Inflammatory bowel disease - Crohn's disease (CD)

21 important questions on Inflammatory bowel disease - Crohn's disease (CD)

What type of diarrhea does CD have?

Blood or non-bloody

Where is CD located?

Entire GI tract (especially the ileum and colon)

What is the depth of CD?

Transmural
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What is the pattern of CD?

Non-continuous "cobblestone"

What are common symptoms of CD?

Chronic diarrhea (often nocturnal), abdominal pain and weight loss

What is used for induction of mild disease in CD?

Budesonide

What can be used for induction in moderate to severe CD?

Biologic with or w/o immunomodulator

What might be needed for severe cases of CD?

Steroids

How long can PO budesonide be used for mild disease of the ileum and/or right colon?

up to 3 months

If needing treatment of mild CD disease for more than 3 months, what can be used after PO budesonide?

Thiopurine or methotrexate

Besides PO budesonide, thiopurine, or methotrexate, what else can be used for mild CD disease?

PO prednisone

What are the preferred treatments for moderate-severe CD?

Anti-TNF with or w/o methotrexate or thiopurine
IL receptor antagonist
Integrin receptor antagonist

What are the 2nd line (alternatives) for moderate-severe CD?

Janus Kinase (JAK) inhibitor
Integrin receptor antagonist

Which budesonide can a patient be discharged on?

Entocort EC (for CD only)

In what patients is methotrexate used?

Induction and maintenance in moderate-severe CD patients that cannot tolerate azathiopurine

Immunosuppressive drug with anti-inflammatory properties, dosed once weekly by IM or SC injection

Methotrexate

Which interleukin receptor antagonist is used in moderate-severe CD?

Risankizumab (Skyrizi)

Integrin receptor antagonist for CD (and MS)

Natalizumab (Tysabri) injection

Natalizumab (Tysabri) dosing

injection every 4 weeks

Natalizumab (Tysabri) should be discontinued if no response, by how many weeks

12 weeks

Natalizumab (Tysabri) is only available through what?

REMS program

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