PEDIATRIC INFLAMMATORY BOWEL DISEASE

Size: px
Start display at page:

Download "PEDIATRIC INFLAMMATORY BOWEL DISEASE"

Transcription

1 PEDIATRIC INFLAMMATORY BOWEL DISEASE Alexis Rodriguez, MD Pediatric Gastroenterology Advocate Children s Hospital Disclosers Abbott Nutrition - Speaker Inflammatory Bowel Disease Chronic inflammatory disease of the gastrointestinal tract ~ Can affect any area of GI tract 2 Major Types: ~ Crohn s Disease ~ Ulcerative Colitis Other Types: ~ Indeterminate colitis ~ Very Early Onset (VEO-IBD) Has relapsing and remitting course ~ Goal is to induce and stay in remission Exact pathogenesis poorly understood 1

2 2

3 Environmental Factors Smoking is a risk factor for CD (OR = 1.76; 95% CI: ) - Protective against UC Appendectomy is a risk factor for CD - Protective against UC (OR = 0.31; 95% CI: ) Vitamin D deficiency risk factor for aggressive CD and UC Western diet risk factor for both UC and CD - High sugar - High animal protein - Decreased complex carbohydrates/plant fibers 3

4 Alliment Pharm May 2015; 42(2) 4

5 How common is IBD? Incidence increasing among children Approx 1.6 million Americans with IBD Pediatric Incidence: ~ CD: 10.7/100,000 ~ UC: 12.2/100,000 Pediatric Prevalence: ~ 45, ,000 children with IBD ~ 100,000 cases diagnosed annually Age of Onset 5

6 4/6/18 Children Vs. Adults Similarities with adults: ~ Disease pathophysiology similar ~ Many of the same treatments Differences from adults: ~ Lack of data ~ Not as many treatment options ~ Growth and development issues Presentation Extraintestinal Symptoms Arthropathies Optho: ~ Episcleritis ~ Uveitis Derm: ~ Erythema Nodosum ~ Pyoderma Gangrenosum Liver: ~ Primary Sclerosing Cholangitis 6

7 Initial workup CBC with differential ~ Anemia ~ Thrombocytosis CMP ~ Hypoalbuminemia Inflammatory markers ~ CRP, ESR ~ Stool calprotectin Infectious studies ~ Stool culture, O&P, C.diff Differential Diagnosis Bacteria: Non Infectious: ~ C.diff ~ HSP ~ Yersinia ~ Behcet s ~ TB ~ Celiac Virus: ~ Immunodeficiency ~ HIV ~ Eating disorder ~ CMV ~ Appendicitis ~ EBV ~ Functional Parasites: ~ Amoebiasis ~ Giardiasis Refer to GI 7

8 Crohn s Endoscopy 8

9 UC Endoscopy 9

10 Histology Small Bowel Imaging Upper GI with small bowel follow through MR Enterography Small Bowel Imaging Capsule Endoscopy 10

11 Goals of IBD Treatment Improve growth and nutrition Improve quality of life Maximize therapeutic response Minimize toxicity Prevent disease complications Maximize adherence Promote psychological health INDUCE REMISSION = CLINICAL RESPONSE 11

12 Goals of IBD Treatment Improve growth and nutrition Improve quality of life Maximize therapeutic response Minimize toxicity Prevent disease complications Maximize adherence Promote psychological health INDUCE REMISSION = CLINICAL RESPONSE MUCOSAL HEALING 12

13 Step Up Approach Future Directions Step Down?? Corticosteroids Used to induce remission only ~ Try to wean off as soon as possible Oral, rectal and IV forms available Suppresses active inflammation Can be used for Crohn s and UC ~ Usually started for disease flares ~ Can serve as bridge to maintenance medication Problem with side effects ~ Less with budesonide (Entocort) 13

14 Aminosalicylates Aminosalicylates (5-ASA) Often first line treatment for mild UC ~ unclear efficacy in Crohn s Oral and rectal preparations available ~ combination most effective for distal disease Locally reduce inflammation in the bowel wall ~ no systemic effects Can be used for induction and maintenance Generally well tolerated ~ side effects (headaches, GI symptoms) more with sulfasalazine Adherence can be an issue due to large number of pills Immunomodulators Thiopurines (6-MP, Azathioprine), Methotrexate Suppress immune response that triggers intestinal damage Used for moderate-severe Crohn s and UC ~ Usually for maintenance therapy ~ Takes weeks to reach maximum efficacy levels Side effects: ~ Bone marrow suppression ~ Hepatitis ~ Teratogenic ~ LYMPHOMA 14

15 Biologics Anti TNF-α monoclonal antibodies ~ Pro-inflammatory cytokine involved in IBD ~ Neutralizes TNF-α and down-regulates other proinflammatory cytokines Anti- integrin antibodies ~ Prevents attachment of T cells to vessel walls in gut Anti-IL 12 and 23 cytokines ~ Disrupts cytokine signaling in inflammatory response Used for severe Crohn s and UC Side effects include infections, infusion reactions, lymphoma 15

16 4/6/18 Surgery Usually last resort for medically refractory disease Can involve limited resection, partial colectomy, total colectomy with pouch creation Total colectomy curative for UC 16

17 Exclusive Enteral Nutrition First line for induction therapy for Crohn s in Europe 100% of nutrition by formula ~ No differences in type of formula As effective as steroids in inducing mucosal healing Exact mechanism unknown ~ Possible effect through changing microbiota Cons: ~ Difficult to sustain ~ Cost ~ Resource demands 17

18 THANK YOU 18

Treatment of Inflammatory Bowel Disease. Michael Weiss MD, FACG

Treatment of Inflammatory Bowel Disease. Michael Weiss MD, FACG Treatment of Inflammatory Bowel Disease Michael Weiss MD, FACG What is IBD? IBD is an immune-mediated chronic intestinal disorder, characterized by chronic or relapsing inflammation within the GI tract.

