This document summarizes chronic conditions of the bowel, including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). IBS is characterized by abdominal pain and altered bowel habits without an organic cause. IBS is subtyped based on stool consistency. IBD includes ulcerative colitis and Crohn's disease, which are chronic inflammatory conditions of the gastrointestinal tract that are treated with medications like aminosalicylates, corticosteroids, immunomodulators, and biologics. Treatment depends on disease location and severity. Biologics are effective but carry risks of serious infections and lymphomas.
This document discusses gall stones, listing various risk factors such as age, sex, pregnancy, oral contraceptives, family history, obesity, rapid weight loss, diabetes, and certain medical conditions. It describes the typical clinical presentation of gall stones as severe pain in the upper right abdomen that may refer to the right shoulder or back, accompanied by nausea and vomiting. Diagnosis involves ultrasound, MRCP, and blood tests checking CBC, CRP, bilirubin, and liver enzymes. Frequently asked questions concern whether there is inflammation, the type and size of stones, evaluating the bile ducts, and complications like pancreatitis.
Ulcerative Colitis: Case Presentation & Disease Overviewfarah al souheil
patient presenting with bloody stools and systemic signs with no previous medical complaints was diagnosed with amoebiasis on top ulcerative colitis (sigmoid-proctitis)
This document provides information on inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. It details the differences between the two conditions in terms of location of inflammation, symptoms, associated conditions, investigations, and treatment options. Medical treatment for Crohn's disease is more difficult than for ulcerative colitis. Surgery may be required for complications like strictures or abscesses in Crohn's disease or toxic megacolon in ulcerative colitis. The case study highlights toxic megacolon as an emergency requiring hospitalization.
This document provides an overview of irritable bowel syndrome (IBS), including its definition, prevalence, demographics, pathophysiology, clinical features, diagnosis, differential diagnosis, severity assessment, management, and prognosis. Some key points are:
- IBS is a functional bowel disorder characterized by abdominal pain associated with changes in bowel habits. It predominantly affects those aged 15-65 and is more common in women.
- The pathophysiology involves altered gut motility, visceral hypersensitivity, abnormal gas handling, low-grade inflammation, food sensitivities, abnormal gut microbiota, and central nervous system dysregulation.
- Diagnosis is based on symptoms meeting certain criteria and exclusion of organic diseases. Management focuses on
Inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis are chronic inflammatory conditions of the gastrointestinal tract. While they share some characteristics, they have distinct pathogenic mechanisms. Treatment involves medications to reduce inflammation like 5-ASA agents, glucocorticoids, immunosuppressants, and anti-TNF therapy. Each drug has its own mechanisms of action, dosing regimens, and potential side effects. Managing IBD requires considering the individual patient's disease severity and response to treatment.
A 54-year-old Malay woman presented with vomiting after eating and epigastric pain for one week. Physical examination revealed tenderness in the epigastric region and jaundice. Laboratory tests showed elevated liver enzymes and bilirubin. Ultrasound found multiple gallstones. She was diagnosed with cholelithiasis and treated with antibiotics and pain medications.
This document discusses gall stones, listing various risk factors such as age, sex, pregnancy, oral contraceptives, family history, obesity, rapid weight loss, diabetes, and certain medical conditions. It describes the typical clinical presentation of gall stones as severe pain in the upper right abdomen that may refer to the right shoulder or back, accompanied by nausea and vomiting. Diagnosis involves ultrasound, MRCP, and blood tests checking CBC, CRP, bilirubin, and liver enzymes. Frequently asked questions concern whether there is inflammation, the type and size of stones, evaluating the bile ducts, and complications like pancreatitis.
Ulcerative Colitis: Case Presentation & Disease Overviewfarah al souheil
patient presenting with bloody stools and systemic signs with no previous medical complaints was diagnosed with amoebiasis on top ulcerative colitis (sigmoid-proctitis)
This document provides information on inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. It details the differences between the two conditions in terms of location of inflammation, symptoms, associated conditions, investigations, and treatment options. Medical treatment for Crohn's disease is more difficult than for ulcerative colitis. Surgery may be required for complications like strictures or abscesses in Crohn's disease or toxic megacolon in ulcerative colitis. The case study highlights toxic megacolon as an emergency requiring hospitalization.
This document provides an overview of irritable bowel syndrome (IBS), including its definition, prevalence, demographics, pathophysiology, clinical features, diagnosis, differential diagnosis, severity assessment, management, and prognosis. Some key points are:
- IBS is a functional bowel disorder characterized by abdominal pain associated with changes in bowel habits. It predominantly affects those aged 15-65 and is more common in women.
- The pathophysiology involves altered gut motility, visceral hypersensitivity, abnormal gas handling, low-grade inflammation, food sensitivities, abnormal gut microbiota, and central nervous system dysregulation.
- Diagnosis is based on symptoms meeting certain criteria and exclusion of organic diseases. Management focuses on
Inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis are chronic inflammatory conditions of the gastrointestinal tract. While they share some characteristics, they have distinct pathogenic mechanisms. Treatment involves medications to reduce inflammation like 5-ASA agents, glucocorticoids, immunosuppressants, and anti-TNF therapy. Each drug has its own mechanisms of action, dosing regimens, and potential side effects. Managing IBD requires considering the individual patient's disease severity and response to treatment.
A 54-year-old Malay woman presented with vomiting after eating and epigastric pain for one week. Physical examination revealed tenderness in the epigastric region and jaundice. Laboratory tests showed elevated liver enzymes and bilirubin. Ultrasound found multiple gallstones. She was diagnosed with cholelithiasis and treated with antibiotics and pain medications.
IBS(Irritable Bowel Syndrome) Management Update-2021Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
The document discusses irritable bowel syndrome (IBS). It covers the epidemiology, pathophysiology, and classification of IBS. Regarding pathophysiology, it discusses genetic factors, visceral hypersensitivity, abnormal motility, low-grade inflammation, immune activation, altered permeability, disordered bile acid metabolism, and the brain-gut axis in IBS. Genetic factors like the serotonin transporter gene may play a role. Visceral hypersensitivity is seen in many IBS patients during balloon distention studies. Altered motility and low-grade inflammation may also contribute to IBS symptoms.
Dyspepsia is one of the most common symptoms in the adult population, and affects 20-40% of adults annually. We present an evidence based approach to this common topic, incorporating the latest guidelines.
This document discusses the growing epidemic of non-alcoholic fatty liver disease (NAFLD) in India. It provides background on NAFLD and highlights several studies that estimate the prevalence of NAFLD in India ranges from 8.7% to 32% based on ultrasound and biopsy data. The risk of NAFLD is increased in Indians due to high rates of obesity, diabetes, and the metabolic syndrome. Left untreated, NAFLD can progress to cirrhosis of the liver, creating a serious future health burden. Increased public health education is needed to raise awareness of obesity risks and promote healthy lifestyles.
