Inflammatory Bowel Disease (IBD)
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Questions and Answers

What is the primary characteristic of Irritable Bowel Syndrome (IBS)?

  • A chronic inflammatory condition of the bowel.
  • Always associated with rectal bleeding.
  • A functional GI disorder with altered bowel habits and no significant structural inflammation. (correct)
  • Exclusively an allergic response to dairy products.

Which management strategies are commonly used for Irritable Bowel Syndrome (IBS)?

  • Radical bowel surgery.
  • Low FODMAP diet and antispasmodics. (correct)
  • Biologic therapy.
  • High-dose steroids.

What is Orofacial Granulomatosis (OFG)?

  • Exclusively a viral infection of the gums.
  • Unrelated to any immune factors.
  • A granulomatous condition affecting orofacial tissues, sometimes mimicking Crohn’s in the mouth. (correct)
  • A fungal disease of the sinuses.

Which of the following might be included in a typical treatment approach for Orofacial Granulomatosis (OFG)?

<p>Removal of dietary triggers, topical/systemic steroids, or immunosuppressants. (C)</p> Signup and view all the answers

What is Sarcoidosis?

<p>A multisystem granulomatous disorder often involving lungs and lymph nodes. (A)</p> Signup and view all the answers

What is a common treatment for symptomatic sarcoidosis?

<p>Steroids (e.g., prednisolone). (B)</p> Signup and view all the answers

How does erythema nodosum typically manifest?

<p>Tender red nodules on the shins. (D)</p> Signup and view all the answers

Which conditions can be associated with erythema nodosum?

<p>IBD (Crohn’s/UC), infections, or unknown triggers. (C)</p> Signup and view all the answers

Which of the following statements best describes pyoderma gangrenosum?

<p>A rare neutrophilic skin ulcer often linked to IBD. (A)</p> Signup and view all the answers

A patient presents with Gastro-Oesophageal Reflux Disease (GORD). Initial management should include what?

<p>Lifestyle changes (weight loss, dietary modification) and proton pump inhibitors. (B)</p> Signup and view all the answers

How do proton pump inhibitors (PPIs) like omeprazole reduce gastric acid secretion?

<p>By blocking the H⁺/K⁺-ATPase in gastric parietal cells. (B)</p> Signup and view all the answers

What constitutes standard triple therapy for Helicobacter pylori infection?

<p>PPI + clarithromycin + amoxicillin/metronidazole. (B)</p> Signup and view all the answers

For which condition are anti-diarrheal or anti-spasmodic agents most commonly prescribed?

<p>Symptomatic relief in IBS or mild IBD. (B)</p> Signup and view all the answers

What is the PRIMARY utility of faecal calprotectin testing in gastroenterology?

<p>Differentiating IBD from IBS by measuring intestinal inflammation. (C)</p> Signup and view all the answers

The Urea Breath Test is the primary diagnostic tool for which gastrointestinal condition?

<p>Helicobacter pylori infection. (D)</p> Signup and view all the answers

A jejunal (small intestine) biopsy that shows villous atrophy is most indicative of:

<p>Coeliac disease. (C)</p> Signup and view all the answers

Which lifestyle factor presents a paradoxical effect, potentially worsening Crohn’s disease but offering slight relief in ulcerative colitis?

<p>Smoking. (B)</p> Signup and view all the answers

What is a cornerstone of peptic ulcer disease prevention?

<p>Avoiding unnecessary NSAIDs and addressing H.pylori infection. (B)</p> Signup and view all the answers

What is a primary recommendation for GORD (Gastro-Oesophageal Reflux Disease) prevention?

<p>Elevate the head of the bed and lose weight if obese. (D)</p> Signup and view all the answers

In the context of Gastrointestinal health, which diagnostic approach offers the MOST comprehensive assessment of small intestinal pathology, surpassing conventional endoscopy and imaging techniques?

<p>Wireless capsule endoscopy (PillCam). (D)</p> Signup and view all the answers

Which of the following options BEST describes Inflammatory Bowel Disease (IBD)?

<p>A group of chronic inflammatory disorders of the gastrointestinal (GI) tract, mainly ulcerative colitis and Crohn’s disease. (A)</p> Signup and view all the answers

Key factors implicated in the development of IBD include which of the following?

<p>Multifactorial causes including genetic predisposition, immune dysregulation, environmental factors, and alterations in the gut microbiome. (C)</p> Signup and view all the answers

Which of the following represents a cornerstone of IBD therapy for moderate-to-severe cases that are not adequately controlled by basic measures?

<p>Biologics (e.g., infliximab) targeting specific inflammatory mediators. (D)</p> Signup and view all the answers

What are the key characteristics of ulcerative colitis?