More information

IBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition

IBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition IBD 101 Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Objectives Identify factors involved in the development of inflammatory bowel

More information

IBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition

IBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition IBD 101 Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Objectives Identify factors involved in the development of inflammatory bowel

More information

Efficacy and Safety of Treatment for Pediatric IBD

Efficacy and Safety of Treatment for Pediatric IBD Efficacy and Safety of Treatment for Pediatric IBD Andrew B. Grossman MD Co-Director, Center for Pediatric Inflammatory Bowel Disease Associate Professor of Clinical Pediatrics Division of Gastroenterology,

More information

INFLAMMATORY BOWEL DISEASE. Jean-Paul Achkar, MD Center for Inflammatory Bowel Disease Cleveland Clinic

INFLAMMATORY BOWEL DISEASE. Jean-Paul Achkar, MD Center for Inflammatory Bowel Disease Cleveland Clinic INFLAMMATORY BOWEL DISEASE Jean-Paul Achkar, MD Center for Inflammatory Bowel Disease Cleveland Clinic WHAT IS INFLAMMATORY BOWEL DISEASE (IBD)? Chronic inflammation of the intestinal tract Two related

More information

Medical Therapy for Pediatric IBD: Efficacy and Safety

Medical Therapy for Pediatric IBD: Efficacy and Safety Medical Therapy for Pediatric IBD: Efficacy and Safety Betsy Maxwell, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Pediatric IBD: Defining Remission

More information

NEW CONCEPTS IN CROHN S DISEASE GLENDON BURRESS, MD PEDIATRIC GASTROENTEROLOGY ROCKFORD, IL

NEW CONCEPTS IN CROHN S DISEASE GLENDON BURRESS, MD PEDIATRIC GASTROENTEROLOGY ROCKFORD, IL NEW CONCEPTS IN CROHN S DISEASE GLENDON BURRESS, MD PEDIATRIC GASTROENTEROLOGY ROCKFORD, IL CROHN S DISEASE Chronic disease of uncertain etiology Etiology- genetic, environmental, and infectious Transmural

More information

My Child Has Inflammatory Bowel Disease : Why? What now? What s next?

My Child Has Inflammatory Bowel Disease : Why? What now? What s next? My Child Has Inflammatory Bowel Disease : Why? What now? What s next? George M. Zacur, M.D., M.S. Clinical Assistant Professor Department of Pediatrics and Communicable Diseases Division of Gastroenterology

More information

Efficacy and Safety of Treatment for Pediatric IBD

Efficacy and Safety of Treatment for Pediatric IBD Efficacy and Safety of Treatment for Pediatric IBD Andrew B. Grossman MD Co-Director, Center for Pediatric Inflammatory Bowel Disease Assistant Professor of Clinical Pediatrics Division of Gastroenterology,

More information

Definitions. Clinical remission: Resolution of symptoms (stool frequency 3/day, no bleeding and no urgency)

Definitions. Clinical remission: Resolution of symptoms (stool frequency 3/day, no bleeding and no urgency) CROHN S DISEASE Definitions Clinical remission: Resolution of symptoms (stool frequency 3/day, no bleeding and no urgency) Recurrence: The reappearance of lesions after surgical resection Endoscopic remission:

More information

ULCERATIVE COLITIS. Sean Lynch, MD and Richard Bloomfeld, MD Wake Forest University School of Medicine Winston-Salem, NC

ULCERATIVE COLITIS. Sean Lynch, MD and Richard Bloomfeld, MD Wake Forest University School of Medicine Winston-Salem, NC ULCERATIVE COLITIS Sean Lynch, MD and Richard Bloomfeld, MD Wake Forest University School of Medicine Winston-Salem, NC What is Ulcerative Colitis? Ulcerative colitis (UC) is a disease marked by inflammation

More information

IBD Understanding Your Medications. Thomas V. Aguirre, MD Santa Barbara GI Consultants

IBD Understanding Your Medications. Thomas V. Aguirre, MD Santa Barbara GI Consultants IBD Understanding Your Medications Thomas V. Aguirre, MD Santa Barbara GI Consultants IBD Understanding Your Medications (& Your Doctor) Thomas V. Aguirre, MD Santa Barbara GI Consultants Disclosure I

More information

Inflammatory Bowel Disease When is diarrhea not just diarrhea?

Inflammatory Bowel Disease When is diarrhea not just diarrhea? Inflammatory Bowel Disease When is diarrhea not just diarrhea? Jackie Kazik, MA, PA C CME Resources CAPA Annual Conference, 2011 Inflammatory Bowel Disease Objectives Discuss what is known about the pathophysiology

More information

SURGICAL MANAGEMENT OF ULCERATIVE COLITIS

SURGICAL MANAGEMENT OF ULCERATIVE COLITIS SURGICAL MANAGEMENT OF ULCERATIVE COLITIS Cary B. Aarons, MD Associate Professor of Surgery Division of Colon & Rectal Surgery University of Pennsylvania AGENDA Background Diagnosis/Work-up Medical Management

More information

The Spectrum of IBD. Inflammatory Bowel Disease. Symptoms. Epidemiology. Tests for IBD. CD or UC? Inflamatory Bowel Disease. Fernando Vega, M.D.

