Pharmacotherapy for Inflammatory Bowel Disease Quiz

Inflammatory Bowel Disease (IBD)

• IBD is a chronic GI condition characterized by inflammation of the gut, including Ulcerative Colitis (UC) and Crohn's Disease (CD)
• UC is a type of IBD characterized by chronic inflammation of the colon

Ulcerative Colitis (UC)

• Definition: UC is a chronic inflammation of the colon, characterized by rectal bleeding, diarrhea, and abdominal pain
• Epidemiology:
  • Prevalence: 10% worldwide among adults
  • More predominant in younger patients and women
• Pathophysiology:
  • Results from altered somatovisceral and motor dysfunction of the intestine
  • Abnormal CNS processing of afferent signals may lead to visceral hypersensitivity
  • Factors contributing to alterations include genetics, motility, inflammation, colonic infections, mechanical irritation, stress, and psychological factors

Treatment of UC

• Treatment is based on:
  • Type of UC (UC vs CD)
  • Severity (Mild, Moderate, Severe, Fulminant)
  • Site of disease (Proctitis, Distal disease, Extensive disease, Small intestine involvement)
  • Need for acute treatment or maintenance therapy
• Treatment options:
  • Topical agents (suppository) for proctitis
  • Systemic or topical therapy or combination for distal disease
  • Systemic agents for extensive colitis
  • May add topical therapy if needed/appropriate
• Mild-Moderate Distal UC:
  • First-line treatment: Topical aminosalicylates (enema/suppository)
  • Mesalamine if inadequate or no response
  • May combine oral and topical aminosalicylates
• Mild-Moderate Extensive UC:
  • First-line treatment: Oral aminosalicylate
  • Budesonide (Uceris) 9 mg/d
  • Sulfasalazine or Mesalamine
• Moderate-Severe UC:
  • First-line treatment: Budesonide 9 mg/day
  • Prednisone 40-60 mg/d
  • Add azathioprine, mercaptopurine, infliximab, adalimumab, or golimumab if no response
• Severe-Fulminant UC:
  • Treatment: Methylprednisolone 40-60 mg daily for 3-5 days
  • IV cyclosporine or infliximab if refractory to IV corticosteroids
  • Add azathioprine, mercaptopurine, infliximab, certolizumab, adalimumab, vedolizumab or tofacitinib if remission achieved
  • Attempt to withdraw prednisone after 1-2 months

Irritable Bowel Syndrome (IBS)

• Definition: IBS is a GI syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause
• Epidemiology:
  • Prevalence: 10% worldwide among adults
  • More predominant in younger patients and women
• Pathophysiology:
  • Results from altered somatovisceral and motor dysfunction of the intestine
  • Abnormal CNS processing of afferent signals may lead to visceral hypersensitivity
  • Factors contributing to alterations include genetics, motility, inflammation, colonic infections, mechanical irritation, stress, and psychological factors

Treatment of IBS

• Treatment options:
  • Linaclotide
  • Rifaximin
  • Tegaserod
  • Plecanatide