Common liver Disease in Primary Care SettingChernHaoChong
- The document discusses common liver problems encountered in primary care, including abnormal liver function tests, abnormal findings on liver ultrasound, and viral hepatitis serology interpretations.
- Studies show that only a small percentage of abnormal liver function tests are actually due to liver disease, while the majority are caused by cancer, cardiovascular disease, or respiratory disease.
- Non-alcoholic fatty liver disease is increasingly common in Asia, with genetic factors playing a stronger role. Screening and management of metabolic complications is important when NAFLD/NASH is identified.
- Assessment for significant liver fibrosis or cirrhosis is important for high-risk NAFLD/NASH patients, while lifestyle modifications remain the first-line
This document discusses the approach to a patient presenting with dyspepsia. It defines dyspepsia and outlines its common causes such as food intolerances, gastrointestinal disorders, drugs, and systemic diseases. The importance of taking a thorough history is emphasized to determine underlying conditions like peptic ulcer disease, GERD, hepatobiliary disease, or irritable bowel syndrome. Physical exam and initial tests can rule out alarming causes. Treatment involves lifestyle changes, antacids, anti-secretory drugs, H. pylori eradication for ulcers, and prokinetics or antidepressants for functional dyspepsia. Endoscopy is recommended for older patients or those with alarming symptoms.
This patient is a 54-year-old female with type 2 diabetes presenting with worsening gastrointestinal symptoms of early satiety, heartburn and nausea despite dietary modifications. Investigations including EGD revealed mild antral erythema and food residue in her stomach, with a hiatal hernia present but no esophagitis or Barrett's esophagus. H. pylori testing was negative. The primary diagnosis is likely gastroparesis, and recommended treatment includes a proton pump inhibitor along with modifying her diabetes medications.
IBD Therapy discusses treatments for Crohn's disease and ulcerative colitis. 5-aminosalicylates are first-line treatments for mild to moderate disease. Corticosteroids are effective for inducing remission but not maintaining it. Immunosuppressants like azathioprine and methotrexate are used when steroids cannot be tapered. Anti-TNF antibodies like infliximab are effective for severe disease refractory to other therapies. Nutritional supplementation is important for patients with Crohn's disease due to potential deficiencies from the condition.
This document presents a case study of a 37-year-old male patient admitted with peptic ulcer disease. The patient reported abdominal pain, vomiting, headache, and melena. Diagnostic tests revealed an ulcer in the duodenum and low hemoglobin. The patient was diagnosed with chronic duodenal ulcer and treated with pantoprazole, ondansetron, amoxicillin, and clarithromycin. After five days of treatment, the patient's symptoms improved and he was discharged on pantoprazole and ondansetron for 15 days.
Dyspepsia refers to pain or discomfort centered in the upper abdomen. It is a common symptom with various potential causes. The document discusses the definitions, epidemiology, evaluation, and management approaches for different types of dyspepsia including functional dyspepsia and its subtypes of epigastric pain syndrome and postprandial distress syndrome. Testing and treatment are targeted based on alarm features and potential underlying causes, with a focus on lifestyle changes, antisecretory drugs, H. pylori treatment, prokinetics, and other pharmacological and psychological interventions.
This document provides guidance on the management of nonalcoholic fatty liver disease (NAFLD). It recommends weight loss through diet and exercise to improve liver enzymes, insulin levels, and histology. Pharmacologic therapies discussed include vitamin E and pioglitazone for certain patients. Silymarine from milk thistle may provide benefits but requires more research. Cirrhosis from NASH should be monitored for complications like portal hypertension, and screening for hepatocellular carcinoma is important. Liver biopsy can help assess fibrosis if non-invasive measures are unclear.
This document discusses management strategies for nonalcoholic fatty liver disease (NAFLD). It begins by outlining lifestyle changes like weight loss through diet and exercise as the foundation for treatment. Weight loss of at least 3-5% is associated with histological improvement. The document then reviews current pharmacologic options, noting that pioglitazone and vitamin E are the only FDA-approved therapies. Surgical management through bariatric surgery can also improve clinical parameters and resolve fibrosis. Emerging investigational therapies discussed include elafibranor, obeticholic acid, and cenicriviroc, though pioglitazone remains the most effective option based on clinical trials to date.
This document discusses dyspepsia, defined as epigastric pain, burning, postprandial fullness, or early satiety. Dyspepsia can be caused by organic diseases like peptic ulcers, GERD, or malignancies. It can also be functional in nature. The evaluation of dyspepsia involves history, physical exam, and testing for H. pylori infection or structural abnormalities. Treatment depends on identified causes, but may include H. pylori eradication therapy, PPIs, or endoscopy.
1. Fahad Fayyaz Butt, a 6-year-old boy, presented with chronic diarrhea, abdominal pain, weight loss, and reduced appetite for 6 months. Physical examination found pallor, mild clubbing, diffuse abdominal tenderness, and anal fistulas.
2. Initial investigations showed anemia, elevated inflammatory markers, and positive anti-gliadin antibodies. Endoscopy found patchy erythema in the esophagus, stomach, and colon.
3. He was diagnosed with Crohn's disease based on his clinical presentation and endoscopic findings. Crohn's disease and ulcerative colitis are the two main types of inflammatory bowel disease.
This document discusses the management of inflammatory bowel disease. It defines IBD and describes the two major types, ulcerative colitis and Crohn's disease. It covers the etiology, clinical features, drug therapy including mesalamine, corticosteroids, immunosuppressants, biologics, antibiotics, and supportive therapies. It also discusses complications, side effects of treatments, and the role of genetic factors like mutations in the NOD2 gene.
Gastroenterology Presentation (& some Abdominal Surgery Stuff!)meducationdotnet
This document provides information on various gastrointestinal conditions and diseases. It discusses investigations like blood tests, imaging, and endoscopy used to evaluate gastrointestinal symptoms. It also reviews management of common issues like gastroesophageal reflux disease, peptic ulcer disease, hepatitis, cirrhosis, and liver failure. Scoring systems are presented to stratify patients based on disease severity. Complications, treatments, and prognosis are outlined for several gastrointestinal cancers as well.
1. Irritable bowel syndrome (IBS) is a common chronic condition characterized by abdominal pain and altered bowel habits that affects 10-15% of the population.
2. IBS is diagnosed based on fulfilling the Rome III criteria through symptom assessment alone in the absence of red flags. Testing is generally not required but celiac serology may be considered in some cases.
3. Treatment involves diet modification, medication based on stool pattern (e.g. linaclotide for IBS-C, loperamide for IBS-D), and psychological therapies if needed. Further testing is pursued only if red flags are present.