<p>Mucosal inflammation limited to the colon and rectum with continuous lesions. (A)</p> Signup and view all the answers

Which of the following is a typical symptom of ulcerative colitis?

<p>Bloody diarrhea. (A)</p> Signup and view all the answers

Which treatment is most commonly used for acute flares of ulcerative colitis?

<p>5-ASA derivatives (e.g., sulfasalazine) or steroids to reduce inflammation. (C)</p> Signup and view all the answers

Crohn’s disease can affect which part(s) of the gastrointestinal tract?

<p>Any part of the GI tract, often with &quot;skip lesions&quot;. (C)</p> Signup and view all the answers

What effect does smoking have on Crohn’s disease?

<p>It tends to worsen the disease and increase the risk of flares and complications. (A)</p> Signup and view all the answers

Why is surgical removal of affected bowel segments NOT considered a curative approach for Crohn’s disease, unlike in some cases of ulcerative colitis?

<p>Disease often reappears in other segments of the bowel due to its transmural and discontinuous nature. (B)</p> Signup and view all the answers

A patient presents with chronic abdominal pain, bloating, and altered bowel habits (both diarrhea and constipation) but no visible signs of inflammation or structural abnormalities in the gastrointestinal tract. Which condition is MOST likely?

<p>Irritable Bowel Syndrome (IBS). (B)</p> Signup and view all the answers

What is the mechanism of action for Proton Pump Inhibitors (PPIs) like omeprazole?

<p>Blocking the H⁺/K⁺-ATPase in gastric parietal cells to reduce acid secretion. (B)</p> Signup and view all the answers

Standard triple therapy for Helicobacter pylori infection includes which combination of medications?

<p>A proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole. (C)</p> Signup and view all the answers

For what purpose are anti-diarrheal or anti-spasmodic agents MOST commonly prescribed in the context of gastrointestinal disorders?

<p>To provide symptomatic relief in Irritable Bowel Syndrome (IBS) or mild Inflammatory Bowel Disease (IBD). (D)</p> Signup and view all the answers

A patient presents with gastrointestinal symptoms, and a faecal calprotectin test is ordered. Which of the following BEST describes the primary utility of this test?

<p>To differentiate between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS) by measuring the level of intestinal inflammation. (C)</p> Signup and view all the answers

Which of the following statements accurately describes the paradoxical effect of smoking on Inflammatory Bowel Disease (IBD)?

<p>Smoking can worsen Crohn’s disease but may offer slight relief in ulcerative colitis, although it is not recommended due to overall health risks. (C)</p> Signup and view all the answers

Which of the following best characterizes the inflammation pattern seen in Ulcerative Colitis?

<p>Continuous inflammation typically starting in the rectum and extending proximally in the colon. (D)</p> Signup and view all the answers

What is the primary mechanism by which biologics like infliximab are thought to help in IBD?

<p>Neutralizing inflammatory mediators, such as TNF-alpha. (C)</p> Signup and view all the answers

A patient newly diagnosed with Crohn's disease asks about the long-term impact of smoking on their condition. What is the MOST accurate response?

<p>Smoking typically worsens Crohn's disease and increases the risk of flares and complications. (B)</p> Signup and view all the answers

Which of the following is LEAST likely etiology of Inflammatory Bowel Disease (IBD)?

<p>Specific, singular bacterial infection. (A)</p> Signup and view all the answers

In a patient experiencing a flare-up of ulcerative colitis, which of the following would be the MOST appropriate initial treatment?

<p>Topical or systemic corticosteroids. (A)</p> Signup and view all the answers

Why is it generally accepted that surgery is often not a curative option for Crohn's Disease compared to Ulcerative Colitis?

<p>The transmural nature and potential for 'skip lesions' in Crohn's disease mean the disease can recur in other parts of the GI tract even after resection. (C)</p> Signup and view all the answers

A 30-year-old patient with a history of Crohn's disease presents with new-onset perianal fistulas and is currently on a stable dose of aminosalicylates. Which of the following would be the MOST appropriate next step in management?

<p>Start a biologic agent (e.g., anti-TNF therapy) or an immunomodulator (e.g., azathioprine). (C)</p> Signup and view all the answers

In the context of IBD management, imagine a hypothetical scenario where researchers discover a novel gene, 'GutShield,' responsible for maintaining intestinal barrier integrity and regulating immune responses to commensal bacteria. Individuals with a homozygous recessive mutation in 'GutShield' exhibit severe, early-onset IBD, refractory to conventional therapies. Which of the following experimental approaches would MOST directly address the underlying genetic defect to restore normal immune function and intestinal homeostasis?

