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Blackwell Clinical Handbook: Inflammatory Bowel Disease

Blackwell Clinical Handbook: Inflammatory Bowel Disease

Edward V. Loftus Jr.

ISBN: 978-1-405-14635-7

Mar 2015, Wiley-Blackwell

224 pages

Select type: Paperback


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This book provides clear, practical, concise clinical guidance for the medical team responsible for the diagnosis, treatment, and management of patients with inflammatory bowel disease (ulcerative colitis, Crohn’s disease, and the microscopic colitides).
1. Introduction and definitions.

· Purpose of book.

· Brief description of IBD subtypes and their classification by extent (e.g., proctitis, left-sided, pancolitis; ileitis, colitis, ileocolitis).

· Burden of disease in USA, Canada, UK, Europe, Australia/N.Z., Japan.

2. Epidemiology and genetics.

· Descriptive epi (incidence, prevalence, mortality).

· Risk factors (smoking, appendectomy, NSAIDs, antibiotics, infections, dietary, etc).

· Family risks, phenotype of familial IBD.

· Genetic epi (NOD2/CARD15, others), both molecular and population level.

· Include brief section on microscopic colitis epi.

3. Pathophysiology.

· Brief overview of mucosal immunology.

· Interactions between gut microbes, epithelial cells, and lymphocytes.

· Lymphocyte trafficking, adhesion molecules, etc.

· Physiological consequences of intestinal inflammation, how it produces symptoms.

4. Clinical features, clinical course, and natural history of Crohn’s disease.

· Symptoms, signs, endoscopic features.

· Disease activity assessment.

· Non-malignant intestinal complications.

· Clinical course/natural history in regards to remission/relapse, need for surgery.

· Quality of life.

5. Clinical features, clinical course, and natural history of ulcerative colitis.

· Symptoms, signs, endoscopic features.

· Disease activity assessment.

· Risk of progression of extent.

· Non-malignant intestinal complications (toxic megacolon, hemorrhage, stricture).

· Clinical course/natural history in terms of relapse, need for surgery.

· Quality of life.

6. Clinical features, clinical course, and natural history of related conditions (pouchitis, microscopic colitis, separate section for each).

· Symptoms and signs.

· Diagnosis.

· Long-term sequelae including risk of surgery and malignancy.

7. Complications of inflammatory bowel disease.

· Classical extraintestinal manifestations (ocular, spondyloarthropathy, dermatologic, hepatobiliary).

· Osteoporosis/osteopenia/fractures.

· Others (nephrolithiasis, cholelithiasis, hematologic, thromboembolism, pancreatitis, neurologic, cardiopulmonary, etc).

· Cancer in IBD (colorectal, small bowel, lymphoma).

8. Diagnosis.

· Blood tests (C-reactive protein, ANCA/ASCA serologies).

· Endoscopy.

· Histology.

· Barium radiography.

· Newer radiologic techniques (CT enterography, MR enterography, tagged WBC scanning, PET scanning).

· Capsule endoscopy.

9. Medical treatment of ulcerative colitis.

· Supportive therapies (anti-diarrheals, anti-spasmodics, analgesics).

· 5-Aminosalicylates (sulfasalazine, mesalamine, balsalazide, olsalazine).

· Corticosteroids.

· Topical therapy (5-ASA and steroids) for proctitis and left-sided disease.

· Antibiotics.

· Purine anti-metabolites (azathioprine, 6-mercaptopurine).

· Methothrexate.

· Cyclosporine.

· Infliximab.

· Probiotics.

· Nicotine.

10. Medical treatment of Crohn’s disease.

· Supportive therapies.

· 5-Aminosalicylates.

· Conventional corticosteroids.

· Budesonide discussed separately.

· Antibiotics.

· Purine anti-metabolites.

· Methotrexate.

· Cyclosporine/tacrolimus.

· Mycophenolate.

· Infliximab (including a discussion of how to minimize antibody formation).

· Other anti-tumor necrosis factor therapies (e.g., adalimumab).

· Other biological therapies studied.

11. Medical treatment of microscopic colitis and pouchitis.

· Pouchitis: antibiotics, probiotics.

· Microscopic colitis: anti-diarrheals, bismuth, budesonide, 5-aminosalicylates, conventional corticosteroids, purine analogs.

12. Surgical indications and therapy in inflammatory bowel disease.

· Emergency indications for both (severe disease, toxic megacolon, bleeding, perforation, obstruction).

· Non-emergent indications (refractory to medical therapy, or adverse events from medical therapy).

· Neoplastic indications.

· Types of surgery for each.

· UC: proctocolectomy with ileostomy, or with ileal pouch-anal anastomosis.

· CD: ileal/ileocolonic resection, stricturoplasty, gastrojejunostomy for gastroduodenal disease, proctocolectomy with ileostomy for colonic, perianal procedures.

· Complications of surgery including pouch dysfunction (exclude pouchitis).

13. Nutritional/dietary treatment of IBD.

· Malnutrition as consequence of IBD.

· Adjunctive treatment of malnutrition.

· Primary therapy for IBD (some evidence for CD, none for UC).

· IBD patients with short bowel syndrome.

14. Integrated management of specific clinical scenarios in IBD.

· Proctitis/left-sided UC.

· Pancolitis (induction, maintenance).

· Steroid-dependent UC.

· AZA-refractory UC.

· Severe UC (in hospital).

· Mild to moderate Crohn’s (induction, maintenance).

· Severe Crohn’s.

· Fistulizing Crohn’s.

· Steroid-dependent Crohn’s

● Provides clear, practical and concise clinical guidance for the whole medical team
● Looks at diagnosis, treatment, and sensitive handling of patients with disorders of the digestive tract
● Covers medical therapy and the integrated management of specific clinical scenarios in IBD
● Considers complications that may occur and looks at long term care of patients through drugs, surgery and dietary modification