Inflammatory Bowel Disease: Pathogenesis, Diagnosis and Management

Preface
Contents
Contributors
Chapter 1: Advances in Our Understanding of the Pathogenesis of Inflammatory Bowel Disease
Introduction
Genetic Factors
Gut Microbiome
Lifestyle
Diet
Smoking
Physical and Emotional Stress and Mental Health
Environmental Factors
Pollution
Low Vitamin D
Hygiene Hypothesis
Pharmacological Agents
NSAIDs
Antibiotics
Oral Contraceptives
Vaccines
Surgeries
Appendectomy
Tonsillectomy
Early Life Events
Cesarean Delivery
Breastfeeding
Summary
References
Chapter 2: Diagnosis and Monitoring in Inflammatory Bowel Disease: Who, When, Where, and How
Pathogenesis
Genetics
Microbiome
Epidemiology
Clinical Presentation of Inflammatory Bowel Disease
Clinical Features of Crohn’s Disease
Small Bowel Crohn’s
Perianal Crohn’s
Colonic Crohn’s
Upper Tract Crohn’s
Extraintestinal Manifestations
Clinical Features of Ulcerative Colitis
Diagnostic Evaluation
Imaging
Unique Radiographic Findings in Inflammatory Bowel Disease
Endoscopy
Revised Montreal Classification
References
Chapter 3: Ulcerative Colitis Diagnosis and Management: Past, Present, and Future Directions
Epidemiology and History of Ulcerative Colitis (UC)
Early Medical Therapies: The Pre-Biologic Era
Diagnosis of UC
Clinical Presentation
Laboratory Testing
Endoscopic Examination
Microscopic Examination
Radiographic Imaging
Management of Ulcerative Colitis
Mild Disease
ACG UC Activity Index
Moderate to Severe Disease
ACG UC Activity Index.
Fulminant UC
ACG UC Activity Index
Goals of Therapy: The Evolution of Treat to Target (T2T)
Colonic Dysplasia and Cancer Surveillance
References
Chapter 4: New Developments in the Management of Crohn’s Disease
Introduction
Currently Available Therapies
5-Aminosalicylates (5ASAs), Antibiotics, and Steroids
Immunomodulators
6-Mercaptopurine/Azathioprine (6-MP/AZA)
Methotrexate (MTX)
Biologics
Anti-Tumor Necrosis Factor
Biosimilars
Integrin Inhibitors
Ustekinumab (Stelara)
Small Molecules
Choice of Therapy
Therapeutic Targets
Health-Related Quality of Life (HRQOL)
Therapeutic Drug Monitoring
De-escalation of Therapy
Prevention of Postoperative Recurrence
Therapies Under Investigation for the Management of Crohn’s Disease
Nutrition
Hematopoietic and Mesenchymal Stem Cell Transplantation
Restoring the Microbiome: Fecal Microbiota Transplantation, Prebiotics, and Probiotics
Hyperbaric Oxygen Therapy
Leukapheresis and Extracorporeal Photopheresis
Conclusion
References
Chapter 5: Extraintestinal Manifestations in Inflammatory Bowel Disease
Introduction
Epidemiology
Pathogenesis
Dermatologic Manifestations
Erythema Nodosum
Epidemiology and Diagnosis
Clinical Presentation
Pyoderma Gangrenosum
Epidemiology
Pathophysiology
Clinical Presentation
Treatment
Sweet Syndrome
Pathophysiology and Epidemiology
Clinical Presentation and Diagnosis
Oral Lesions
Epidemiology
Clinical Presentation and Pathophysiology
Anti-TNF-Induced Skin Lesions
Epidemiology and Pathophysiology
Clinical Presentation and Diagnosis
Treatment
Metastatic Crohn’s Disease
Clinical Presentation and Diagnosis
Treatment
Ocular Manifestations
Episcleritis
Clinical Presentation
Treatment
Scleritis
Epidemiology
Clinical Presentation and Diagnosis
Treatment
Uveitis
Epidemiology
Clinical Presentation
Rheumatologic Manifestations
Peripheral Arthropathy/Arthritis
Epidemiology
Clinical Presentation
Axial Arthropathy/Arthritis
Types, Epidemiology, and Clinical Presentation
Treatment
Hepatobiliary Manifestations
Primary Sclerosing Cholangitis (PSC)
Epidemiology
Clinical Presentation
Pathogenesis
Diagnosis
Small Duct PSC
Treatment
Other Organ Systems
Primary Manifestations
Secondary Manifestations
Overlapping Conditions
References
Chapter 6: Infectious Complications in Inflammatory Bowel Disease
Introduction
Therapy for IBD and Infection Risk
Specific Drugs and Drug Classes for the Treatment of IBD
Anti-TNF Agents
Vedolizumab
Ustekinumab
Janus Kinase (JAK) Inhibitor
Infection Risk Based on Organism and Organism Type
Bacterial
Mycobacterium tuberculosis
Nontuberculous Mycobacteria (NTM)
Listeria monocytogenes
Streptococcus pneumoniae
Viral
Herpes Zoster (HZ)
Disseminated Herpes Zoster (DHZ)
Chronic Hepatitis B Virus (HBV)
Chronic Hepatitis C (HCV)
Fungal
Candidiasis
Histoplasmosis
Coccidioidomycosis
Blastomycosis
Aspergillosis
Cryptococcosis
Parasitic
Leishmaniasis
Strongyloides
Preventing Infections in IBD
Taking a History from an Infectious Disease (ID) Perspective
Travel History and Future Plans
Occupation
Hobbies and Activities
Diet
Animal Exposures
Sexual History
Substance Use and Other Practices
Screening Methods for Specific Infections
Tuberculosis
Histoplasmosis and Coccidioidomycosis
Hepatitis B
Strongyloides