The Spectrum of IBD. Inflammatory Bowel Disease. Symptoms. Epidemiology. Tests for IBD. CD or UC? Inflamatory Bowel Disease. Fernando Vega, M.D. The Spectrum of IBD Inflammatory Bowel Disease Fernando Vega, M.D. Epidemiology CD and UC together 1:400 UC Prevalence 1:500 UC Incidence 6-12K/annum CD Prevalence 1:1000 CD Incidence 3-6K/annum Symptoms

More information

Speaker Introduction

Speaker Introduction Speaker Introduction Stephen B. Hanauer, MD Professor of Medicine and Clinical Pharmacology University of Chicago Pritzker School of Medicine Chief of Gastroenterology, Hepatology, and Nutrition University

More information

CCFA. Crohns Disease vs UC: What is the best treatment for me? November

CCFA. Crohns Disease vs UC: What is the best treatment for me? November CCFA Crohns Disease vs UC: What is the best treatment for me? November 8 2009 Ellen J. Scherl,, MD, FACP,AGAF Roberts Inflammatory Bowel Disease Center Weill Medical College Cornell University New York

More information

The National Association of Crohn s and Colitis of Trinidad and Tobago CROHN S DISEASE AND ULCERATIVE COLITIS GENERAL PATIENT INFORMATION

The National Association of Crohn s and Colitis of Trinidad and Tobago CROHN S DISEASE AND ULCERATIVE COLITIS GENERAL PATIENT INFORMATION The National Association of Crohn s and Colitis of Trinidad and Tobago CROHN S DISEASE AND ULCERATIVE COLITIS GENERAL PATIENT INFORMATION You are reading this pamphlet because you or someone you known

More information

Patho Basic Chronic Inflammatory Bowel Diseases. Jürg Vosbeck Pathology

Patho Basic Chronic Inflammatory Bowel Diseases. Jürg Vosbeck Pathology Patho Basic Chronic Inflammatory Bowel Diseases Jürg Vosbeck Pathology General Group of chronic relapsing diseases with chronic bloody or watery diarrhea Usually ulcerative colitis (UC) or Crohn s disease

More information

Crohn's disease CAUSES COURSE OF CROHN'S DISEASE TREATMENT. Sulfasalazine

Crohn's disease CAUSES COURSE OF CROHN'S DISEASE TREATMENT. Sulfasalazine Crohn's disease Crohn's disease is an inflammatory condition of the digestive tract that affects children and adults. Common features of Crohn's disease include mouth sores, diarrhea, abdominal pain, weight

More information

Dietary Options for Inflammatory Bowel Disease

Dietary Options for Inflammatory Bowel Disease Dietary Options for Inflammatory Bowel Disease Michael J. Rosen, MD, MSCI Schubert-Martin Inflammatory Bowel Disease Center Learning objectives Worldwide rise in the incidence of IBD The relationship between

More information

Laurie S. Conklin, M.D. Inflammatory Bowel Disease Program Children s National Medical Center

Laurie S. Conklin, M.D. Inflammatory Bowel Disease Program Children s National Medical Center Laurie S. Conklin, M.D. Inflammatory Bowel Disease Program Children s National Medical Center CROHN S DISEASE Patchy inflammation Mouth to anus involvement Full-thickness inflammation Variable involvement

More information

September 12, 2015 Millie D. Long MD, MPH, FACG

September 12, 2015 Millie D. Long MD, MPH, FACG Update on Biologic Therapy in 2015 September 12, 2015 Millie D. Long MD, MPH, FACG Assistant Professor of Medicine Inflammatory Bowel Disease Center University of North Carolina-Chapel Hill Outline Crohn

More information

Beyond Anti TNFs: positioning of other biologics for Crohn s disease. Christina Ha, MD Cedars Sinai Inflammatory Bowel Disease Center

Beyond Anti TNFs: positioning of other biologics for Crohn s disease. Christina Ha, MD Cedars Sinai Inflammatory Bowel Disease Center Beyond Anti TNFs: positioning of other biologics for Crohn s disease Christina Ha, MD Cedars Sinai Inflammatory Bowel Disease Center Objectives: To define high and low risk patient and disease features

More information

Slide 1 Medications in inflammatory bowel disease a primer for health care providers. Slide 2. Slide 3 Theory of pathogenesis. IBD - epidemiology

Slide 1 Medications in inflammatory bowel disease a primer for health care providers. Slide 2. Slide 3 Theory of pathogenesis. IBD - epidemiology Slide 1 Medications in inflammatory bowel disease a primer for health care providers Athos Bousvaros, MD Associate director Inflammatory Bowel Disease Center Boston Children s Hospital 617 355 2962 Slide

More information

Best Practices in the Diagnosis and Treatment of Inflammatory Bowel Disease

Best Practices in the Diagnosis and Treatment of Inflammatory Bowel Disease Best Practices in the Diagnosis and Treatment of Inflammatory Bowel Disease Mark Lazarev, MD Summary Inflammatory bowel disease (IBD) is a complex disease that is costly both in terms of medical costs

