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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Characterize the pathophysiologic mechanisms underlying inflammatory bowel disease (IBD).

  2. Recognize the signs and symptoms of IBD, including major differences between ulcerative colitis (UC) and Crohn's disease (CD).

  3. Identify appropriate therapeutic outcomes for patients with IBD.

  4. Describe pharmacologic treatment options for patients with acute or chronic symptoms of UC and CD.

  5. Create a patient-specific drug treatment plan based on symptoms, severity, and location of UC or CD.

  6. Recommend appropriate monitoring parameters and patient education for drug treatments for IBD.

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KEY CONCEPTS

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  • Image not available. Inflammatory bowel disease (IBD) includes both ulcerative colitis (UC) and Crohn's disease (CD) and is associated with chronic inflammation of various areas of the GI tract.

  • Image not available. Differentiation of UC and CD is based on signs and symptoms as well as characteristic endoscopic findings including the extent, pattern, and depth of inflammation.

  • Image not available. Patients may manifest extraintestinal symptoms of IBD, such as arthritis, primary sclerosing cholangitis, erythema nodosum, and pyoderma gangrenosum, among others.

  • Image not available. Major treatment goals for patients with IBD include alleviation of signs and symptoms, induction of remission, suppression of inflammation during acute episodes, and maintenance of remission thereafter.

  • Image not available. When designing a drug regimen for treatment of IBD, several factors should be considered, including the patient's symptoms, medical history, current medication use, drug allergies, and location and severity of disease.

  • Image not available. Antidiarrheal medications that reduce GI motility, such as loperamide, diphenoxylate/atropine, and codeine, should be avoided in patients with active IBD due to the risk of precipitating acute colonic dilation (toxic megacolon).

  • Image not available. Treatment of acute episodes of UC is dictated by the severity and extent of disease, and first-line therapy of mild to moderate disease involves oral or topical aminosalicylate derivatives.

  • Image not available. Maintenance of remission of UC may be achieved with oral or topical aminosalicylates. Immunosuppressants such as azathioprine, 6-mercaptopurine (6-MP), or infliximab can be used for unresponsive patients or those who develop corticosteroid dependency.

  • Image not available. Treatment of active mild to moderate CD involves use of oral budesonide or oral or topical aminosalicylate derivatives, whereas moderate to severe disease may require systemic corticosteroid or anti-tumor necrosis factor (anti-TNF) antibody therapy.

  • Image not available. Maintenance of remission of CD may be achieved with immunosuppressants (azathioprine, 6-MP, or methotrexate), biologic agents (infliximab, adalimumab, certolizumab pegol, or natalizumab), and less frequently with oral or topical aminosalicylate derivatives.

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INTRODUCTION

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Image not available. Inflammatory bowel disease (IBD) encompasses both Crohn's disease (CD) and ulcerative colitis (UC). Both disorders are associated with chronic inflammation of various regions within the GI tract. Differences exist between UC and CD with regard to the regions of the GI tract that may be affected as well as in the distribution and depth of inflammation. Some patients with IBD may also have inflammation involving organs other than the GI tract, known as extraintestinal manifestations. Symptoms of IBD are associated with significant morbidity, reduction in quality of life, and substantial costs to the healthcare system. ...

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