Non-alcoholic fatty liver disease (NAFLD) is characterized by fat accumulation in the liver in the absence of excessive alcohol use. It ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. NAFLD affects 25% of Americans and its prevalence is increasing worldwide. Risk factors include obesity, diabetes, and metabolic syndrome. Diagnosis involves blood tests and imaging, while biopsy is needed to diagnose NASH. Treatment focuses on lifestyle changes like weight loss and exercise. Medications being investigated include antioxidants, diabetes medications, cytoprotective agents, and lipid lowering drugs, but more research is still needed to determine the optimal pharmacotherapy.
This talk discusses GI/liver side effects of commonly used drugs and provides guidance on advising patients and monitoring or preventing adverse effects. It covers factors that may contribute to side effects like drug interactions and underlying diseases. Specific drugs discussed include statins, NSAIDs, aspirin, and ketoconazole. The speaker emphasizes advising patients on medication use and seeking medical help if unwell, considering individual risk factors when prescribing or recommending prophylaxis, and consulting specialists if serious adverse effects occur.
This document provides an analysis of a 65-year-old male with chronic hepatitis C and cirrhosis who presented for follow up of anemia. He has a history of multiple failed hepatitis C treatments and complications of cirrhosis including ascites, encephalopathy, and esophageal varices. His current medications and management plan are outlined, focusing on preventing further liver damage and complications through lifestyle changes, medication adherence, screening for hepatocellular carcinoma, and treatment of ascites and encephalopathy. Economic and ethical considerations related to his condition are also discussed.
Crohn’s Disease is a chronic inflammatory disease of the small and large intestine affecting more than 1 million U.S. citizens. According to the CDC, “The majority of Crohn’s patients will require surgery at some point during their lives.” Join us in this discussion of how medical cannabis can help manage Crohn’s symptoms and progression.
IBS(Irritable Bowel Syndrome) Management Update-2021Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
The document discusses irritable bowel syndrome (IBS). It covers the epidemiology, pathophysiology, and classification of IBS. Regarding pathophysiology, it discusses genetic factors, visceral hypersensitivity, abnormal motility, low-grade inflammation, immune activation, altered permeability, disordered bile acid metabolism, and the brain-gut axis in IBS. Genetic factors like the serotonin transporter gene may play a role. Visceral hypersensitivity is seen in many IBS patients during balloon distention studies. Altered motility and low-grade inflammation may also contribute to IBS symptoms.
Dyspepsia is one of the most common symptoms in the adult population, and affects 20-40% of adults annually. We present an evidence based approach to this common topic, incorporating the latest guidelines.
This document discusses the growing epidemic of non-alcoholic fatty liver disease (NAFLD) in India. It provides background on NAFLD and highlights several studies that estimate the prevalence of NAFLD in India ranges from 8.7% to 32% based on ultrasound and biopsy data. The risk of NAFLD is increased in Indians due to high rates of obesity, diabetes, and the metabolic syndrome. Left untreated, NAFLD can progress to cirrhosis of the liver, creating a serious future health burden. Increased public health education is needed to raise awareness of obesity risks and promote healthy lifestyles.
Common liver Disease in Primary Care SettingChernHaoChong
- The document discusses common liver problems encountered in primary care, including abnormal liver function tests, abnormal findings on liver ultrasound, and viral hepatitis serology interpretations.
- Studies show that only a small percentage of abnormal liver function tests are actually due to liver disease, while the majority are caused by cancer, cardiovascular disease, or respiratory disease.
- Non-alcoholic fatty liver disease is increasingly common in Asia, with genetic factors playing a stronger role. Screening and management of metabolic complications is important when NAFLD/NASH is identified.
- Assessment for significant liver fibrosis or cirrhosis is important for high-risk NAFLD/NASH patients, while lifestyle modifications remain the first-line
This document discusses the approach to a patient presenting with dyspepsia. It defines dyspepsia and outlines its common causes such as food intolerances, gastrointestinal disorders, drugs, and systemic diseases. The importance of taking a thorough history is emphasized to determine underlying conditions like peptic ulcer disease, GERD, hepatobiliary disease, or irritable bowel syndrome. Physical exam and initial tests can rule out alarming causes. Treatment involves lifestyle changes, antacids, anti-secretory drugs, H. pylori eradication for ulcers, and prokinetics or antidepressants for functional dyspepsia. Endoscopy is recommended for older patients or those with alarming symptoms.
This patient is a 54-year-old female with type 2 diabetes presenting with worsening gastrointestinal symptoms of early satiety, heartburn and nausea despite dietary modifications. Investigations including EGD revealed mild antral erythema and food residue in her stomach, with a hiatal hernia present but no esophagitis or Barrett's esophagus. H. pylori testing was negative. The primary diagnosis is likely gastroparesis, and recommended treatment includes a proton pump inhibitor along with modifying her diabetes medications.
IBD Therapy discusses treatments for Crohn's disease and ulcerative colitis. 5-aminosalicylates are first-line treatments for mild to moderate disease. Corticosteroids are effective for inducing remission but not maintaining it. Immunosuppressants like azathioprine and methotrexate are used when steroids cannot be tapered. Anti-TNF antibodies like infliximab are effective for severe disease refractory to other therapies. Nutritional supplementation is important for patients with Crohn's disease due to potential deficiencies from the condition.
This document presents a case study of a 37-year-old male patient admitted with peptic ulcer disease. The patient reported abdominal pain, vomiting, headache, and melena. Diagnostic tests revealed an ulcer in the duodenum and low hemoglobin. The patient was diagnosed with chronic duodenal ulcer and treated with pantoprazole, ondansetron, amoxicillin, and clarithromycin. After five days of treatment, the patient's symptoms improved and he was discharged on pantoprazole and ondansetron for 15 days.
Dyspepsia refers to pain or discomfort centered in the upper abdomen. It is a common symptom with various potential causes. The document discusses the definitions, epidemiology, evaluation, and management approaches for different types of dyspepsia including functional dyspepsia and its subtypes of epigastric pain syndrome and postprandial distress syndrome. Testing and treatment are targeted based on alarm features and potential underlying causes, with a focus on lifestyle changes, antisecretory drugs, H. pylori treatment, prokinetics, and other pharmacological and psychological interventions.
This document provides guidance on the management of nonalcoholic fatty liver disease (NAFLD). It recommends weight loss through diet and exercise to improve liver enzymes, insulin levels, and histology. Pharmacologic therapies discussed include vitamin E and pioglitazone for certain patients. Silymarine from milk thistle may provide benefits but requires more research. Cirrhosis from NASH should be monitored for complications like portal hypertension, and screening for hepatocellular carcinoma is important. Liver biopsy can help assess fibrosis if non-invasive measures are unclear.
This document discusses management strategies for nonalcoholic fatty liver disease (NAFLD). It begins by outlining lifestyle changes like weight loss through diet and exercise as the foundation for treatment. Weight loss of at least 3-5% is associated with histological improvement. The document then reviews current pharmacologic options, noting that pioglitazone and vitamin E are the only FDA-approved therapies. Surgical management through bariatric surgery can also improve clinical parameters and resolve fibrosis. Emerging investigational therapies discussed include elafibranor, obeticholic acid, and cenicriviroc, though pioglitazone remains the most effective option based on clinical trials to date.