More information

Latest Treatment Updates for Ulcerative Colitis: Evolving Treatment Goals

Latest Treatment Updates for Ulcerative Colitis: Evolving Treatment Goals Latest Treatment Updates for Ulcerative Colitis: Evolving Treatment Goals Stephen Hanauer, MD Professor of Medicine Medical Director, Digestive Disease Center Northwestern Medicine Chicago, Illinois Speaker

More information

New and Emerging Therapies in IBD. Sarah Streett MD, AGAF Clinical Associate Professor of Medicine Stanford University

New and Emerging Therapies in IBD. Sarah Streett MD, AGAF Clinical Associate Professor of Medicine Stanford University New and Emerging Therapies in IBD Sarah Streett MD, AGAF Clinical Associate Professor of Medicine Stanford University New and Emerging Therapies in IBD I have no relevant financial disclosures. IBD is

More information

Anne Griffiths MD, FRCPC. SickKids Hospital, University of Toronto. Buenos Aires, August 16, 2014

Anne Griffiths MD, FRCPC. SickKids Hospital, University of Toronto. Buenos Aires, August 16, 2014 Management and Medical Therapies for Crohn disease: strategies to enhance mucosal healing Anne Griffiths MD, FRCPC SickKids Hospital, University of Toronto Buenos Aires, August 16, 2014 New onset Crohn

More information

Ali Keshavarzian MD Rush University Medical Center

Ali Keshavarzian MD Rush University Medical Center Treatment: Step Up or Top Down? Ali Keshavarzian MD Rush University Medical Center Questions What medication should IBD be treated with? Can we predict which patients with IBD are high risk? Is starting

More information

IBD :- a new era of diagnostics and therapy Dr Martyn Dibb Consultant Luminal Gastroenterologist Royal Liverpool University Hospital

IBD :- a new era of diagnostics and therapy Dr Martyn Dibb Consultant Luminal Gastroenterologist Royal Liverpool University Hospital IBD :- a new era of diagnostics and therapy Dr Martyn Dibb Consultant Luminal Gastroenterologist Royal Liverpool University Hospital Aims To understand the aetiology of IBD To understand the impact that

More information

Moderately to severely active ulcerative colitis

Moderately to severely active ulcerative colitis Adalimumab in the Treatment of Moderate-to-Severe Ulcerative Colitis: ULTRA 2 Trial Results Sandborn WJ, van Assche G, Reinisch W, et al. Adalimumab induces and maintains clinical remission in patients

More information

Treatment Options. Suresh Pola, MD Kaiser San Diego

Treatment Options. Suresh Pola, MD Kaiser San Diego Treatment Options Suresh Pola, MD Kaiser San Diego Overview of Treatments! Medications! Diet! Complementary and Alternative Medicines! How to treat Pain Treatment Goals and Target! Goals of Treatment should

More information

Best Practices in the Diagnosis and Treatment of Inflammatory Bowel Disease

Best Practices in the Diagnosis and Treatment of Inflammatory Bowel Disease Mark Lazarev, MD November 14, 2013 Assistant Professor of Medicine, Johns Hopkins University School of Medicine Best Practices in the Diagnosis and Treatment of Inflammatory Bowel Disease 1 Talk outline

More information

Biologic Therapy for Inflammatory. Is Top-Down Too Top-Heavy? S. Devi Rampertab, MD, FACG, AGAF Associate Professor of Medicine University of Florida

Biologic Therapy for Inflammatory. Is Top-Down Too Top-Heavy? S. Devi Rampertab, MD, FACG, AGAF Associate Professor of Medicine University of Florida Biologic Therapy for Inflammatory Bowel Disease: Is Top-Down Too Top-Heavy? S. Devi Rampertab, MD, FACG, AGAF Associate Professor of Medicine University of Florida Learning Objectives Evaluate evidence

More information

How to manage your IBD patient: Tips for diagnosis and care

How to manage your IBD patient: Tips for diagnosis and care How to manage your patient: Tips for diagnosis and care Oriana M. Damas, M.D. Assistant Prof Clinical Medicine Division of Gastroenterology No relevant disclosures Case Presentation: A.R. 32 yo woman with

More information

Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease

Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease Robert Isfort, M.D. TriHealth Digestive Institute IBD Family Education Day 2019 Learning Objectives Review manifestations

More information

Title: Author: Journal:

Title: Author: Journal: IMPORTANT COPYRIGHT NOTICE: This electronic article is provided to you by courtesy of Ferring Pharmaceuticals. The document is provided for personal usage only. Further reproduction and/or distribution

More information

Από τη θεωρία στη πράξη: Συζήτηση κλινικών περιστατικών. Κωνσταντίνος Κατσάνος Επίκουρος Καθηγητής Γαστρεντερολογίας Πανεπιστήμιο Ιωαννίνων

Από τη θεωρία στη πράξη: Συζήτηση κλινικών περιστατικών. Κωνσταντίνος Κατσάνος Επίκουρος Καθηγητής Γαστρεντερολογίας Πανεπιστήμιο Ιωαννίνων Από τη θεωρία στη πράξη: Συζήτηση κλινικών περιστατικών Κωνσταντίνος Κατσάνος Επίκουρος Καθηγητής Γαστρεντερολογίας Πανεπιστήμιο Ιωαννίνων Conflict of interest By means of this, the speaker confirms that

