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Evaluation of Inflammatory Bowel Disease, An Issue of Gastroenterology Clinics- E-Book

Evaluation of Inflammatory Bowel Disease, An Issue of Gastroenterology Clinics- E-Book

Samir Shah | Edward Feller | Adam Harris

(2012)

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Book Details

Abstract

The Guest Editors have focused on methods of diagnosing and evaluating IBD to help guide optimal treatment to maximize clinical outcomes and minimize risks. Authors have provided state-of-the-art updates with practical information/guidelines/algorithms and cutting-edge data for incorporation into practice. The first set of articles deals with endoscopy: its role in diagnosis and monitoring IBD; the growing importance of chromoendoscopy in IBD surveillance exams; assessment of post-operative recurrence; and finally the emerging role of capsule endoscopy. The second section focuses on specific scenarios that IBD physicians encounter frequently: health maintenance in IBD focusing on proper vaccinations; the growing problem of Clostridium difficile in IBD; assessment of pouch problems; optimal evaluation of perianal disease; the state of the art in using thiopurines including use of allopurinol to optimize metabolites and optimizing the use of infliximab by measuring levels and antibodies to infliximab; factors to consider in choosing monotherapy versus combination therapy and communication of risk/benefit to patients; and finally disability assessment in IBD. The third and final section highlights noninvasive methods to evaluate IBD: clinical predictors of aggressive or disabling disease; the evolving role of specific antibodies in diagnosing, subtyping and most recently prognosticating in IBD; stool markers (calproctectin and lactoferrin) for evaluating and monitoring IBD; the growing role of imaging modalities with emphasis on MR enterography and CT enterography; and finally, the genetics of IBD and the potential role of genetic testing in the diagnosis/prognosis and tailoring of therapy.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Gastroenterology Clinics of North America: Evaluation of Inflammatory Bowel Disease i
Copyright Page ii
Table of Contents vii
Contributors iii
Preface: Evaluation of Inflammatory Bowel Disease xiii
Chapter 1. Endoscopic Assessment of Inflammatory Bowel Disease: Colonoscopy/Esophagogastroduodenoscopy 271
DIAGNOSIS OF IBD BY ENDOSCOPY 271
DISTINGUISHING IBD FROM OTHER DISORDERS 275
ENDOSCOPIC ASSESSMENT OF DISEASE EXTENT AND SEVERITY 277
ENDOSCOPIC ASSESSMENT OF RESPONSE TO TREATMENT 278
DYSPLASIA AND COLORECTAL CANCER SURVEILLANCE 279
THERAPEUTIC ENDOSCOPY 281
SUMMARY 282
REFERENCES 282
Chapter 2. Chromoendoscopy in Inflammatory Bowel Disease 291
DETECTION OF ADENOMAS AND COLITIS-ASSOCIATED DYSPLASIA IN INFLAMMATORY BOWEL DISEASE 291
CHROMOENDOSCOPY 292
SURFACE GUIDELINES AND EXAMINATIONTECHNIQUE 293
NARROW BAND IMAGING 297
CLE 298
SUMMARY 300
REFERENCES 300
Chapter 3. Evaluation for Postoperative Recurrence of Crohn Disease 303
DEFINITION AND PATTERNS OF RECURRENCE 304
RISK FACTORS FOR RECURRENCE 304
ENDOSCOPIC EVALUATION OF POSTOPERATIVE CROHN DISEASE 305
PROPOSED ALGORITHM FOR EVALUATION AND TREATMENT OF POSTOPERATIVE CROHN DISEASE RECURRENCE 310
SUMMARY 311
REFERENCES 311
Chapter 4. The Role of Capsule Endoscopy in Evaluating Inflammatory Bowel Disease 315
PREPARATION 316
CAPSULE ENDOSCOPY FINDINGS ARE NONSPECIFIC 316
SPECIFIC SITUATIONS 317
SUMMARY 320
REFERENCES 320
Chapter 5. Health Maintenance in the Inflammatory Bowel Disease Patient 325
VACCINES 325
GOALS OF VACCINATION 326
LIVE VACCINES 327
INACTIVATED VACCINES 328
HEALTH MAINTENANCE: BEYOND VACCINES 329
SUMMARY 332
REFERENCES 334
Chapter 6. Detecting and Treating Clostridium Difficile Infections in Patients with Inflammatory Bowel Disease 339