This document discusses dyspepsia, defined as epigastric pain, burning, postprandial fullness, or early satiety. Dyspepsia can be caused by organic diseases like peptic ulcers, GERD, or malignancies. It can also be functional in nature. The evaluation of dyspepsia involves history, physical exam, and testing for H. pylori infection or structural abnormalities. Treatment depends on identified causes, but may include H. pylori eradication therapy, PPIs, or endoscopy.
1. Fahad Fayyaz Butt, a 6-year-old boy, presented with chronic diarrhea, abdominal pain, weight loss, and reduced appetite for 6 months. Physical examination found pallor, mild clubbing, diffuse abdominal tenderness, and anal fistulas.
2. Initial investigations showed anemia, elevated inflammatory markers, and positive anti-gliadin antibodies. Endoscopy found patchy erythema in the esophagus, stomach, and colon.
3. He was diagnosed with Crohn's disease based on his clinical presentation and endoscopic findings. Crohn's disease and ulcerative colitis are the two main types of inflammatory bowel disease.
This document discusses the management of inflammatory bowel disease. It defines IBD and describes the two major types, ulcerative colitis and Crohn's disease. It covers the etiology, clinical features, drug therapy including mesalamine, corticosteroids, immunosuppressants, biologics, antibiotics, and supportive therapies. It also discusses complications, side effects of treatments, and the role of genetic factors like mutations in the NOD2 gene.
Gastroenterology Presentation (& some Abdominal Surgery Stuff!)meducationdotnet
This document provides information on various gastrointestinal conditions and diseases. It discusses investigations like blood tests, imaging, and endoscopy used to evaluate gastrointestinal symptoms. It also reviews management of common issues like gastroesophageal reflux disease, peptic ulcer disease, hepatitis, cirrhosis, and liver failure. Scoring systems are presented to stratify patients based on disease severity. Complications, treatments, and prognosis are outlined for several gastrointestinal cancers as well.
1. Irritable bowel syndrome (IBS) is a common chronic condition characterized by abdominal pain and altered bowel habits that affects 10-15% of the population.
2. IBS is diagnosed based on fulfilling the Rome III criteria through symptom assessment alone in the absence of red flags. Testing is generally not required but celiac serology may be considered in some cases.
3. Treatment involves diet modification, medication based on stool pattern (e.g. linaclotide for IBS-C, loperamide for IBS-D), and psychological therapies if needed. Further testing is pursued only if red flags are present.
Non-alcoholic fatty liver disease (NAFLD) is characterized by fat accumulation in the liver in the absence of excessive alcohol use. It ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. NAFLD affects 25% of Americans and its prevalence is increasing worldwide. Risk factors include obesity, diabetes, and metabolic syndrome. Diagnosis involves blood tests and imaging, while biopsy is needed to diagnose NASH. Treatment focuses on lifestyle changes like weight loss and exercise. Medications being investigated include antioxidants, diabetes medications, cytoprotective agents, and lipid lowering drugs, but more research is still needed to determine the optimal pharmacotherapy.
This talk discusses GI/liver side effects of commonly used drugs and provides guidance on advising patients and monitoring or preventing adverse effects. It covers factors that may contribute to side effects like drug interactions and underlying diseases. Specific drugs discussed include statins, NSAIDs, aspirin, and ketoconazole. The speaker emphasizes advising patients on medication use and seeking medical help if unwell, considering individual risk factors when prescribing or recommending prophylaxis, and consulting specialists if serious adverse effects occur.
This document provides an analysis of a 65-year-old male with chronic hepatitis C and cirrhosis who presented for follow up of anemia. He has a history of multiple failed hepatitis C treatments and complications of cirrhosis including ascites, encephalopathy, and esophageal varices. His current medications and management plan are outlined, focusing on preventing further liver damage and complications through lifestyle changes, medication adherence, screening for hepatocellular carcinoma, and treatment of ascites and encephalopathy. Economic and ethical considerations related to his condition are also discussed.
Crohn’s Disease is a chronic inflammatory disease of the small and large intestine affecting more than 1 million U.S. citizens. According to the CDC, “The majority of Crohn’s patients will require surgery at some point during their lives.” Join us in this discussion of how medical cannabis can help manage Crohn’s symptoms and progression.
This document describes a 5-year observational study to assess the long-term safety and effectiveness of etanercept (Enbrel) for the treatment of plaque psoriasis. The study will involve 2500 patients across 375 sites in the US and Canada. Patients will receive etanercept treatment determined by their physician and be evaluated every 6 months for 5 years. The primary objectives are to determine incidence rates of serious adverse events, serious infections, and malignancies. Secondary objectives include evaluating effectiveness outcomes using measures like Psoriasis Area and Severity Index. Data will be analyzed using descriptive statistics and Kaplan-Meier methodology.
Psoriatic Arthritis and Connection to Diet: an Individualized ApproachIFSMED
This document discusses psoriatic arthritis, including its causes, symptoms, diagnosis, subtypes, and treatment options. It notes that psoriatic arthritis affects up to 30% of people with psoriasis, causing joint pain, stiffness and swelling. Both non-steroidal anti-inflammatory drugs and disease-modifying drugs can help treat symptoms, while biologics approved for psoriatic arthritis include etanercept, adalimumab, golimumab and infliximab. Diet and food sensitivities also play a role, so an individualized approach considering food intolerance testing and elimination diets is recommended.
Zepatier is a fixed-dose combination of elbasvir and grazoprevir approved to treat chronic hepatitis C virus (HCV) genotypes 1 or 4 in adults. Elbasvir is an HCV NS5A inhibitor that blocks viral RNA replication, while grazoprevir is an HCV NS3/4A protease inhibitor that inhibits viral replication and particle formation. Zepatier is administered as a once-daily oral tablet, with or without ribavirin, for 12 to 16 weeks. Common side effects include fatigue, nausea, anemia, and headache. The drug is contraindicated in those with moderate to severe hepatic or renal impairment, during pregnancy or lactation.
1. This patient has aggressive relapsing-remitting multiple sclerosis (RRMS) based on more than 2 relapses in the past year and active lesions on MRI.
2. Treatment guidelines recommend natalizumab (Tysabri) or fingolimod (Gilenya) for aggressive RRMS, depending on JCV antibody status.
3. As this patient is JCV antibody negative, treatment with natalizumab is recommended due to its higher efficacy in reducing relapses and disability progression compared to other disease-modifying therapies.
Clinical Impact of New HIV Data From the 2016 Comorbidities-Adverse Drug Reac...hivlifeinfo
In this downloadable slideset, expert faculty members Todd T. Brown, MD, PhD, and Jordan E. Lake, MD, MSc, review key studies presented at the 2016 Comorbidities/Adverse Drug Reactions Workshop.
