Note that both chrons involving colon and UC can cause colon cancer.
More common in Chrons: Mass, Upper GIT, Perianal disease (Perianal Abscess and Fistula), hypocalcemia from fat malabsorption, obstruction, kidney stones (CaOx), gall stones (cholesterol), B12 malabsorption.
Post diagnosis of IBD for 8-10 years you need to screen with colonoscopy every 1-2 years.
Treatment and Management
Treatment for UC and Chrons depends on the severity of the disease. The severity can be objectively evaluated with the following:
Chrons disease: severity is objectively measure via CDAI interpretation.
Mild to Moderate active
Moderate to severely active
Severely active to fulminant disease.
Initial Therapy for UC and Chrons
Mesalamine (not Sulfasalazine) due to side effect: rash, Interstitial nephritis, hemolytic anemia.
Steroids (Prednisone/Budesonide) for both Chrons and UC
Azathioprine or 6MP to wean patient off steroid [both can cause pancreatitis] in severe cases dependent on steroid. All need vitamin D and Calcium.
Recurrent symptoms when steroids are stopped start
Azathioprine, 6-mercaptopurine (6-MP), wean off steroid.
Chronic Maintenance of remission (5-ASA derivatives = mesalamine) different types used
Asacol – UC ; Rowasa – UC (limited to rectum); Pentasa – CD
Sulfasalazine (obsolete version of mesalamine) can cause Rash, AIN,hemolysis, infertility in men (reversible) and Leukopenia.
Metronidazole + Ciprofloxacin (perianal disease in chrons)
Infliximab (Fistula of Chrons or Refractory severe disease of IBD) fistula = severe.
Need PPD/Quantiferon screen and has Joint pain side effect: TNF cause granuloma, hence inhibit can release TB from granuloma
If PPD positive (Isoniazid for 9 months) and CXR negative
No need to wait 9 months to begin therapy infliximab
Newer drugs active only in colon (Balsalazide, Olsalazine)
Vedolizumab: IV for moderate to severe IBD not controlled with other medications. Need for induction and maintenance therapy. Better than Natalizumab due to no documented PML.
Surgery – Curative for UC if refractory to medication. Chrons usually recur at anastomosis but still do due to obstruction/stricture.