Vaccines
Inactivated Vaccines
Tetanus, Diphtheria, and Pertussis Vaccination
Influenza
Streptococcus pneumoniae
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Meningococcal Disease
Live Vaccines
Measles, Mumps and Rubella (MMR)
Varicella
Herpes Zoster
Conclusions
References
Chapter 7: Healthcare Maintenance in the Patient with Inflammatory Bowel Disease: High-Yield Interventions
Introduction
Immunizations
Immunizations: Influenza
Immunizations: Pneumococcal Pneumonia
Immunizations: Varicella and Herpes Zoster
Immunizations: Hepatitis A, B, and C
Immunizations: MMR, HPV, Meningococcal, and Tdap
Screenings
Screenings: Bone Health
Screenings: Eye Health
Screenings: Colon Cancer
Screenings: Skin Cancer
Screenings: Cervical Cancer
Screenings: Depression
Screenings: Fatigue
Screenings: Tobacco
Nutrition
Nutrition: Diet Counseling
Nutrition: Vitamin B12
Nutrition: Iron
Nutrition: Vitamin D
Special Considerations
Special Considerations: Healthcare Maintenance in the Older Adult
Special Considerations: Medication Adherence
Special Considerations: Complementary Medicine
Cannabis
Conclusion
References
Chapter 8: The Woman with Inflammatory Bowel Disease: Fertility, Pregnancy, and beyond
Overview
Fertility
Preconception
Contraception
Healthcare Maintenance
Genetics
Nutrition and Supplements
Disease Control
Medications
Conception
Disease in Remission
Active Disease
Medications
Surgery
Delivery and Postpartum Care
Mode of Delivery
Breastfeeding
Infant Monitoring
Summary
References
Chapter 9: Unique Challenges in the Diagnosis and Management of the Pediatric IBD Patient
Overview
Clinical Manifestations
Differential Diagnosis
Diagnosis
Growth Failure and Poor Weight Gain in IBD
Pathogenesis of Growth Failure
Vitamin and Mineral Deficiencies
Nutritional Assessment
Treatment
Medical
Nutritional
Surgical
Health Maintenance Issues
Immunizations
Psychological Support
Transitioning to Adult Care
Very Early-Onset Inflammatory Bowel Disease (VEO-IBD)
Overview
Clinical Features
Genetics
Treatment
References
Chapter 10: Colon Cancer Screening and Surveillance in the IBD Patient
Epidemiology and Risk Factors
Common Considerations for Ulcerative Colitis (UC) and Crohn’s Disease (CD)
Epidemiology and Risk Factors for Colorectal Cancer in Crohn’s Disease
Epidemiology and Risk Factors for Colorectal Cancer in Ulcerative Colitis
Carcinogenesis in IBD
Role of Inflammation
Genetic Alteration
Free Radical and Immune-Mediated
Microbiome
Surveillance and Intervals
Goals and Considerations of Surveillance
Endoscopic and Histological Considerations Dictating Intervals of Surveillance
Method of Surveillance
Intervals
Future Trends in Surveillance
Chemoprevention
Conclusion
References
Chapter 11: The Utility of Endoscopy in Inflammatory Bowel Disease
Introduction
Screening Guidelines
Typical Endoscopic Findings
Crohn’s Disease
Ulcerative Colitis
Post-op Endoscopic Evaluation in Crohn’s Disease and Ulcerative Colitis
Specialized Endoscopic Evaluations
Therapeutic Endoscopy in IBD
References
Chapter 12: Changing Paradigms in the Management of the Elderly IBD Patient
Introduction
Elderly-Onset vs. Adult-Onset Elderly
Genetics and Pathophysiology
Treatment Considerations
Overview
5-ASA
Steroids
Immunomodulators
Biologic Agents
TNF-Alpha Antagonists
Vedolizumab
Ustekinumab
Tofacitinib
Surgery
Frailty
Cancer and Mortality
COVID-19 and the Elderly IBD Patient
Conclusion
Bibliography
Chapter 13: Surgical Management of the Complex Crohn’s and Ulcerative Colitis Patient: When to Redo a Pouch
Role of the IBD Surgeon
Operative Management of Crohn’s Disease
Surgical Management of UC: Restorative Proctocolectomy with Pelvic Pouch
Surgical Management of Acute Toxic Colitis and Chronic Ulcerative Colitis
When to Redo a Pouch
Redo Pouch Workup
Redo IPAA
References
Chapter 14: The Economics of IBD: Is There a Future for a Medical Home?
Introduction
Healthcare Costs of Pharmacologic Treatment in IBD
Hospitalizations and Surgical Costs
Overall Cost of IBD
IBD Specialty Medical Home
How to Start an IBD Specialty Medical Home?
Conclusion
References
Chapter 15: A Physician Patient’s Perspective: Personal Challenges and the Role of Subspecialist Telemedicine
The Explosion of Telemedicine
Journey Through Telemedicine
What Is Telemedicine?
A Snapshot in the History of Telemedicine
Challenges and Limitations with Telemedicine
Use of Telemedicine in the Era of COVID-19
Future Directions of Telemedicine
References
Chapter 16: IBD in the Time of COVID-19
Introduction
Pathophysiology
Effect of Inflammatory Bowel Disease (IBD) on COVID-19
Effect of COVID-19 on Inflammatory Bowel Disease (IBD)
SARS-CoV-2 Vaccination in Patients with Inflammatory Bowel Disease
Conclusion
References
Index