<p>Developing a gene therapy strategy to introduce a functional 'GutShield' gene into the patient's intestinal cells or hematopoietic stem cells. (D)</p> Signup and view all the answers

What is the underlying cause of villous atrophy in coeliac disease?

<p>Autoimmune reaction triggered by gluten (D)</p> Signup and view all the answers

What is the role of 5-ASA compounds like sulphasalazine in managing ulcerative colitis?

<p>Inducing remission and maintaining it in mild/moderate cases (A)</p> Signup and view all the answers

In severe or steroid-dependent Inflammatory Bowel Disease (IBD), what is the primary reason for adding immunosuppressants like azathioprine to the treatment plan?

<p>To control inflammation and reduce dependence on steroids (B)</p> Signup and view all the answers

Why is metronidazole used in Crohn’s disease, particularly when perianal disease or abscesses are present?

<p>It targets anaerobic bacteria often involved in perianal infections and abscesses. (B)</p> Signup and view all the answers

What is the primary mechanism by which biologic agents like infliximab and adalimumab work in treating Inflammatory Bowel Disease (IBD)?

<p>They block specific inflammatory mediators, such as TNF-α. (A)</p> Signup and view all the answers

In the context of proctocolitis, which diagnostic method is MOST likely to be used to determine the etiology and severity of the inflammation?

<p>Colonoscopy with biopsy (A)</p> Signup and view all the answers

What is the MOST SPECIFIC pathological feature that differentiates Crohn’s disease from ulcerative colitis?

<p>Transmural inflammation with granulomas (A)</p> Signup and view all the answers

Which of these factors is LEAST likely to trigger or exacerbate orofacial granulomatosis (OFG)?

<p>Gingivitis (D)</p> Signup and view all the answers

If a patient with erythema nodosum is suspected to have underlying sarcoidosis, which additional test would be MOST appropriate to order initially?

<p>Chest X-ray (B)</p> Signup and view all the answers

In a patient presenting with symptoms suggestive of Gastro-Oesophageal Reflux Disease (GORD), but who has failed to respond to a 4-week trial of a PPI, what would be the MOST appropriate next step in management?

<p>Refer for upper endoscopy (A)</p> Signup and view all the answers

A patient presents with suspected peptic ulcer disease. After performing an endoscopy, biopsies are taken. Histological analysis reveals the presence of Helicobacter pylori. What is the PRIMARY treatment goal at this stage?

<p>Eradicating the bacterial infection (A)</p> Signup and view all the answers

A 35-year-old patient is diagnosed with coeliac disease. Besides adhering to a strict gluten-free diet, what other nutritional deficiency is MOST likely to require monitoring and potential supplementation?

<p>Vitamin B12 and iron (D)</p> Signup and view all the answers

Which of the following is the MOST accurate statement regarding the extraintestinal manifestations of Inflammatory Bowel Disease (IBD)?

<p>They can affect various organs and may sometimes precede bowel symptoms (C)</p> Signup and view all the answers

Consider a patient with longstanding Crohn's disease who has developed a fibrostenotic stricture in the ileum causing recurrent partial bowel obstructions. What is the MOST appropriate next step in management if medical therapies have failed to provide adequate relief?

<p>Perform endoscopic balloon dilation or surgical resection (B)</p> Signup and view all the answers

A patient with Ulcerative Colitis who is being treated with infliximab presents to the clinic with a persistent cough, shortness of breath, and a fever. Which opportunistic infection is MOST critical to exclude in this patient, given their immunosuppressed state?

<p><em>Pneumocystis jirovecii</em> pneumonia (PCP) (C)</p> Signup and view all the answers

Flashcards

Inflammatory Bowel Disease (IBD)

A group of chronic inflammatory conditions affecting the GI tract, primarily ulcerative colitis and Crohn’s disease.

IBD Development Factors

Development involves genetic predisposition, immune system issues, environmental factors, and changes in the gut microbiome.

IBD Therapy (Moderate-to-Severe)

Therapy includes biologics that target inflammatory mediators.

Ulcerative Colitis

Inflammation limited to the colon and rectum with continuous lesions.

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Ulcerative Colitis Symptom

A typical symptom is bloody diarrhea.

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Ulcerative Colitis Flare Treatment

Treatments commonly used include 5-ASA derivatives or steroids.

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Crohn’s Disease

Can affect any part of the GI tract, often with "skip lesions".

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Smoking and Crohn’s Disease

Smoking tends to worsen the disease.

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Surgery & Crohn's Disease

Disease often reappears in other segments of the bowel.