More information

Top 10 Things you need to know about IBD. Suresh Pola, MD Kaiser San Diego

Top 10 Things you need to know about IBD. Suresh Pola, MD Kaiser San Diego Top 10 Things you need to know about IBD Suresh Pola, MD Kaiser San Diego Top 10 Things to Know: IBD What you can eat How to treat the pain Not all diarrhea is a flare Ways to reduce your risk of getting

More information

Improving outcome of Inflammatory Bowel Disease in children

Improving outcome of Inflammatory Bowel Disease in children Improving outcome of Inflammatory Bowel Disease in children Dinesh Pashankar, MD Pediatric Gastroenterologist Director- Pediatric IBD program Yale University School of Medicine Pediatric Gastroenterology

More information

The ABCs of Inflammatory Bowel Disease. Jennifer Choi, M.D. Associate Director March 31, 2012

The ABCs of Inflammatory Bowel Disease. Jennifer Choi, M.D. Associate Director March 31, 2012 The ABCs of Inflammatory Bowel Disease Jennifer Choi, M.D. Associate Director March 31, 2012 What Will This Talk Cover? What is IBD? What causes it? What are complications of it? How do I find out if I

More information

Disclosures. What Do I Do When Anti-TNF Therapy Is Not Working Anymore? Fadi Hamid, M.D. Saint Luke s GI Specialists

Disclosures. What Do I Do When Anti-TNF Therapy Is Not Working Anymore? Fadi Hamid, M.D. Saint Luke s GI Specialists What Do I Do When Anti-TNF Therapy Is Not Working Anymore? Fadi Hamid, M.D. Saint Luke s GI Specialists Disclosures No financial relationships to disclose. 1 Learning Objectives Case 24M with ileocolonic

More information

Azathioprine for Induction and Maintenance of Remission in Crohn s Disease

Azathioprine for Induction and Maintenance of Remission in Crohn s Disease Azathioprine for Induction and Maintenance of Remission in Crohn s Disease William J. Sandborn, MD Chief, Division of Gastroenterology Director, UCSD IBD Center Objectives Azathioprine as induction and

More information

Understanding Inflammatory Bowel Diseases (IBD):

Understanding Inflammatory Bowel Diseases (IBD): Understanding Inflammatory Bowel Diseases (IBD): What Every Patient Needs to Know William H Holderman, MD Digestive Health Specialists Tacoma, WA Today s Objectives Define IBD, its potential causes and

More information

Position of Biologics in IBD Circa 2006: Top Down vs. Step Up Therapy

Position of Biologics in IBD Circa 2006: Top Down vs. Step Up Therapy Position of Biologics in IBD Circa 2006: Top Down vs. Step Up Therapy Stephen B. Hanauer, MD University of Chicago Potential Conflicts: Centocor/Schering, Abbott, UCB, Elan, Berlex, PDL Goals of Treatment

More information

Indications for use of Infliximab

Indications for use of Infliximab Indications for use of Infliximab Moscow, June 10 th 2006 Prof. Dr. Dr. Gerhard Rogler Klinik und Poliklinik für Innere Medizin I Universität Regensburg Case report 1989: Diagnosis of Crohn s disease of

More information

I B D. etter than this. isease UNDERSTANDING INFLAMMATORY BOWEL DISEASES

I B D. etter than this. isease UNDERSTANDING INFLAMMATORY BOWEL DISEASES I B D m etter than this isease UNDERSTANDING INFLAMMATORY BOWEL DISEASES What types of people have learned how to manage their IBD? Athletes Musicians Firefighters DOCTORS HEROES Artists Presidents Actors

More information

P a g e 1. Inflammatory Bowel Disease Guidelines

P a g e 1. Inflammatory Bowel Disease Guidelines P a g e 1 Inflammatory Bowel Disease Guidelines Introduction Inflammatory bowel disease (IBD) is a chronic inflammatory disease affecting the gastrointestinal (GI) system. It is comprised of two major

More information

New treatment options in UC. Rob Bryant IBD Consultant Royal Adelaide Hospital

New treatment options in UC. Rob Bryant IBD Consultant Royal Adelaide Hospital New treatment options in UC Rob Bryant IBD Consultant Royal Adelaide Hospital Talk Outline 1. Raising expectations 2. Optimising UC therapy 3. Clinical trials 4. What s new on the PBS? 5. Questions 1.

More information

Garrick Brown, MD. Digestive Health Specialists Tacoma Gig Harbor

Garrick Brown, MD. Digestive Health Specialists Tacoma Gig Harbor Garrick Brown, MD Digestive Health Specialists Tacoma Gig Harbor Today s Objectives Define IBD, its potential causes and diagnosis Discuss management and treatment Discuss complementary and alternative

More information

IBD Updates. Themes in IBD IBD management journey. New tools for therapeutic monitoring. First-line treatment in IBD

IBD Updates. Themes in IBD IBD management journey. New tools for therapeutic monitoring. First-line treatment in IBD IBD Updates Maria T. Abreu, MD University of Miami Miller School of Medicine Miami, Florida Themes in IBD 213 First-line treatment in IBD New tools for therapeutic monitoring Biologic therapy for CD and

More information

What is IBD and Why Me?