Format: Microsoft PowerPoint (.ppt)
File size: 1.37 MB
Date posted: 10/14/2016
This document discusses Harvoni and its role in treating Hepatitis C. It provides an overview of Hepatitis C, including epidemiology and clinical presentation. It describes the mechanism of action and pharmacokinetics of the two drugs in Harvoni - Ledipasvir and Sofosbuvir. It summarizes several clinical trials that evaluated Harvoni's efficacy and safety in treating genotype 1 Hepatitis C in treatment-naive and experienced patients, with and without cirrhosis, finding high sustained virologic response rates with 12 weeks of Harvoni treatment.
1. Rheumatoid arthritis is an autoimmune disease that causes inflammation of the joints, most commonly in the hands and feet. It can lead to long-term joint damage and functional disability if not adequately treated.
2. Biologics target specific components of the immune system that drive inflammation in rheumatoid arthritis patients. They are generally reserved for patients who have not responded sufficiently to conventional disease-modifying drugs. Available biologics include TNF inhibitors such as etanercept, infliximab, and adalimumab as well as drugs targeting IL-1, IL-6, CD20, and T-cell co-stimulation.
3. While biologics can significantly reduce
The document discusses Risk Evaluation and Mitigation Strategies (REMS) implemented by the FDA for certain drugs that pose serious safety risks. REMS can include medication guides, communication plans, and elements to assure safe use. Examples provided include specific REMS programs for drugs like alosetron, clozapine, isotretinoin, thalidomide, and dofetilide that require enrollment of prescribers and pharmacies, patient counseling and monitoring, and other restrictions to ensure the safe use of the medication. REMS are intended to help ensure the benefits of medications outweigh the risks when serious safety issues have been identified.
This document summarizes the discovery and properties of the antibiotic Teixobactin. Teixobactin was isolated from a previously uncultured soil bacterium using a new cultivation method called iChip that allowed bacteria to grow in conditions simulating their natural environment. Teixobactin showed activity against Gram-positive bacteria like Staphylococcus aureus but not Gram-negatives. It demonstrated a novel mechanism of action inhibiting cell wall synthesis and no resistant strains were obtained in the lab. Teixobactin was effective in mouse models of MRSA and pneumonia infections. While promising, more testing is still needed to develop Teixobactin into a clinical drug.
Teixobactin is a newly discovered antibiotic found in the soil bacteria Efetheria Terrae. It was originally thought to be a detergent but experiments showed it did not damage human cells. Teixobactin was very effective at killing gram-positive bacteria, including drug-resistant strains like MRSA, and improved outcomes in mouse infection models. However, it was not effective against gram-negative bacteria. While promising, more research is still needed to understand Teixobactin's effects on humans and potential long-term side effects.
Ichip is a novel method for in situ cultivation of environmental microorganisms. A study found that ichips incubated directly in soil and seawater samples led to significantly higher bacterial colony counts compared to traditional petri dishes. Microbial species grown in ichips were also more novel and diverse than those in petri dishes, with little overlap between the two methods. The ichip approach recovered many bacterial strains and genera not previously identified, supporting its ability to cultivate the "uncultivable" majority of environmental microbes.
Paclitaxel is a chemotherapy medication used to treat breast cancer and other cancers. It works by preventing cell division and causing cancer cell death. Special safety measures must be taken when administering paclitaxel due to potential side effects and interactions with other drugs. Nurses closely monitor patients during infusion and have emergency equipment available in case of hypersensitivity reactions. Proper communication between the healthcare team and patients is important for safe administration of paclitaxel.
Hivtreatmentdecember2011 111204184012 Phpapp02Positive Life
1) HIV treatment involves taking a combination of antiretroviral drugs from different classes that target different stages of the HIV lifecycle.
2) Guidelines recommend starting treatment when a patient's CD4 count drops below 500 or if they have an AIDS-defining illness, though some experts argue for earlier treatment given potential benefits.
3) Common treatment regimens involve two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) as the "backbone" plus either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI). The goals are to suppress viral load, increase CD4 count, and prevent disease progression.
Depression is common in medically ill patients and can be caused by medical conditions, medications, or substances. It is important to rule out these potential causes and differentiate depression from symptoms of the underlying illness. Treatment involves addressing any contributing factors, using antidepressants such as SSRIs, and providing psychotherapy. Combining medications, therapies, and alternative treatments can effectively treat depression in medically ill patients.
Newer drugs approved by US-FDA - Rxvichu!!!RxVichuZ
1. The document presents an overview of 14 newer drugs approved by the US FDA in 2016 for various therapeutic indications. It provides details on the drug name, approval date, classification, indication, mechanism of action, adverse effects and dosing for each drug. The drugs are for treating conditions like hepatitis C, epilepsy, anthrax infection, psoriasis, asthma, and various types of cancer.
2. It also includes two diagnostic imaging agents - one for detecting recurrent prostate cancer and another for neuroendocrine tumors. The last drug discussed is an ophthalmic solution for treating dry eye disease. In summary, the document outlines the key details of 14 novel pharmaceutical agents approved in the US in 2016 for a range of
The Updated CDC’s Compendium of Evidence-based Behavioral Interventions for R...CDC NPIN
The document summarizes recent updates to the CDC's Compendium of Evidence-Based Behavioral Interventions for reducing HIV risk behaviors and promoting HIV medication adherence. The efficacy review identified 4 new evidence-based interventions for risk reduction and 8 new evidence-based interventions for medication adherence. The Compendium provides a comprehensive list of evidence-based interventions stratified by characteristics to guide research translation and dissemination efforts. Gaps in the scientific literature were also discussed to identify priority areas for future research.
Ulcerative colitis is a chronic inflammatory bowel disease that involves the colonic mucosa. It typically affects the rectum first and may extend proximally in a continuous manner. The disease runs a relapsing and remitting course. Treatment involves 5-aminosalicylates and corticosteroids to induce and maintain remission. For moderate to severe disease, immunosuppressants like azathioprine, anti-TNF agents, and vedolizumab may be used. Surgery with proctocolectomy and ileal pouch-anal anastomosis is the treatment of choice for those who require colectomy.
UC is an idiopathic IBD that affects the colonic mucosa.
Hallmark of UC is bloody diarrhea often with prominent symptoms of rectal urgency and tenesmus.
The clinical course is marked by exacerbations and remissions.
The diagnosis of UC is suspected on clinical grounds and supported by the appropriate findings on
Proctosigmoidoscopy or colonoscopy
Biopsy
By negative stool examination for infectious causes
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease. Some key points:
- IBD is a group of chronic inflammatory disorders of the gastrointestinal tract of unknown cause. UC primarily involves the colonic mucosa, while Crohn's can involve all layers of the intestinal wall.
