IBD Patient UpdateIBD Patient UpdateCase VignettesCase Vignettes

12 November 201112 November 2011

Case #1Case #1

J.O. is a 22 yo graduate student diagnosed with J.O. is a 22 yo graduate student diagnosed with Ulcerative proctosigmoiditis 2 years ago and has Ulcerative proctosigmoiditis 2 years ago and has been treated 5-ASA three tabs 3x daily (3.6g). been treated 5-ASA three tabs 3x daily (3.6g).

Since beginning grad school, he has had Since beginning grad school, he has had increased fecal urgency, and rectal bleeding.increased fecal urgency, and rectal bleeding.

Non smokerNon smoker

no NSAIDs no NSAIDs

““usually takes at least 1 tab of 5-ASA a day”usually takes at least 1 tab of 5-ASA a day”

Case #1 questionsCase #1 questions

Is this my U.C.? How can I tell?Is this my U.C.? How can I tell?

Do I really need to take my medicines as Do I really need to take my medicines as prescribed?prescribed?

Do I need to step-up my regimen? Do I need to step-up my regimen?

Is there an alternative to my regimen?Is there an alternative to my regimen?

Can stress affect my symptoms?Can stress affect my symptoms?

Case #2Case #2

W.B. is a 41 yo male with a 15 year history W.B. is a 41 yo male with a 15 year history of ileo-colonic Crohn’s diseaseof ileo-colonic Crohn’s disease

Treated with Azathioprine for past 5 yrs Treated with Azathioprine for past 5 yrs

Over the past year, he has had two Over the past year, he has had two hospitalizations for partial small bowel hospitalizations for partial small bowel obstructionobstruction

CT Enterography identified 2 cm stricture CT Enterography identified 2 cm stricture in the distal ileum.in the distal ileum.

Case #2 QuestionsCase #2 Questions

What are the surgical options for the What are the surgical options for the management of small bowel Crohn’s management of small bowel Crohn’s strictures?strictures?

Are there any medical options for the Are there any medical options for the management of these strictures?management of these strictures?

Case #3Case #3

S.E. is a 28 yo female with Crohn’s S.E. is a 28 yo female with Crohn’s ileocolitis who has had worsening symptoms ileocolitis who has had worsening symptoms over the past few months while on Pentasa. over the past few months while on Pentasa.

Last week she was started on Last week she was started on Azathioprine. Azathioprine.

Developed severe nausea, vomiting and Developed severe nausea, vomiting and abdominal discomfort and discontinued the abdominal discomfort and discontinued the medication. medication.

Case #3 QuestionsCase #3 Questions

What are some of the risks and side What are some of the risks and side effects of Azathioprine?effects of Azathioprine?Is there any way to mitigate potential risks Is there any way to mitigate potential risks before starting Azathioprine?before starting Azathioprine?If I develop side effects from Azathioprine If I develop side effects from Azathioprine are there other options available to me?are there other options available to me?If prescribed a new medication, how long If prescribed a new medication, how long will I need to be on it?will I need to be on it?

Case #4Case #4

JR is a 45 yo male with 2 year history of JR is a 45 yo male with 2 year history of ulcerative pancolitisulcerative pancolitis

Asacol 3.6g and AZA of 100mg dailyAsacol 3.6g and AZA of 100mg daily

Over past few months Over past few months – increasing fecal urgency increasing fecal urgency – recurrence of rectal bleedingrecurrence of rectal bleeding

Stool negative for C. DifficileStool negative for C. Difficile

Anemia and increased ESR and CRPAnemia and increased ESR and CRP

Flex sig showed: severe inflammationFlex sig showed: severe inflammation

Case #4 QuestionsCase #4 Questions

F.S. started on prednisone 40mg dailyF.S. started on prednisone 40mg daily

How long will I be on Prednisone?How long will I be on Prednisone?

Do I need to change my medical regimen?Do I need to change my medical regimen?

Will I need a colectomy?Will I need a colectomy?

Case #5Case #5

S.S. is a 28 yo female with a 2 year history of left-S.S. is a 28 yo female with a 2 year history of left-sided UC diagnosed by colonoscopy sided UC diagnosed by colonoscopy

Canasa suppositories and Asacol 2.4g/dayCanasa suppositories and Asacol 2.4g/day– Her symptoms resolved. Her symptoms resolved.

