Gastroenterology
Inflammatory Bowel Disease
Gastroenterology

Inflammatory Bowel Disease

Crohn vs UC + escalation therapy + toxic megacolon.

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◆UC escalation

  • •Mild-moderate: 5-ASA (mesalamine)
  • •Moderate-severe: corticosteroids for flares + immunomodulators (azathioprine, 6-MP)
  • •Severe flare or steroid-refractory: IV corticosteroids → infliximab or cyclosporine
  • •Colectomy if toxic megacolon, perforation, refractory
  • •Surveillance colonoscopy q1–3 yr starting 8 years after dx

◆Crohn escalation

  • •Mild: 5-ASA (mesalamine — safe in sulfa allergy unlike sulfasalazine)
  • •Moderate: immunomodulators (azathioprine, 6-MP, methotrexate)
  • •Severe: anti-TNF (infliximab, adalimumab)
  • •Steroids for flares, NOT maintenance

◆Toxic megacolon

  • •Colon diameter >6 cm + systemic toxicity
  • •Causes: UC, Crohn, C. diff
  • •AVOID anti-motility agents and opioids
  • •Bowel rest, IVF, broad-spectrum abx, IV steroids (NOT in C. diff alone)
  • •C. diff-associated: oral vancomycin ± IV metronidazole
  • •Colectomy if no improvement 24–72 hr or perforation

◆C. difficile

  • •After abx (clindamycin, fluoroquinolones, cephalosporins)
  • •Stool PCR/NAAT for toxin
  • •First-line: oral vancomycin OR fidaxomicin (metronidazole no longer first-line)
  • •Severe: oral vanc + IV metronidazole
  • •Recurrent: fecal microbiota transplant
FeatureCrohn diseaseUlcerative colitis
LocationMouth to anus, skip lesionsContinuous, rectum + colon only
InflammationTransmuralMucosa/submucosa only
ComplicationsFistulas, strictures, granulomasToxic megacolon, colorectal cancer
SmokingWORSENSProtective
B12 deficiencyYes (terminal ileum)No
BleedingLess commonBloody diarrhea common
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