Dedication

v

Acknowledgments

xiii

About the Editors

xv

Contributing Authors

xix

Preface

xxiii

Foreword by Stephen B Hanauer, MD, FACG, AGAF

xxv

Question 1

I Recently Did a Colonoscopy on a Patient with Rectal Bleeding the Patient Had Inflammation in the Rectosigmoid and Also in the Cecal Area is this Crohn’s Disease?   Kleanthis Dendrinos, MD and Francis A. Farraye, MD, Msc, FACG, FASGE

1

Question 2

When is it Appropriate to Switch to Another Biologic Therapy?   David T. Rubin, MD, FACG, AGAF and Sonia Friedman, MD

5

Question 3

Is there Ever a Time to Switch 5-Aminosalicyclic Acids in Ulcerative Colitis?   Stephen B. Hanauer, MD, FACG, AGAF

11

Question 4

When and How do You Use Aminosalicylates in Crohn’s Disease? How do You Monitor Response to Therapy with these Agents?   Stephen B. Hanauer, MD, FACG, AGAF

13

Question 5

What is the Role of Concomitant Immunomodulators with Biologic Use in Inflammatory Bowel Disease?   Mark Lazarev, MD and Miguel Regueiro, MD

15

Question 6

What New Drugs have Recently been Released to Treat Inflammatory Bowel Disease? What New Drugs can We Anticipate being Released in the Next 5 Years? How will They Change Our Treatment Algorithms?   Remo Panaccione, MD, FRCPC

21

Question 7

What are the Risks of Biologic Therapies, and How do You Communicate this to Patients?   L. Campbell Levy, MD and Corey A. Siegel, MD

27

Question 8

Should I Measure Thiopurine Methyltransferase Genotype or Enzyme Activity Before Starting a Patient on Azathioprine or 6-Mercaptopurine?   Paul Rutgeerts, MD, PhD, FRCP; Gert Van Assche, MD, PhD; and Séverine Vermeire, MD, PhD

33

Question 9

How do You Monitor Patients on Azathioprine/6-Mercaptopurine?   Miles Sparrow, MB, BS, FRACP

39

Question 10

How Long do You Wait Before Declaring Treatment Failure with Azathioprine/6-Mercaptopurine, and do You Ever Consider Stopping Therapy with these Agents After a Period of Time?   Daniel H. Present, MD, MACG

45

Question 11

My Partner Uses Methotrexate as His First Line Agent in Crohn’s Disease. How do You Choose Between 6-Mercaptopurine and Methotrexate?   A. Hillary Steinhart, MD, Msc, FRCPC

47

Question 12

If I Want to Use Methotrexate for My Patients with Crohn’s Disease, What Dose(S) and What Route of Administration (Subcutaneous, Intramuscular, or Oral) should I Use? is there a Risk of Hepatotoxicity or Pulmonary Toxicity?   A. Hillary Steinhart, MD, Msc, FRCPC

49

Question 13

Which Patients might be Better for a “Top-Down” Approach (Using Anti-Tumor Necrosis Factor Therapy Before Steroids or Proven Failure of Oral Thiopurines)? What Clinical Behavior or Serological Markers might You Use to Identify these Patients?   Sonia Friedman, MD

51

Question 14

How do You Approach Polypoid Lesions in Patient with Inflammatory Bowel Disease?   Francis A. Farraye, MD, Msc, FACG, FASGE

57

Question 15

Should I be Using Chromoendoscopy in My Surveillance Colonoscopy in Inflammatory Bowel Disease? How and Which Agent? would Narrow Band Imaging be an Alternative for This?   David T. Rubin, MD, FACG, AGAF

63

Question 16

Can We Follow Flat Low-Grade Dysplasia? is Any Dysplasia Really Flat or Just a Spectrum of Depth and Size?   Arun Swaminath, MD and Thomas Ullman, MD, FACG

67

Question 17

Can Medications Like Folic Add, Ursodeoxycholic Acid, or 5-Aminosalicyclic Acids Lower the Risk of Colorectal Cancer or Dysplasia in Patients with Inflammatory Bowel Disease?   Bret A. Lashner, MD

71

Question 18

Which of My Inflammatory Bowel Disease Patients should I Screen for Osteoporosis? should I Also Screen for Vitamin D Deficiency?   Kleanthis Dendrinos, MD and Francis A. Farraye, MD, Msc, FACG, FASGE

75

Question 19

How do You Screen and Survey for Dysplasia in Crohn’s Patients? can You Perform Segmental Resection in Crohn’s Patients with Dysplasia?   Sonia Friedman, MD

79

Question 20

What should We be Telling Our Patients and their Pediatricians About Using Anti-Tumor Necrosis Factor Alpha Therapy during Pregnancy?   Maria C. Dubinsky, MD

83

Question 21

What are the Risks to the Fetus and to the Baby Regarding Azathioprine and 6-Mercaptopurine in Pregnancy and Nursing?   Uma Mahadevan-Velayos, MD

87

Question 22

My 25-Year-Old Patient with Crohn’s Disease on Azathioprine was Recently Diagnosed with HPV is it Safe to Continue the Azathioprine?   Sunanda Kane, MD, MSPH, FACG, FACP, AGAF

