Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Review

Volume 2, Number 4, August 2009, pages 200-208

Common Pitfalls in Management of Inflammatory Bowel Disease

Figure

Figure 1.
Figure 1. The suggested management of dyplasia in IBD

Tables

Table 1. Medications approved for treatment of IBD
 
ClassExamplesIndications
Sulfasalazine and 5-amino salicylatesAzulfidine-Olsalazine, Asacol, Pentasa, BalsalazideMild to moderate UC and CD
CorticosteroidsHydrocortisone, Prednisone, BudesonideUC and CD
ImmunosuppressivesAzathioprine, 6-Mercaptopurine, MethotrexateEvidence for CD > UC. MTX-no role in UC
Anti-TNFα AntibodyInfliximab, Adalimumab, Certolizumab pegolSevere UC (Infliximab)/ all 3 for CD
AntibioticsMetronidazole, Trimethoprim-sulfamethoxazole, Ciprofloxacin, Clarithromycin,Ancillary in treatment of IBD

 

Table 2. Major side effects of medicines used for treatment of IBD
 
Sulfasalazine and 5-ASA compoundsHypersensitivity, sperm abnormalities, blood dyscrasias
CorticosteroidsAdrenal insufficiency, hyperglycemia, edema, osteonecrosis, cataracts myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, altered cell mediated immunity
Azathioprine/ MethotrexateBlood dyscrasia, drug induced hepatitisand pancreatitis. AZA implied in T cell lymphoma, MTX in Hodgkin’s lymphoma
MetronidazoleSeizures, peripheral neuropathy, disulfiram reaction with alcohol
TNF–Alpha inhibitorsAnaphylaxis, superinfections, chest pain or rash, risk of reactivation of tuberculosis, rare occurrence of multifocal leucoencephalopathy

 

Table 3. Common causes of non- flare pain and diarrhea in IBD
 
1. Bile acid diarrhea
2. Increased NSAID use
3. Short gut syndrome
4.Infectious
5. Ischemic
6. Irritable bowel syndrome

 

Table 4. Indications for surgery in IBD
 
Crohn’s diseaseUlcerative colitis
1. Intra-abdominal/ perianal abcess1. Dysplasia complicating long standing UC
2. Complex fistulae2. Recurrent, frequent relapses with poor quality of life despite optimal therapy
3. Mechanical complications like fibrotic strictures3. Fulminant UC unreponsive to medical therapy
4. Fulminant CD unreponsive to medical therapy