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Irritable Bowel Syndrome (IBS)

A functional bowel disorder without structural changes.

Signup and view all the flashcards

IBS Management Strategies

Dietary changes (low FODMAP) and antispasmodic medications to manage symptoms.

Signup and view all the flashcards

Orofacial Granulomatosis (OFG)

A granulomatous condition affecting orofacial tissues, sometimes mimicking Crohn’s disease in the mouth.

Signup and view all the flashcards

OFG Treatment

Removal of dietary triggers, topical/systemic steroids, or immunosuppressants.

Signup and view all the flashcards

Sarcoidosis

A multisystem granulomatous disorder often involving lungs and lymph nodes.

Signup and view all the flashcards

Sarcoidosis Treatment

Steroids (e.g., prednisolone)

Signup and view all the flashcards

Erythema Nodosum

Tender red nodules typically found on the shins.

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Erythema Nodosum Associations

IBD (Crohn’s/UC), infections, or unknown triggers.

Signup and view all the flashcards

Pyoderma Gangrenosum

A rare neutrophilic skin ulcer often linked to IBD.

Signup and view all the flashcards

Pyoderma Gangrenosum Treatment

Local and systemic immunosuppression (e.g., steroids, immunosuppressants).

Signup and view all the flashcards

How PPIs Work

Blocks the H+/K+-ATPase in gastric parietal cells, reducing acid secretion.

Signup and view all the flashcards

H. pylori Triple Therapy

PPI + clarithromycin + amoxicillin/metronidazole

Signup and view all the flashcards

Anti-diarrheals/Spasmodics

Provide symptomatic relief in IBS or mild IBD.

Signup and view all the flashcards

Fecal Calprotectin Test

Differentiates IBD from IBS by measuring intestinal inflammation.

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Urea Breath Test Use

Diagnose Helicobacter pylori infection.

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Jejunal Biopsy Finding

Key to diagnosing Coeliac disease.

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Smoking Effect on IBD

Can worsen Crohn’s disease, might slightly help ulcerative colitis.

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Peptic Ulcer Prevention

Avoiding unnecessary NSAIDs and addressing H.pylori infection.

Signup and view all the flashcards

GORD Prevention Advice

Elevate the head of the bed and lose weight if obese.

Signup and view all the flashcards

Why do Faecal calprotectin testing?

To screen for coeliac disease.

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Key factors implicated in IBD

Multifactorial causes (genetic predisposition, immune dysregulation, environment, gut microbiome)

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Cornerstone of IBD therapy

Biologics (e.g., infliximab) targeting inflammatory mediators

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Ulcerative colitis is characterized by

Mucosal inflammation limited to the colon/rectum with continuous lesions

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A typical symptom of ulcerative colitis

Bloody diarrhoea

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Treatments for ulcerative colitis flares

5-ASA derivatives (e.g., sulphasalazine) or steroids

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Crohn’s disease can affect

Any part of the GI tract, often with “skip lesions”

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Smoking effect on Crohn’s disease

It tends to worsen the disease

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Common IBS strategies

Low FODMAP diet and antispasmodics

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Typical OFG treatment

Removal of dietary triggers, topical/systemic steroids, or immunosuppressants.

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Symptomatic sarcoidosis treament

Steroids (e.g., prednisolone)

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Erythema nodosum presentation

Tender red nodules on the shins.

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Proctocolitis refers to...

The rectum and colon.

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Causes of Proctocolitis

Radiation, infections, ulcerative colitis, Crohn’s

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GORD presentation

Heartburn due to acid reflux and possible oesophagitis.

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Initial GORD treatment

Lifestyle changes (weight loss, dietary modification) and proton pump inhibitors.

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Peptic ulcer location

The stomach or duodenum.

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Study Notes

Inflammatory Bowel Disease (IBD)

  • IBD is a group of chronic inflammatory disorders affecting the GI tract, mainly ulcerative colitis and Crohn’s disease.
  • Key factors implicated in IBD development are multifactorial: genetic predisposition, immune dysregulation, environmental factors, and gut microbiome.
  • Biologics (e.g., infliximab) targeting inflammatory mediators are a cornerstone of IBD therapy for moderate-to-severe cases not controlled by basic measures.

Ulcerative Colitis

  • Ulcerative colitis is characterized by mucosal inflammation limited to the colon/rectum with continuous lesions.
  • A typical symptom of ulcerative colitis is bloody diarrhoea.
  • 5-ASA derivatives (e.g., sulphasalazine) or steroids are commonly used treatments for ulcerative colitis flares.