91

Question 23

What is the Role of Computed Tomographic Enterography in the Diagnosis and Management of Inflammatory Bowel Disease? has it Replaced Barium Radiography?   Edward V. Loftus, Jr., MD

93

Question 24

I Recently Did a Capsule Endoscopy on a Young Patient with Diarrhea the Colonoscopy, Endoscopy, and Biopsies Were All Normal, But the Capsule Showed Several Erosions Scattered Throughout the Small Bowel. is this Crohn’s Disease?   Jonathan A. Leighton, MD, FACG, AGAF

97

Question 25

How do You Diagnose Pouchitis?   Bo Shen, MD, FACG

101

Question 26

How do You Treat Pouchitis?   Kim L. Isaacs, MD, PhD, AGAF

105

Question 27

My Partner Tells me that “Serology 7” Profiles can Predict Which Crohn’s Disease Patients will Progress Rapidly should I Order this for All of My Newly Diagnosed Crohn’s Disease Patients? are there Additional Clinical or Genetic Factors that Identify a High-Risk Group?   Maria C. Dubinsky, MD

109

Question 28

Do Any Medications Slow the Progression of Primary Sclerosing Cholangitis?   Marshall M. Kaplan, MD, MACP

113

Question 29

What is the Best Approach to Dosing Cyclosporine for Severe Ulcerative Colitis? can Infliximab be Used Before Cyclosporine Dosing? can Cyclosporine be Used Before Infliximab?   Seamus J. Murphy, PhD, MRCP and Asher Kornbluth, MD

117

Question 30

When should Bowel Rest or Elemental Feeding be Used in the Management of Crohn’s Disease?   Douglas L. Seidner, MD, FACG and Rene Rivera, MD

121

Question 31

How do You Treat Microscopic Colitis?   Darrell S. Pardi, MD, FACG, AGAF

127

Question 32

Should I Dilate Colonic Strictures in Patients with Crohn’s Disease?   Jerome D. Waye, MD, FACG, AGAF, FASGE

131

Question 33

Is there a Role for Measuring C-Reactive Protein, Erythrocyte Sedimentation Rate, or Fecal Calprotectin in My Inflammatory Bowel Disease Patients?   Paul Rutgeerts, MD, PhD, FRCP; Gert Van Assche, MD, PhD; and Severine Vermeire, MD, PhD

135

Question 34

What is the Definition of Corticosteroid Dependence? How do I Treat Patients with Corticosteroid-Dependent Inflammatory Bowel Disease?   David Kotlyar, BS; Wojciech Blonski, MD, PhD; and Gary R. Lichtenstein, MD

139

Question 35

How can I Clarify the Diagnosis in My Patient with Indeterminate Colitis?   William J. Tremaine, MD

143

Question 36

How should I Treat My Crohn’s Patient Postoperatively?   Russell D. Cohen, MD, FACG, AGAF

147

Question 37

Is it Safe and Effective to Vaccinate My Patient with Inflammatory Bowel Disease?   Carmen Cuffari, MD

151

Question 38

What is the Risk of Developing Lymphoma in My Patients with Crohn’s Disease, and do the Immunomodulators and Biologic Agents Increase the Risk?   Jim D. Lewis, MD, MSCE, AGAF

157

Question 39

How do You Dose 5-Aminosalicyclic Acids? When do You Use Topical Therapy? How do You Monitor during Therapy? Russell D. Cohen, MD, FACG, AGAF

161

Question 40

Do Probiotics have a Role in Treating Inflammatory Bowel Disease Patients?   Joshua R. Korzenik, MD

165

Question 41

What is Your First Line Approach to the Diagnosis and Treatment of Patients with Perianal Crohn’s Disease?   David A. Schwartz, MD

169

Question 42

How do You Handle an Inflammatory Bowel Disease Patient with Clostridium Difficile Infection?   David G. Binion, MD

173

Question 43

How do You Manage Moderate to Severe Duodenal Crohn’s Disease?   Charles N. Bernstein, MD and Linda Tang, MD

177

Question 44

What is the Necessary Testing that should be Performed Before Initiating Biologic Therapy?   David T. Rubin, MD, FACG, AGAF

181

Question 45

How do You Manage Pyoderma Gangrenosum in the Setting of Inflammatory Bowel Disease?   Laura S. Winter Field, MD and Abrar Qureshi, MD, MPH

185

Question 46

My 25-Year-Old Patient has Diffuse Arthralgias can He Take Non-Steroidal Anti-Inflammatory Drugs?   Sarah N. Flier, MD and Adam S. Cheifetz, MD

189

Question 47

My Patient has a History of Breast Cancer and is in Remission from that Condition She Also has Crohn’s Disease can I Use Azathioprine or Infliximab to Treat Her?   Remo Panaccione, MD, FRCPC

193

Question 48

I have a Patient Whose Brother has Crohn’s Disease is there Anything I should Tell Him to Prevent Disease Onset or to Diagnose the Disease Sooner?   Juan L. Mendoza, MD, PhD and Maria T. Abreu, MD

197

Question 49

Is the Diagnosis, Treatment, and Response to Treatment Different in Nonwhites?   Robert Burakoff, MD, MPH, FACG, FACP

201

Index

205