BURDEN OF C DIFFICILE INFECTION 339
PATHOGENESIS AND VARIANT STRAINS OF C DIFFICILE 340
RISK FACTORS FOR CDI 341
CLINICAL FEATURES 341
IMPACT OF C DIFFICILE INFECTION ON COURSE OF IBD 342
SPECIAL SITUATIONS RELATED TO CDI IN IBD PATIENTS 342
DIAGNOSIS OF C DIFFICILE INFECTION 343
TREATMENT OF C DIFFICILE INFECTION 344
MANAGEMENT OF RECURRENT DISEASE 347
INFECTION CONTROL 348
GAPS IN RESEARCH 348
SUMMARY 348
REFERENCES 349
Chapter 7. Evaluating Pouch Problems 355
INTRODUCTION AND CLASSIFICATION OF COMPLICATIONS OF ILEAL POUCH 355
CLINICAL EVALUATION 363
ENDOSCOPIC EVALUATION 364
LABORATORY EVALUATION 366
HISTOLOGY 368
ABDOMINAL IMAGING 369
EXAMINATION UNDER ANESTHESIA 369
MOTILITY AND FUNCTIONAL ASSESSMENT 370
TREATMENTS 371
SUMMARY 371
REFERENCES 371
Chapter 8. The Evaluation and Treatment of Crohn Perianal Fistulae: EUA, EUS, MRI, and Other Imaging Modalities 379
IMAGING MODALITIES FOR INITIAL EVALUATION 381
MRI OR EUS TO GUIDE THERAPY AND MONITOR RESPONSE TO THERAPY 384
SURGICAL EVALUATION AND INTERVENTIONS 384
SUMMARY 388
REFERENCES 388
Chapter 9. Optimizing Immunomodulators and Anti-TNF Agents in theTherapy of Crohn Disease 393
OPTIMIZING THIOPURINE THERAPY 394
OPTIMIZING ANTI-TNF THERAPY 399
THE THIOPURINES VIS-À-VIS THE ANTI-TNF MAB’S 404
REFERENCES 405
Chapter 10. Patient-Specific Approach to Combination Versus Monotherapy with the Use of Antitumor Necrosis Factor α Agents for Inflammatory Bowel Disease 411
THE HISTORY OF THE COMBINATION THERAPY VERSUS MONOTHERAPY DEBATE (HOW DID WE GET HERE ANYWAY?) 412
WHAT ARE THE INFECTIOUS RISKS ASSOCIATED WITH COMBINATION THERAPY? 414
IS THERE AN INCREASED RISK OF NHL WITH COMBINATION THERAPY, AND HOW SHOULD WE APPROACH THE RISK OF HSTCL? 415
WHAT IS THE BENEFIT OF COMBINATION THERAPY? 416
WHAT DOES COMBINATION THERAPY MEAN: AZA? MTX? EITHER? 419
ONE SIZE DOES NOT FIT ALL: A SYSTEMATIC APPROACH TO DEVELOP AN ALGORITHM FOR WHEN TO USE COMBINATION THERAPY 420
CAN WE WITHDRAW THE ANTI-TNFα AGENT WHEN A PATIENT ON COMBINATION THERAPY IS DOING WELL? 424
WHAT ARE THE QUESTIONS WE NEED ANSWERED? 424
SUMMARY 424
REFERENCES 424
Chapter 11. Disability in Inflammatory Bowel Disease 429
DEFINING DISABILITY 429
PREDICTORS OF DISABILITY 433
A PRIMER ON DISABILITY BENEFITS 435
SPECIAL ISSUES IN DISABILITY 438
SUMMARY 439
REFERENCES 439
Chapter 12. Clinical Predictors of Aggressive/Disabling Disease: Ulcerative Colitis and Crohn Disease 443
ULCERATIVE COLITIS 443
CROHN DISEASE 452
Summary 458
REFERENCES 458
Chapter 13. The Promise and Pitfalls of Serologic Testing in Inflammatory Bowel Disease 463
PATHOGENESIS 464
CHARACTERISTICS OF IBD ANTIBODIES 465
FALSE-POSITIVE ANTIBODIES 470
IBD SEROLOGIES IN THE DIFFERENTIAL DIAGNOSIS OFGASTROINTESTINAL DISEASES 473
ASSOCIATION WITH DISEASE CHARACTERISTICS 474
SUMMARY 477
REFERENCES 478
Chapter 14. Fecal Markers: Calprotectin and Lactoferrin 483
CLINICAL SIGNIFICANCE OF FECAL BIOMARKERS 483
DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE 484
PREDICTOR OF DISEASE ACTIVITY 486
PREDICTION OF RESPONSE TO TREATMENT 487
PREDICTION OF DISEASE RELAPSE 487
PREDICTION OF MUCOSAL HEALING 488
CD 489
UC 489
PREDICTION OF HISTOLOGIC REMISSION 489
ASSESSMENT AFTER SURGERY 490
POUCHITIS 491
MICROSCOPIC COLITIS 492
SUMMARY 492
REFERENCES 492
Chapter 15. Imaging for Luminal Disease and Complications: CT Enterography, MR Enterography, Small-Bowel Follow-Through, and Ultrasound 497
CROSS-SECTIONAL ENTEROGRAPHY: CTE AND MRE 498
FUTURE DIRECTIONS 509
SUMMARY 509
REFERENCES 510
Chapter 16. Genetics in Diagnosing and Managing Inflammatory Bowel Disease 513
EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE 513
THE COMPLEX LANDSCAPE OF IBD GENETICS 514
GENETIC OVERLAP AMONG AUTOIMMUNE DISEASES 516
GENOMIC MEDICINE 516
DIAGNOSTIC AND THERAPEUTIC GENETICS IN IBD 517
BIOMARKERS AND GENETICS 519
SUMMARY 519
REFERENCES 520
Index 523
Moving ? 539