What is IBD and Why Me? Johns Hopkins Symposium: An Integrative Medicine Approach to Inflammatory Bowel Disease (IBD) What is IBD and Why Me? Steven R. Brant, M.D. Associate Professor of Medicine Director, Meyerhoff Inflammatory

More information

Ulcerative Colitis Therapy. Faculty Disclosure. Acknowledgements 28/11/2013. Amy Morse November 30/13

Ulcerative Colitis Therapy. Faculty Disclosure. Acknowledgements 28/11/2013. Amy Morse November 30/13 Ulcerative Colitis Therapy Amy Morse November 30/13 GI for GP s Jasper AB Faculty Disclosure Faculty: Amy Morse Relationships with commercial interests: Grants/Research Support: Therapeutic Fellowship

More information

My child was diagnosed IBD, Now What?

My child was diagnosed IBD, Now What? My child was diagnosed IBD, Now What? Judy Fuentebella, MD For Educational Purposes Only 1 The good and the bad Good Diagnosis is made We have treatment Disease is manageable Lots of new therapies Bad

More information

INFLAMMATORY BOWEL DISEASE

INFLAMMATORY BOWEL DISEASE National University Faculty of Medicine INFLAMMATORY BOWEL DISEASE Gehan M. Osman, MD. MBBS Pediatrician Jaffar Ibn Auf Specialized Hospital EDUCATIONAL OBJECTIVES Definitions and spectrum of (IBD) Epidemiology

More information

INFLAMMATORY BOWEL DISEASE (IBD): CROHN S DISEASE

INFLAMMATORY BOWEL DISEASE (IBD): CROHN S DISEASE INFLAMMATORY BOWEL DISEASE (IBD): CROHN S DISEASE Symptoms The symptoms of Crohn s disease can vary from person to person, based on where the disease is in the body and how bad the inflammation is. The

More information

Hot Topics In Nutrition & IBD January 6, Kate Vance, RD Wael N. Sayej, MD

Hot Topics In Nutrition & IBD January 6, Kate Vance, RD Wael N. Sayej, MD Hot Topics In Nutrition & IBD January 6, 2018 Kate Vance, RD Wael N. Sayej, MD Nutrients of Focus Calories Calcium Vitamin D Iron Nutritional Treatment in IBD Improve nutritional status As primary therapy

More information

How do I choose amongst medicines for inflammatory bowel disease. Maria T. Abreu, MD

How do I choose amongst medicines for inflammatory bowel disease. Maria T. Abreu, MD How do I choose amongst medicines for inflammatory bowel disease Maria T. Abreu, MD Overview of IBD Pathogenesis Bacterial Products Moderately Acutely Inflamed Chronic Inflammation = IBD Normal Gut Mildly

More information

Current management options and recent advances in IBD

Current management options and recent advances in IBD n DRUG REVIEW Current management options and recent advances in IBD Ben Warner BSc, MRCP and Peter Irving MA, MD, FRCP SPL The advent of biological therapies has revolutionised the management of inflammatory

More information

Dr David Epstein Vincent Pallotti Hospital and University of Cape Town

Dr David Epstein Vincent Pallotti Hospital and University of Cape Town Inflammatory Bowel Disease Management in South Africa in 2016 Pharmaceutical Care Management Association Dr David Epstein Vincent Pallotti Hospital and University of Cape Town Inflammatory Bowel Disease

More information

Michael D. Kreines, M.D.

Michael D. Kreines, M.D. Michael D. Kreines, M.D. Gastroenterology Section Chief Medical Director, IBD Program The Christ Hospital of Cincinnati Ohio GI and Liver Institute www.ohiogi.com This Year s Story How to figure out how

More information

Doncaster & Bassetlaw Medicines Formulary

Doncaster & Bassetlaw Medicines Formulary Doncaster & Bassetlaw Medicines Formulary Section 1.5 Chronic Bowel Disorders (including IBD) Aminosalicylates: Mesalazine 400mg and 800mg MR Tablets (Octasa) Mesalazine 1.2g MR Tablets (Mezavant XL) Mesalazine

More information

Crohn s Disease. Resident Lecture 1/17/19

Crohn s Disease. Resident Lecture 1/17/19 Crohn s Disease Resident Lecture 1/17/19 Objectives Features/Classification of Crohn s Disease Medical Treatment Surgical Indications Surgical Considerations 2 Case 25 yo F presents to your office with

More information

Medical Management of Inflammatory Bowel Disease

Medical Management of Inflammatory Bowel Disease Medical Management of Inflammatory Bowel Disease John K. Marshall MD MSc FRCPC AGAF Division of Gastroenterology McMaster University John K. Marshall: Conflicts of Interest Speaker: AbbVie, Allergan, Ferring,

More information

Pediatric Inflammatory Bowel Diseases

Pediatric Inflammatory Bowel Diseases Pediatric Inflammatory Bowel Diseases Michael Stephens, M.D. Denny Sanford Pediatric Symposium November 21 2014, Sioux Falls, SD 2014 slide-1 Disclosures I have nothing to disclose 2014 slide-2 Objectives

More information

Dr. Elmer Schabel, MD. Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany (No conflicts of interest)

Dr. Elmer Schabel, MD. Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany (No conflicts of interest) EMA workshop on the development of new medicinal products for the treatment of ulcerative colitis and Crohn s disease Overview of authorised medicines for IBD in Europe - previous regulatory positions

More information

What is ulcerative colitis?