- Treatment involves medications to control inflammation like aminosalicylates, corticosteroids, immunosuppressants, antibiotics, and antispasmodics. Surgery is reserved for complications.
- UC has a 20-25% risk of requiring colectomy. Prognosis is variable but long-term mortality is around 5
This document provides information on several gastrointestinal conditions:
1. Achalasia is a motility disorder of the esophagus characterized by loss of peristalsis and failure of the lower esophageal sphincter to relax properly.
2. Esophageal cancer can be squamous cell carcinoma or adenocarcinoma, with risk factors including smoking, alcohol, and Barrett's esophagus. Treatment depends on cancer stage and may include surgery, chemotherapy, or radiation.
3. Peptic ulcer disease is caused by a bacterial infection with H. pylori in most cases. Treatment involves eradicating H. pylori with antibiotic therapy and proton pump inhibitors.
Inflammatory bowel disease (IBD) refers to chronic inflammatory disorders of the gastrointestinal tract including ulcerative colitis (UC) and Crohn's disease. The causes are unknown but may involve genetic and immune factors. UC primarily involves the colonic mucosa while Crohn's disease can involve all layers of the intestinal wall. Treatment involves medications to suppress inflammation such as aminosalicylates, corticosteroids, immunosuppressants, antibiotics, and antispasmodics. While some patients can be managed medically, many will require surgery for complications or refractory disease. The prognosis is generally better for UC than Crohn's disease.
A 38-year-old woman presents with upper abdominal pain worse after meals but no other symptoms. Her H. pylori test is positive. The doctor treats her empirically with Prevpac. A year later, she reports frequent heartburn. Lifestyle modifications and PPI treatment are recommended. She does not need an endoscopy unless symptoms fail to improve.
Mesenteric ischemia presentation by Dr.NOSHI Capital Hospital Islamabad Paki...drfarhanali2008
The document describes a case of mesenteric ischemia in a 36-year-old male patient who presented with lower abdominal pain and vomiting. Key details include:
- The patient reported 4 days of lower abdominal pain that became severe and was accompanied by vomiting for 1 day.
- Examination found abdominal tenderness and guarding. Imaging showed fatty liver and mild ascites.
- Exploratory laparotomy revealed infarcted small intestine requiring a double barrel stoma.
- The patient was optimized after surgery and underwent stoma reversal surgery.
- Mesenteric ischemia occurs when blood supply to the intestine is inadequate and can be acute or chronic, having various etiologies including embol
This document provides tips and instructions for using a PowerPoint presentation on peptic ulcers. It discusses:
- Freely editing, modifying, and adding your name to the presentation.
- Many slides are blank except for the title to facilitate active learning sessions where students provide information before each slide is shown.
- The presentation can be used for self-study as well, with notes providing bibliographic references.
- The presentation covers topics on peptic ulcers including introduction/history, pathophysiology, etiology, clinical features, investigations, management, and prevention. Diagrams and explanations are provided for each topic.
This document provides information on evaluating and diagnosing dyspepsia. It lists the most common causes of dyspepsia as functional or non-ulcer dyspepsia. Other potential causes discussed include peptic ulcer disease, GERD, biliary tract disease, pancreatitis, cancer, IBS, and various metabolic disorders and medications. It provides questions to ask patients to determine the underlying cause, such as symptoms, medical history, risk factors. Common drugs associated with dyspepsia are also listed. Diagnosis involves considering the differential, patient history, and potentially endoscopy, urea breath testing, and other studies.
Why Does My Stomach Ache? - Dennis Han, MD, Gastroenterologist - Morristown &...Summit Health
Do you have stomach issues which are bothering you and you can't figure out why? Learn about conditions that could be causing abdominal pain or discomfort at this virtual program. Our expert will discuss different conditions such as: Irritable Bowel Syndrome; Inflammatory Bowel Disease; Celiac Disease and other conditions that require a gluten-free diet; and GERD (Reflux). He will explain the differences between these various conditions, how they are diagnosed, and treatment options available. Hosted by Morristown & Morris Township Public Library.
This document describes a 62-year-old male presenting with abdominal pain and black tarry stools. He reports intermittent epigastric pain for 2 months that worsens after meals, along with belching, bloating, and nausea. His past medical history includes COPD, diabetes, and osteoarthritis, and he smokes and drinks alcohol regularly. On examination, he has epigastric tenderness and tachycardia. Stool is positive for blood. The initial impression is peptic ulcer disease likely caused by long-term NSAID use for osteoarthritis pain. Differential diagnoses include gastritis and pancreatitis. Workup may include endoscopy, labs for anemia, and tests for H. py
Evaluation and management of patients with Dyspepsia.pptxgarvitnanecha
Evaluation and management of patients with Dyspepsia.
Dyspeptic symptoms.
Causes of dyspepsia
Approach to adult with Dyspepsia.
Newer advancement about diagnosing dyspepsia causes.
GERD and peptic ulcer and many more organic diseases.
Functional Dyspepsia and organic dyspepsia
Inflammatory bowel disease (IBD) includes chronic disorders like ulcerative colitis and Crohn's disease that cause inflammation in the intestines. Genetic factors contribute to IBD risk, and symptoms include abdominal pain, diarrhea, and bloody stools. Treatment involves lifestyle changes, medications like 5-aminosalicylates and immunosuppressants to reduce inflammation, and sometimes surgery for severe cases.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It involves diffuse inflammation and ulceration of the colonic mucosa. The cause is unknown but likely related to genetic and immune factors. Symptoms include bloody diarrhea. Diagnosis involves colonoscopy and biopsy. Treatment involves medications to induce and maintain remission such as mesalamine, corticosteroids, immunomodulators, and biologics. Surgery may be required for severe cases or cancer prevention. Long-term monitoring is needed due to cancer risk.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
This document provides information on acute pancreatitis including:
1. The epidemiology, causes, pathophysiology, clinical presentation, investigations, management, and complications of acute pancreatitis are summarized. Gallstones and alcohol are the most common causes.
2. Laboratory markers like lipase and amylase are used to diagnose, while CT, MRI, and ultrasound can identify complications like fluid collections and necrosis. Treatment involves fluid resuscitation, pain management, and treating any organ dysfunction.
3. Complications include pancreatic and extra-pancreatic complications like fluid collections, necrosis, infection, and vascular or bowel issues. Infected necrosis requires antibiotics while severe cases may require drainage procedures or surgery.
Formal case ( 5 problems duodenal ulcer , hypertension , anemia , smoking , h...Aya Ali
A 55-year-old African American male presented with epigastric abdominal pain, dizziness, and darkening of stool. He has a history of hypertension and takes furosemide. He also takes ibuprofen and antacids over-the-counter without relief of symptoms. Physical exam revealed mild abdominal tenderness and a positive fecal occult blood test. Endoscopy showed multiple gastric ulcers. He was assessed with NSAID-induced duodenal ulcer, secondary gastric ulcers, and anemia. Treatment included stopping ibuprofen and starting omeprazole to prevent complications and promote healing.
