therapies 101Clinical Take Home Messages 101Infliximab 102Efficacy in Ulcerative Colitis 102Efficacy in Crohn’s Disease 105Safety 108Adalimumab 110Efficacy in Ulcerative Colitis 110Efficacy in Crohn’s Disease 111Certolizumab Pegol 112Efficacy in Crohn’s Disease 113Newer Therapies 115Case Studies and Multiple Choice Questions 116References 117Answers to Questions 1219 Antibiotics 123Clinical Take Home Messages 123Efficacy in Ulcerative Colitis 123Efficacy in Crohn’s Disease 124Other Microbial Modification Methods – Probiotics and Fecal Microbiota Transplantation 125Multiple Choice Questions 126References 127Answers to Questions 129Section III Management 13110 Medical Management of Ulcerative Colitis 133Clinical Take Home Messages 133Assessment of Extent, Activity, and Severity 133Limited Colitis – Proctitis, Proctosigmoiditis, and Left‐sided Colitis 135Pancolitis 136Mild to Moderate Disease 137Moderate to Severe Disease 138Severe Disease 140Case Studies and Multiple Choice Questions 142References 144Answers to Questions 14611 Medical Management of Crohn’s Disease 149Clinical Take Home Messages 149Mild to Moderate Disease 150Moderate to Severe Disease 151Case Studies and Multiple Choice Questions 154References 156Answers to Questions 15712 Surgical Management of Inflammatory Bowel Diseases 159Clinical Take Home Messages 159Surgery for Ulcerative Colitis 159Pouch‐related Complications in Ulcerative Colitis 161Surgery for Crohn’s Disease 163Prophylaxis for Prevention of Postoperative Recurrence in Crohn’s Disease 164Case Studies and Multiple Choice Questions 167References 168Recommended Reading 169Answers to Questions 17013 Complications of Inflammatory Bowel Diseases 171Clinical Take Home Messages 171Complications of Ulcerative Colitis 172Toxic Megacolon and Perforation 172Colonic Strictures 173Clostridium difficile and Cytomegalovirus Colitis 173Colorectal Dysplasia and Cancer 174Magnitude and Risk Factors 174Surveillance for Dysplasia and Cancer 175Management of Dysplasia 175Chemoprevention 176Complications of Crohn’s Disease 176Fibrostenosis and Strictures 176Abscesses 177Fistulizing Crohn’s Disease 178Small‐bowel Cancer 181Case Studies and Multiple Choice Questions 182References 184Answers to Questions 187Section IV Special Considerations 18914 Nutrition in Inflammatory Bowel Diseases 191Clinical Take Home Messages 191Malnutrition and Micronutrient Deficiencies 191Dietary Therapies for Inflammatory Bowel Diseases 193Case Studies and Multiple Choice Questions 194References 195Answers to Questions 19715 Pregnancy, Conception, and Childbirth 199 Clinical Take Home Messages 199Fertility 199Effect of Pregnancy on Disease 200Effect of Disease on Pregnancy 200Maternal Medication Use During Pregnancy 201Paternal Medication Use 203Inheritance 203Case Studies and Multiple Choice Questions 204References 205Answers to Questions 20716 Inflammatory Bowel Disease During Childhood and Adolescence 209Clinical Take Home Messages 209Epidemiology and Clinical Features 209Treatment of Pediatric Inflammatory Bowel Disease 210Very Early‐onset Inflammatory Bowel Disease 211Transition of Care in Pediatric Crohn’s Disease 211Case Studies and Multiple Choice Questions 213References 214Answers to Questions 216Index 217