What is ulcerative colitis? What is ulcerative colitis? Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells

More information

Pediatric Inflammatory Bowel Disease in Less Than 30 Minutes

Pediatric Inflammatory Bowel Disease in Less Than 30 Minutes Pediatric Inflammatory Bowel Disease in Less Than 30 Minutes Shervin Rabizadeh, M.D., M.B.A. Director, Pediatric Gastroenterology and Pediatric Inflammatory Bowel Disease Program Cedars-Sinai Medical Center

More information

Management of the Hospitalized IBD Patient. Drew DuPont MD

Management of the Hospitalized IBD Patient. Drew DuPont MD Management of the Hospitalized IBD Patient Drew DuPont MD Ulcerative Colitis: Indications for Admission Severe ulcerative colitis Frequent loose bloody stools ( 6 per day) Severe cramps Systemic toxicity:

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 20 October 2010

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 20 October 2010 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 20 October 2010 MEZAVANT LP 1200 mg, prolonged-release gastro-resistant tablets B/60 (CIP code: 378 689-2) Applicant

More information

Crohn s Disease: The First Visit

Crohn s Disease: The First Visit Crohn s Disease: The First Visit Jack A. Di Palma, MD University of South Alabama Mobile, Alabama 1 Adverse Experiences Colombel, SONIC N Engl J Med 2010 Any Adverse Event Serious Adverse Event Azathioprine

More information

IBD in teenagers Biological and Transition

IBD in teenagers Biological and Transition IBD in teenagers Biological and Transition Dr Warren Hyer Consultant Paediatric Gastroenterologist St Mark s Hospital Chelsea and Westminster Hospital Conflict of Interest None to declare Fee for presentation

More information

What Will This Talk Cover? 101: The Basics of Inflammatory Bowel Disease. Terms & Abbreviations. What Is Normal GI Anatomy?

What Will This Talk Cover? 101: The Basics of Inflammatory Bowel Disease. Terms & Abbreviations. What Is Normal GI Anatomy? 101: The Basics of Inflammatory Bowel Disease What Will This Talk Cover? What is IBD? What causes it? What are complications of it? How do I find out if I have IBD? How do we treat IBD? Jennifer Choi,

More information

Mucosal Healing in Crohn s Disease. Geert D Haens MD, PhD University Hospital Gasthuisberg University of Leuven Leuven, Belgium

Mucosal Healing in Crohn s Disease. Geert D Haens MD, PhD University Hospital Gasthuisberg University of Leuven Leuven, Belgium Mucosal Healing in Crohn s Disease Geert D Haens MD, PhD University Hospital Gasthuisberg University of Leuven Leuven, Belgium Mucosal Lesions in CD: General Features CD can affect the entire GI tract

More information

What is Inflammatory Bowel Disease (IBD)?

What is Inflammatory Bowel Disease (IBD)? INFLAMMATORY BOWEL DISEASE (IBD) What is Inflammatory Bowel Disease (IBD)? Inflammatory bowel disease, or IBD, is when there is inflammation, or swelling, in the gastrointestinal (GI) tract and a lifelong

More information

Policy #: 472 Latest Review Date: May 2017

Policy #: 472 Latest Review Date: May 2017 Name of Policy: Fecal Calprotectin Testing Policy #: 472 Latest Review Date: May 2017 Category: Laboratory Policy Grade: A Background/Definitions: As a general rule, benefits are payable under Blue Cross

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 3 October 2012

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 3 October 2012 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 3 October 2012 REMICADE 100 mg, powder for concentrate for solution for infusion B/1 vial (CIP code: 562 070-1) Applicant:

More information

Update in Pediatric IBD: 2018

Update in Pediatric IBD: 2018 Update in Pediatric IBD: 2018 Jeffrey S. Hyams, MD Head, Division of Digestive Diseases, Hepatology and Nutrition Mandell-Braunstein Family Endowed Chair in Pediatric Inflammatory Bowel Disease Connecticut

More information

Managing. Inflammatory Bowel Disease. Slide 1. Slide 2. Slide 3. Disclosures. Vijay Yajnik, MD., PhD 01/25/14. None relevant to this talk

Managing. Inflammatory Bowel Disease. Slide 1. Slide 2. Slide 3. Disclosures. Vijay Yajnik, MD., PhD 01/25/14. None relevant to this talk Slide 1 Managing Inflammatory Bowel Disease Vijay Yajnik, MD., PhD 01/25/14 Slide 2 Disclosures None relevant to this talk 2 Slide 3 Inflammatory Bowel Disease Topics Covered My friend called me and she

More information

INFLAMMATORY BOWEL DISEASE

INFLAMMATORY BOWEL DISEASE 1. Medical Condition INFLAMMATORY BOWEL DISEASE (IBD) specifically includes Crohn s disease (CD) and ulcerative colitis (UC) but also includes IBD unclassified (IBDu), seen in about 10% of cases. These

More information

Judith Collins, MD Assoc Professor of Gastroenterology & Hepatology Inflammatory Bowel Disease Program, OHSU

Judith Collins, MD Assoc Professor of Gastroenterology & Hepatology Inflammatory Bowel Disease Program, OHSU Judith Collins, MD Assoc Professor of Gastroenterology & Hepatology Inflammatory Bowel Disease Program, OHSU Today s Objectives Define IBD, its potential causes and diagnosis Discuss management and treatment

More information

WHAT IS ULCERATIVE COLITIS?

