Preface ix
Section I Pathogenesis and Clinical Features 1
1 Epidemiology and Pathogenesis 3
Clinical Take Home Messages 3
Epidemiology 3
Pathogenesis 6
Genetics 6
Microbiome 8
Environmental Triggers 9
Case Studies and Multiple Choice Questions 12
References 13
Answers to Questions 15
2 Clinical Features and Diagnosis of Crohn's Disease 17
Clinical Take Home Messages 17
Clinical Features 19
Disease Course and Natural History 20
Diagnosis 21
History and Physical Examination 21
Laboratory Investigations 22
Serologic Markers 23
Endoscopy 23
Histology 25
Imaging Studies 25
Case Studies and Multiple Choice Questions 27
References 28
Answers to Questions 31
3 Clinical Features and Diagnosis of Ulcerative Colitis 33
Clinical Take Home Messages 33
Clinical Features 34
Disease Course and Natural History 35
Diagnosis 35
History and Physical Examination 36
Laboratory Investigations 36
Serologic Markers 37
Endoscopy 37
Histology 39
Imaging Studies 40
Differential Diagnosis (UC and CD) 40
Case Studies and Multiple Choice Questions 44
References 45
Answers to Questions 47
4 Extraintestinal Manifestations of Inflammatory Bowel Diseases 49
Clinical Take Home Messages 49
Arthritis and Arthropathy 50
Metabolic Bone Disease 51
Cutaneous Manifestations 52
Hepatobiliary Manifestations 53
Ophthalmologic Manifestations 55
Renal Complications 55
Thromboembolic and Cardiovascular Complications 56
Case Studies and Multiple Choice Questions 57
References 58
Answers to Questions 61
Section II Therapeutic Agents 63
5 Aminosalicylates 65
Clinical Take Home Messages 65
Efficacy in Ulcerative Colitis 66
Efficacy in Crohn's Disease 68
Safety 68
Multiple Choice Questions 70
References 71
Answers to Questions 73
6 Corticosteroids 75
Clinical Take Home Messages 75
Efficacy in Ulcerative Colitis 76
Efficacy in Crohn's Disease 77
Safety 78
Case Studies and Multiple Choice Questions 80
References 81
Answers to Questions 83
7 Immunomodulators 85
Clinical Take Home Messages 85
Thiopurines 85
Efficacy in Ulcerative Colitis 87
Efficacy in Crohn's Disease 88
Safety 89
Methotrexate 90
Efficacy in Ulcerative Colitis 90
Efficacy in Crohn's Disease 91
Safety 91
Calcineurin Inhibitors 91
Efficacy in Ulcerative Colitis 91
Efficacy in Crohn's Disease 93
Case Studies and Multiple Choice Questions 94
References 95
Answers to Questions 99
8 Biologic Therapies 101
Clinical Take Home Messages 101
Infliximab 102
Efficacy in Ulcerative Colitis 102
Efficacy in Crohn's Disease 105
Safety 108
Adalimumab 110
Efficacy in Ulcerative Colitis 110
Efficacy in Crohn's Disease 111
Certolizumab Pegol 112
Efficacy in Crohn's Disease 113
Newer Therapies 115
Case Studies and Multiple Choice Questions 116
References 117
Answers to Questions 121
9 Antibiotics 123
Clinical Take Home Messages 123
Efficacy in Ulcerative Colitis 123
Efficacy in Crohn's Disease 124
Other Microbial Modification Methods - Probiotics and Fecal Microbiota Transplantation 125
Multiple Choice Questions 126
References 127
Answers to Questions 129
Section III Management 131
10 Medical Management of Ulcerative Colitis 133
Clinical Take Home Messages 133
Assessment of Extent, Activity, and Severity 133
Limited Colitis - Proctitis, Proctosigmoiditis, and Left¿sided Colitis 135
Pancolitis 136
Mild to Moderate Disease 137
Moderate to Severe Disease 138
Severe Disease 140
Case Studies and Multiple Choice Questions 142
References 144
Answers to Questions 146
11 Medical Management of Crohn's Disease 149
Clinical Take Home Messages 149
Mild to Moderate Disease 150
Moderate to Severe Disease 151
Case Studies and Multiple Choice Questions 154
References 156
Answers to Questions 157
12 Surgical Management of Inflammatory Bowel Diseases 159
Clinical Take Home Messages 159
Surgery for Ulcerative Colitis 159
Pouch¿related Complications in Ulcerative Colitis 161
Surgery for Crohn's Disease 163
Prophylaxis for Prevention of Postoperative Recurrence in Crohn's Disease 164
Case Studies and Multiple Choice Questions 167
References 168
Recommended Reading 169
Answers to Questions 170
13 Complications of Inflammatory Bowel Diseases 171
Clinical Take Home Messages 171
Complications of Ulcerative Colitis 172
Toxic Megacolon and Perforation 172
Colonic Strictures 173
Clostridium difficile and Cytomegalovirus Colitis 173
Colorectal Dysplasia and Cancer 174
Magnitude and Risk Factors 174
Surveillance for Dysplasia and Cancer 175
Management of Dysplasia 175
Chemoprevention 176
Complications of Crohn's Disease 176
Fibrostenosis and Strictures 176
Abscesses 177
Fistulizing Crohn's Disease 178
Small¿bowel Cancer 181
Case Studies and Multiple Choice Questions 182
References 184
Answers to Questions 187
Section IV Special Considerations 189
14 Nutrition in Inflammatory Bowel Diseases 191
Clinical Take Home Messages 191
Malnutrition and Micronutrient Deficiencies 191
Dietary Therapies for Inflammatory Bowel Diseases 193
Case Studies and Multiple Choice Questions 194
References 195
Answers to Questions 197
15 Pregnancy, Conception, and Childbirth 199
Clinical Take Home Messages 199
Fertility 199
Effect of Pregnancy on Disease 200
Effect of Disease on Pregnancy 200
Maternal Medication Use During Pregnancy 201
Paternal Medication Use 203
Inheritance 203
Case Studies and Multiple Choice Questions 204
References 205
Answers to Questions 207
16 Inflammatory Bowel Disease During Childhood and Adolescence 209
Clinical Take Home Messages 209
Epidemiology and Clinical Features 209
Treatment of Pediatric Inflammatory Bowel Disease 210
Very Early¿onset Inflammatory Bowel Disease 211
Transition of Care in Pediatric Crohn's Disease 211
Case Studies and Multiple Choice Questions 213
References 214
Answers to Questions 216
Index 217