Discontinued Asacol after a few monthsDiscontinued Asacol after a few monthsDiscontinued Canasa suppositories 6 mos ago Discontinued Canasa suppositories 6 mos ago Over the past 3 mos - Diarrhea and bloody stool Over the past 3 mos - Diarrhea and bloody stool Presented to ED - felt to be a UC flare. Presented to ED - felt to be a UC flare.

Routine urine pregnancy test is positive.Routine urine pregnancy test is positive.

Case #5 QuestionsCase #5 Questions

Doesn’t my disease affect my chances of Doesn’t my disease affect my chances of having become pregnant?having become pregnant?

Does my disease affect my pregnancy?Does my disease affect my pregnancy?

Will my pregnancy affect my disease?Will my pregnancy affect my disease?

Are my medications safe during pregnancy?Are my medications safe during pregnancy?

If my symptoms don’t continue to improve If my symptoms don’t continue to improve do I have other medical options?do I have other medical options?

Case #6Case #6

D.F. is a 45 yo male with Crohn’s pan-colitis D.F. is a 45 yo male with Crohn’s pan-colitis diagnosed 8 years ago who is asymptomatic diagnosed 8 years ago who is asymptomatic on 5-ASA 2.4g daily. on 5-ASA 2.4g daily.

He underwent colonoscopy by his He underwent colonoscopy by his gastroenterologist to survey for dysplasia. gastroenterologist to survey for dysplasia.

Random biopsies were taken throughout Random biopsies were taken throughout his colon. No dysplasia was seen. He was his colon. No dysplasia was seen. He was told to have a repeat colonoscopy in 1-2 told to have a repeat colonoscopy in 1-2 years.years.

Case #6 QuestionsCase #6 Questions

Is there increased risk of colon cancer in Is there increased risk of colon cancer in Crohn’s disease?Crohn’s disease?

What is dyplasia?What is dyplasia?

How often should I undergo colonoscopy How often should I undergo colonoscopy to look for precancerous changes?to look for precancerous changes?

Is there anything I can do to decrease my Is there anything I can do to decrease my risk of dysplasia and colorectal cancer?risk of dysplasia and colorectal cancer?

Case #7Case #7

F.S. is a 36 yo male contractor with Crohn’s F.S. is a 36 yo male contractor with Crohn’s ileocolitis which has been well managed on ileocolitis which has been well managed on azathioprine 100mg daily. azathioprine 100mg daily.

He recently started a new job 2 months ago. He recently started a new job 2 months ago. Every weekday morning while at work he has Every weekday morning while at work he has urgency, bloating and lower abdominal cramping urgency, bloating and lower abdominal cramping which resolves by the evening. He was which resolves by the evening. He was asymptomatic during a recent 7 day vacation. asymptomatic during a recent 7 day vacation. However, symptoms recurred upon his return.However, symptoms recurred upon his return.

Case #7 Questions Case #7 Questions

Is this my Crohn’s disease?Is this my Crohn’s disease?

Are there tests to help decide if this is my Are there tests to help decide if this is my IBD or IBS?IBD or IBS?

Are there certain foods I should avoid that Are there certain foods I should avoid that may be complicating my symptoms?may be complicating my symptoms?

Is it safe for me to take anti-diarrheals?Is it safe for me to take anti-diarrheals?

What change in symptoms should be of What change in symptoms should be of concern?concern?

Case #8Case #8

ZE is a 19 yo female recently diagnosed with ZE is a 19 yo female recently diagnosed with Ulcerative Colitis during an evaluation for Ulcerative Colitis during an evaluation for rectal bleeding and fecal urgency.rectal bleeding and fecal urgency.

She was initially treated with 5-ASAShe was initially treated with 5-ASA

Elected to pursue a homeopathic approach Elected to pursue a homeopathic approach – discontinued her 5-ASA therapydiscontinued her 5-ASA therapy

She has had recurrence of rectal bleeding She has had recurrence of rectal bleeding and abdominal pain prompting a hospital and abdominal pain prompting a hospital admissionadmission

Case #8 QuestionsCase #8 Questions

What are the real risks of my medical What are the real risks of my medical therapy?therapy?

What are the risks of not taking my What are the risks of not taking my medical therapy?medical therapy?

What nutritional options are available?What nutritional options are available?

What stress management options area What stress management options area available?available?