WHAT IS ULCERATIVE COLITIS? 235 60th Street, West New York, NJ 07093 T: (201) 854-4646 F: (201) 854-4647 810 Main Street, Hackensack, NJ 07601 T: (201) 488-0095 Ulcerative Colitis WHAT IS ULCERATIVE COLITIS? Ulcerative colitis is

More information

Disease Management Strategies for Moderate to Severe IBD in Adults

Disease Management Strategies for Moderate to Severe IBD in Adults Disease Management Strategies for Moderate to Severe IBD in Adults Alyssa Parian, MD Assistant Professor of Medicine Johns Hopkins University April 21, 2016 Outline Overview of IBD Treatments (Benefits/Risks)

More information

Implementation of disease and safety predictors during disease management in UC

Implementation of disease and safety predictors during disease management in UC Implementation of disease and safety predictors during disease management in UC DR ARIELLA SHITRIT DIGESTIVE DISEASES INSTITUTE SHAARE ZEDEK MEDICAL CENTER JERUSALEM Case presentation A 52 year old male

More information

OUNCE OF PREVENTION WORTH A POUND OF CURE

OUNCE OF PREVENTION WORTH A POUND OF CURE Healthcare maintenance in the patient with Inflammatory Bowel Disease. OUNCE OF PREVENTION WORTH A POUND OF CURE Your gastroenterologist is NOT your primary care physician Your gastroenterologist is NOT

More information

Positioning Biologics in Ulcerative Colitis

Positioning Biologics in Ulcerative Colitis Positioning Biologics in Ulcerative Colitis Bruce E. Sands, MD, MS Acting Chief, Gastrointestinal Unit Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Sequential Therapies

More information

Medical therapies and IBD

Medical therapies and IBD Medical therapies and IBD Although there is no cure for IBD, there are many treatment options available. There is no standard treatment for IBD that is effective in all situations or for all patients,

More information

New Perspectives on the Diagnosis and Management of IBD. Disclosures

New Perspectives on the Diagnosis and Management of IBD. Disclosures New Perspectives on the Diagnosis and Management of IBD Joel R. Rosh, MD Director, Pediatric Gastroenterology Goryeb Children's Hospital/Atlantic Health Professor of Pediatrics Icahn School of Medicine

More information

Treatment of Pediatric IBD: What is Different?

Treatment of Pediatric IBD: What is Different? Treatment of Pediatric IBD: What is Different? January 13, 2017 Michael Kappelman MD, MPH University of North Carolina at Chapel Hill Overview Is Pediatric IBD the same disease? Treatment considerations

More information

Treatment Goals. Current Therapeutic Pyramids Crohn s Disease Ulcerative Colitis 11/14/10

Treatment Goals. Current Therapeutic Pyramids Crohn s Disease Ulcerative Colitis 11/14/10 Current Management of IBD: From Conventional Agents to Biologics Stephen B. Hanauer, M.D. University of Chicago Treatment Goals Induce and maintain response/ remission Prevent complications Improve quality

More information

What is Crohn's disease?

What is Crohn's disease? What is Crohn's disease? Crohn's disease is a chronic inflammatory disorder that causes inflammation of the digestive tract. It can affect any area of the GI tract, from the mouth to the anus, but it most

More information

Inflammatory Bowel Disease

Inflammatory Bowel Disease Inflammatory Bowel Disease Objectives: NOT FOUND. Team Members: Shrouq alsomali + Basel almeflh + Alaa alaqeel + Raneem alghamdi Team Leader: Haneen Alsubki Revised By: Maha AlGhamdi Resources: 435 team

More information

Clinical Study Clinical Study of the Relation between Mucosal Healing and Long-Term Outcomes in Ulcerative Colitis

Clinical Study Clinical Study of the Relation between Mucosal Healing and Long-Term Outcomes in Ulcerative Colitis Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2013, Article ID 192794, 6 pages http://dx.doi.org/10.1155/2013/192794 Clinical Study Clinical Study of the Relation between

More information

ACG Clinical Guideline: Management of Crohn s Disease in Adults

ACG Clinical Guideline: Management of Crohn s Disease in Adults CLINICAL GUIDELINES 481 CME ACG Clinical Guideline: Management of Crohn s Disease in Adults Gary R. Lichtenstein, MD, FACG1, E dw ard V. L oftus Jr, M D, FAC G 2, Kim L. Isaacs, MD, PhD, FACG3, Miguel

More information

Inflammatory Bowel Disease

Inflammatory Bowel Disease Inflammatory Bowel Disease William Sonnenberg, MD Titusville, PA Disclosure Dr. William Sonnenberg has no conflict of interest, financial agreement, or working affiliation with any group or organization.

More information

What do we need for diagnosis of IBD

What do we need for diagnosis of IBD What do we need for diagnosis of IBD Kaichun Wu Dept. of Gastroenterology, Xijing Hospital Fourth Military Medical University Xi an an,, China In China UC 11.6/10 5,CD 1.4/10 5 Major cause of chronic diarrhea

More information

Understanding Your Benefits and Risks

Understanding Your Benefits and Risks IBD Treatment Options Understanding Your Benefits and Risks benefit risk assessment tool Understand your options. Improve your health... and life. Inflammatory bowel disease (IBD) is two, separate disorders

More information