The document provides tips for using a PowerPoint presentation on gastroesophageal reflux disease (GERD). It suggests:
1. Using blank slides to elicit what students already know about each topic before presenting new information
2. Repeating this process of blank slide then information slide three times for active learning
3. The presentation can be used for self-study as well by reviewing the notes and bibliography
The presentation covers learning objectives and sections on introduction/history, etiology, pathophysiology, clinical features, investigations, management, and multiple choice questions. It provides detailed information on each topic in an engaging format designed for teaching.
Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. It is characterized by transmural, patchy inflammation with skip lesions. Common symptoms include diarrhea, abdominal pain, and weight loss. The cause is unknown but may involve genetic and environmental factors. Treatment involves medications to reduce inflammation like 5-aminosalicylates, corticosteroids, and immunosuppressants. Surgery is considered for complications like strictures, abscesses, or fistulas.
1. CHRONIC CONDITIONS
OF THE BOWEL
L I B B Y D A U G H E R T Y
P H A R M . D . C A N D I D A T E , C L A S S O F 2 0 1 7
A P P E 3 – A M B U L A T O R Y C A R E – E N C O M P A S S R X
A U G U S T 1 0 , 2 0 1 6
2. OVERVIEW
• Irritable Bowel Syndrome
– IBS with Diarrhea (IBS-D)
– IBS with Constipation (IBS-C)
– Mixed IBS (IBS-M)
• Inflammatory Bowel Disease
– Ulcerative Colitis (UC)
– Crohn’s Disease (CD)
• Most prevalent in developed countries,
especially in the northern hemisphere.
– North America
– Northern Europe
– Great Britain
• Incidence is increasing worldwide
• Women prone to IBS and CD
• Men prone to UC
• Older age at onset of symptoms is
associated with better outcomes
4. CLINICAL PRESENTATION
• Gastrointestinal syndrome characterized by:
– Chronic abdominal pain
• Not nocturnal
• Not progressive
– Altered bowel habits
• Diarrhea
• Constipation
– In the absence of any organic cause
• Infection
• Celiac disease
• Colorectal cancer
• Inflammatory disease
• Caused by:
– Infectious gastroenteritis
• The only proven cause of IBS
• Food poisoning leads to chronic IBS in 10%
of patients
• Other Possible Causes:
– Bacterial overgrowth
• 60% of IBS-D patients have excessive
enterobacteracea in their small intestines
– Food sensitivity
– Genetics
5. DIAGNOSIS
• The Manning Criteria
– Chronic or recurrent abdominal pain for
at least 6 months
– Two or more of the following:
• Abdominal pain relieved with defecation
• Abdominal pain associated with more
frequent stools
• Abdominal pain associated with looser
stools
• Abdominal distension
• Feeling of incomplete evacuation after
defecation
• Mucus in stools
• Rome IV Diagnostic Criteria
– Recurrent abdominal pain for at least 1
day per week in the last 3 months
– Two or more of the following:
• Related to defecation
• Associated with a change in frequency of
stool
• Associated with a change in
form/appearance of stool
– For at least 6 months
7. XIFAXAN (RIFAXIMIN) FOR IBS-D
• Bacteriostatic antibiotic: Inhibits bacterial RNA
synthesis by binding to bacterial RNA
polymerase
• Absorption based on hepatic function
– Healthy liver = low systemic absorption
• 550mg TID x 14 Days
– Provides 6 to 24 weeks of symptomatic relief
• 50% abdominal pain
• 70% diarrhea
– Average relief = 10 weeks
– May repeat two times if symptoms recur
• Common side effects
– Headache
– Dizziness
– Fatigue
• Serious side effects:
– Hypersensitivity reaction
9. ULCERATIVE COLITIS
CLINICAL PRESENTATION
• Diarrhea that lasts for weeks to months
(often bloody)
• Colicky abdominal pain
• Urgency
• Tenesmus
• Incontinence
• Systemic symptoms
– Fatigue
– Weight loss
• Progressive/gradual onset
• Intermittent exacerbations (“flare-ups”)
alternating with periods of symptomatic
remission
• 67% of patients have at least one relapse
10 years after initial diagnosis
• Complications include severe bleeding,
toxic megacolon, perforation, strictures,
dysplasia, and colorectal cancer
• 20-30% of patients will eventually
require a colectomy for complications or
intractable disease
10. U L C E R A T I V E C O L I T I S
D I A G N O S I S
Endoscopy
Loss of vascular markings (haustra)
Pseudopolyps
Ulceration, often with gross bleeding
Inflammation limited to rectum and colon
Biopsy
Crypt abscesses/distortion
Imaging
Barium enema
MRI
CT
11. CROHN’S DISEASE
CLINICAL PRESENTATION
• More variable than UC
• Prolonged diarrhea
• With or without bleeding
• Abdominal pain
• Systemic symptoms
– Fatigue
– Weight loss
• Secondary symptoms
– Fistulas
– Abscesses
– Perianal disease
– Malabsorption
• Progressive/gradual onset
• Intermittent exacerbations (“flare-ups”)
alternating with periods of symptomatic
remission
• 10-20% of patients experience prolonged
remission after initial presentation
• 13% have a relapse-free course
• 20% have annual relapses
• 67% have a combination of years in relapse and
years in remission
• <5% have continuous active disease
• Many patients ultimately require surgical
intervention
12. C R O H N ’ S D I S E A S E
D I A G N O S I S
Endoscopy
Polypoid mucosal changes that give a
“cobblestone” appearance
Skip areas
Fissures
Can involve the entire GI tract and usually
involves multiple sites
Biopsy
Focal ulcerations
Acute and chronic inflammation
Imaging
Most useful for upper GI
Serologic markers
13. TREATMENT
Nutritional Support
Elimination of food
that exacerbates
symptoms
Enteral
supplementation
Probiotics
Aminosalicylates
Sulfasalazine
Mesalamine
Corticosteroids
Prednisone
Prednisolone
Budesonide
Hydrocortisone
Methylprednisolone
Immunomodulators
6-mercaptopurine
(6-MP)
Azathioprine
Methotrexate
Cyclosporine
Biologics
Tumor Necrosis Factor
(TNF- α) Inhibitors
Selective Adhesion-
Molecule Inhibitors
Surgery
Fistula repair
Resection
Total Colectomy
14. U L C E R A T I V E
C O L I T I S
Possible to achieve remission in
mild/moderate disease with just
aminosalicylates and/or
steroids.
Topical aminosalicylates are
more effective than oral ones.
Steroids are particularly
effective at relieving tenesmus,
but less effective than ASAs for
other.
Systemic steroids are used
regardless of disease location.
Biologics are only used after all
other therapies have failed.
15. C R O H N ’ S D I S E A S E
Aminosalisylates have not been
shown to be efficacious in CD but
are still often used as first-line
therapy.