Crohn’s Disease

  • Crohn’s disease can affect any part of the GI tract, often with “skip lesions.”
  • Smoking tends to worsen Crohn’s disease.
  • Surgery is not curative for Crohn’s disease because the disease often reappears in other segments of the bowel.

Irritable Bowel Syndrome (IBS)

  • Irritable Bowel Syndrome (IBS) is primarily a functional GI disorder with altered bowel habits and no significant structural inflammation.
  • Common management strategies for IBS include a low FODMAP diet and antispasmodics.

Orofacial Granulomatosis (OFG)

  • Orofacial granulomatosis (OFG) is a granulomatous condition affecting orofacial tissues, sometimes mimicking Crohn’s in the mouth.
  • A typical treatment approach for OFG might include removal of dietary triggers, topical/systemic steroids, or immunosuppressants.

Sarcoidosis

  • Sarcoidosis is a multisystem granulomatous disorder often involving the lungs and lymph nodes.
  • In symptomatic sarcoidosis, the mainstay of treatment is often steroids (e.g., prednisolone).

Erythema Nodosum

  • Erythema Nodosum commonly presents as tender red nodules on the shins.
  • IBD (Crohn’s/UC), infections, or unknown triggers can be associated with erythema nodosum.

Pyoderma Gangrenosum

  • Pyoderma gangrenosum is a rare neutrophilic skin ulcer often linked to IBD.
  • Treatment of pyoderma gangrenosum typically involves local and systemic immunosuppression (e.g., steroids, immunosuppressants).

Proctocolitis

  • Proctocolitis refers to inflammation of the rectum and colon.
  • Causes of proctocolitis include radiation, infections, ulcerative colitis, and Crohn’s disease.

Gastro-Oesophageal Reflux Disease (GORD)

  • Gastro-oesophageal reflux disease (GORD) most commonly presents with heartburn due to acid reflux and possible oesophagitis.
  • A key initial treatment for GORD is lifestyle changes (weight loss, dietary modification) and proton pump inhibitors.

Peptic Ulcer Disease

  • Peptic ulcer disease involves ulceration typically in the stomach or duodenum.
  • Common causes of peptic ulcers include Helicobacter pylori infection, NSAIDs, alcohol, and smoking.
  • Eradication therapy for H. pylori–related peptic ulcer usually involves triple therapy (PPI + two antibiotics).

Helicobacter Pylori Infection

  • Helicobacter pylori is a bacterium that colonizes the stomach and is linked to gastritis and peptic ulcers.
  • Preventive measures against H. pylori infection include good hygiene practices and possibly screening in high-risk areas.

Coeliac Disease

  • Coeliac disease is an autoimmune disorder triggered by gluten, causing small bowel villous atrophy.
  • The mainstay of treatment for coeliac disease is a lifelong gluten-free diet.

Drug/Treatment Questions

  • Prednisolone (a corticosteroid) is commonly used short-term to control acute IBD flares.
  • 5-ASA compounds (e.g., sulphasalazine) are primarily used for mild/moderate ulcerative colitis.
  • In more severe or steroid-dependent IBD, immunosuppressants (e.g., azathioprine) are commonly added
  • Metronidazole is an antibiotic especially used in Crohn’s disease when there is perianal disease or abscesses (anaerobic infection).
  • Biologic agents (infliximab, adalimumab) work by blocking TNF-α or other specific inflammatory mediators.
  • Proton Pump Inhibitors (PPIs) such as omeprazole act by blocking the H⁺/K⁺-ATPase in gastric parietal cells to reduce acid secretion.
  • Standard triple therapy for H. pylori infection includes PPI + clarithromycin + amoxicillin/metronidazole.
  • Anti-diarrheal or anti-spasmodic agents are typically used for symptomatic relief in IBS or mild IBD.

Diagnostic/Investigation Questions

  • Faecal calprotectin testing is used to differentiate IBD from IBS by measuring intestinal inflammation.
  • The Urea Breath Test is primarily used to diagnose Helicobacter pylori infection.
  • A jejunal biopsy confirming villous atrophy is key to diagnosing coeliac disease.

Optional Bonus Questions (Prevention & Other Aspects)

  • Smoking can worsen Crohn’s disease but might slightly help ulcerative colitis.
  • In peptic ulcer disease, a key prevention strategy is avoiding unnecessary NSAIDs and addressing H. pylori infection.
  • For GORD prevention, patients are often advised to elevate the head of the bed and lose weight if obese.

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Overview of Inflammatory Bowel Disease (IBD), including ulcerative colitis and Crohn’s disease. Key factors include genetic predisposition, immune dysregulation, environmental factors. Biologics are a cornerstone of IBD therapy.

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