IBD Notes

** Th summary of AIBD conference in only one slide 2024

** 12 golden points in IBD .

T2T strategy in CD

اللهم اهدنا

using anti- TNF in Patient with MI :-

** The contraindication to using an anti-TNF in heart disease is heart failure.

** There’s a black box warning from the FDA saying that
anti-TNFs should not be used in patients with NYHA classification three or four heart failure.

Ozanimod

- is a selective sphingosine-1-phosphate receptor modulator that has been used for relapsing MS and was recently approved in patients with moderate to severe UC.

- The medication is in pill form with once-daily dosing. This is a newer medication with some limited data. However, it seems effective in patients with mild to moderate UC who are anti-TNF naïve.
Some of the known side effects :-
- infection, malignancy, macular edema, bradycardia, and ele
vated LFTs.

Anti-tumor necrosis factor ( Infliximab , adalimumab, golimumab & certolizumab ) and thiopurines are associated with a small increased risk of lymphoma.

Vedolizumab has not been associated with solid tumor or lymphoma risk.

Thiopurine methyltransferase is recommended before initiating thiopurines to identify patients at high risk for leukopenia

Patients receiving azathioprine should be monitored for lymphopenia with complete blood count with differential periodically

The timing of trough levels should be just prior to the next administration of drug (within 24 hours before the next dose)

1-Tobacco
2-younger age at diagnosis (

Crohn’s disease after an operation is assessed using the Rutgeerts score. Fewer than 5 ulcers (i1) is considered low risk for postoperative recurrence and continuation of current therapy is most appropriate.

More than 5 ulcers would be classified as Rugeerts i2 or greater and medical optimization would be recommended at that time.

Routine endoscopic monitoring 6 to 12 months after surgical resection, with endoscopy-guided treatment is recommended to decrease risk of recurrence of CD, regardless of early postoperative management.

Endoscopic recurrence precedes clinical recurrence so waiting for symptomatic recurrence is too late