Steroids are chosen according to
location of disease.
Immunomodulators cannot
induce remission, but they can
maintain steroid-induced
remission.
Combination therapy of biologics
and immunomodulators has been
shown to be more efficacious than
either agent alone, but this
regimen may increase the chance
of serious side effects like
lymphomas.
16. BIOLOGICS
Drug Class Route UC CD
Remicade (Infliximab) TNF-α Inhibitors IV Infusion X X
Humira (Adalimumab) SQ Injection X X
Cimzia (Certolizumab
pegol)
SQ Injection X
Simponi (Golimumab) SQ Injection X
Entyvio (Vedolizumab) Selective Adhesion-
Molecule Inhibitors
IV Infusion X X
Tysabri (Natalizumab) IV Infusion X
17. • 5mg/kg at 0, 2, and 6
weeks
• 5mg/kg every 8 weeks
• 160mg on Day 1
• 80mg every 2 weeks
• 400mg at 0, 2, and 4
weeks
• 400mg every 4 weeks
• CD only
• 200mg on Day 1
• 100mg on Day 15
• 100mg every 4 weeks
• UC only
TNF-α INHIBITORS
• Reduce activity of TNF-α to decrease
inflammation
• Common Side Effects
– Infusion/Injection site reactions
– Predisposition to infections
• Serious Side Effects
– Lymphoma (Black Box Warning)
– Bone marrow suppression
– Heart failure exacerbation
– Reactivation of infections
• Avoid in patients with active or recurrent
infections
• Contraindicated in patients with NYHA class
III/IV Heart Failure
18. SELECTIVE ADHESION-MOLECULE
INHIBITORS
• Anti alpha-4 integrin antibodies
• Inhibit leukocyte adhesion to reduce
inflammation
• Indicated for patients unresponsive to
conventional treatment and TNF-α inhibitors
• Common Side Effects
– Infusion reactions
– Headache
– Arthralgia
• Serious Side Effects
– Progressive multifocal leukoencephalopathy
(Black Box Warning)
– Hepatotoxicity
– Depression
• 300mg over 30 minutes at 0, 2, 6 weeks
• 300mg every 8 weeks
• Discontinue after 14 weeks if no evidence of
therapeutic benefit
• 300mg over 1 hour every 4 weeks
• Discontinue after 12 weeks if no evidence of
therapeutic benefit
• CD only
19. REFERENCES
• A. W. (2016, June 16). Clinical manifestations and diagnosis of irritable bowel syndrome in adults (N. J.
Talley, Ed.). Retrieved August 09, 2016, from UpToDate.
• About Xifaxan. (n.d.). Retrieved August 09, 2016, from https://www.xifaxan.com/About-Xifaxan
• Fabel, P. H., & Shealy, K. M. (2014). Diarrhea, Constipation, and Irritable Bowel Syndrome. In J. T. DiPiro
(Author), Pharmacotherapy: A pathophysiologic approach. New York; Madrid: McGraw-Hill Education.
• Hemstreet, B. A. (2014). Inflammatory Bowel Disease. In J. T. DiPiro (Author), Pharmacotherapy: A
pathophysiologic approach. New York; Madrid: McGraw-Hill Education.
• Peppercorn, M. A., & Kane, S. V. (2015, December 17). Clinical manifestations, diagnosis and prognosis
of Crohn disease in adults (P. R., Ed.). Retrieved August 09, 2016, from UpToDate.
• Peppercorn, M. A., & Kane, S. V. (2015, December 21). Clinical manifestations, diagnosis, and prognosis
of ulcerative colitis in adults (P. Rutgeerts, Ed.). Retrieved August 9, 2016, from UpToDate.
IBS presents as either diarrhea- or constipation-predominant disease.
Inflammatory Bowel Disease (IBD) is a group of chronic and inflammatory disorders that affect the intestines and the colon
IBD encompasses both Crohn’s disease (CD) and ulcerative colitis (UC)
Chronic, uncontrolled inflammation of the intestinal mucosa is the hallmark of IBD
Manning = 1970’s, debatable predictive ability
Rome Criteria updated from III to IV in May 2016
Abdominal “discomfort” removed, now only “pain” qualifies
Threshold increased from 3 days/month to 1 day/week
+ Absence of alarm symptoms
Gas-producing foods
Beans, onions, celery, carrots, raisins, bananas, apricots, prunes, Brussel sprouts, wheat germ, pretzels, bagels, caffeine, alcohol
Fermentable oligo-, di- and monosaccharide and polyols – FODMAPs
Fructose, honey, apples, pears, mangoes, cherries, wheat
(Zelnorm) Tegaserod – pulled from US market due to
Weight loss d/t decreased appetite – pts feel better when they do not eat
Nutritional support is tricky because these patients are usually malnourished due to malabsorption and reduced appetites.
Supplemental enteral nutrition increases remission rates.
Probiotics have not been shown to be efficacious but they also do no harm.
Most patients with mild to moderate UC can be managed with oral/topical ASAs.
Treatment of UC and CD has traditionally used a “step-up” approach. Those drugs are much cheaper but also are less efficacious and have arguably more severe side effects.
“STEP-UP VERSUS TOP-DOWN THERAPY — There are two general approaches to the treatment of mild to moderate Crohn disease: step-up therapy and top-down therapy. Step-up therapy typically starts with medications that are less potent and (often) associated with fewer side effects. If those therapies are ineffective, more potent (and potentially more toxic) medications are used. Top-down therapy starts with more potent therapies, such as biologic therapy or immunomodulator therapy, relatively early in the course of the disease before patients become glucocorticoid dependent, and possibly even before they receive glucocorticoids.
The relative merits of these strategies have not been extensively studied. One of the largest controlled trials included a total of 133 patients with newly diagnosed Crohn disease who were randomly assigned to combined immunosuppression (with infliximab andazathioprine) or conventional management with glucocorticoids followed by azathioprine and infliximab as needed [4]. Significantly more patients in the initial immunosuppression (top-down) group were in clinical remission at 26 weeks (60 versus 36 percent) and at 52 weeks (62 verus 42 percent). Serious adverse events were seen in a similar proportion of both groups (31 versus 25 percent). Similarly, in a study of 508 moderate and severely ill patients with Crohn disease who had not previously received immunosuppressive or biologic agents, the combination of infliximab and azathioprine was more effective than either infliximab or azathioprine alone at inducing a glucocorticoid-free remission.”
TNF-α are contraindicated in NYHA class III/IV heart failure.
Remicade is preferred by the guidelines
Humira is indicated for patients who no longer respond to infliximab
Cimzia has higher response rates in patients with CR P> 10mg/L
Stelara currently indicated for Psoriatic arthritis and Plaque psoriasis.
Phase II trials for UC and CD indications completed.
Currently recruiting for Phase III trial for UC.