Medical Therapy of Inflammatory Bowel Disease - Gastroenterology Clinics of North America Vol 33 Issue 2

Cover......Page 1
Preface......Page 2
Calcineurin inhibitors......Page 4
Clinical pharmacology......Page 5
Clinical response in Crohn’s disease......Page 6
Clinical response in ulcerative colitis......Page 9
Blood concentrations: monitoring and correlation with clinical response......Page 11
Safety of cyclosporine in inflammatory bowel disease......Page 12
Dosing and toxicity monitoring......Page 13
Clinical response in inflammatory bowel disease......Page 14
Clinical response......Page 16
Dosing and toxicity monitoring......Page 19
Clinical response......Page 20
Dosing and toxicity monitoring......Page 23
References......Page 25
Corticosteroid preparations......Page 33
Mechanism of action......Page 34
Systemic corticosteroids......Page 36
Topical corticosteroids......Page 37
Nonsystemic corticosteroids......Page 38
Systemic corticosteroids......Page 39
Nonsystemic corticosteroids......Page 40
Corticosteroids in pregnancy......Page 42
Complications of corticosteroid therapy......Page 43
Summary......Page 45
References......Page 46
Impact of inflammatory bowel disease on quality of life......Page 52
Measures of disease activity in ulcerative colitis......Page 53
5-Aminosalicylic acid agents......Page 54
Corticosteroids......Page 56
Cyclosporine......Page 57
6-Mercaptopurine and azathioprine......Page 58
Measures of disease activity in Crohn’s disease......Page 59
5- Aminosalicylic acid agents......Page 60
Corticosteroids......Page 61
Methotrexate......Page 62
Infliximab......Page 63
Summary......Page 64
References......Page 65
Pharmacology......Page 70
Crohn’s disease......Page 72
Ulcerative colitis......Page 77
Onset of action and duration of therapy......Page 79
Side effects......Page 80
Dosing, metabolite monitoring, and pharmacogenetic testing......Page 83
Drug interactions......Page 86
Pregnancy......Page 87
Summary......Page 88
References......Page 89
Evaluation......Page 96
Management......Page 97
Medical therapies......Page 98
Cyclosporine......Page 99
Infliximab......Page 101
Antibiotics......Page 103
Leukocytopheresis......Page 104
Current treatment strategies......Page 105
References......Page 106
Novel biologics in inflammatory bowel disease......Page 112
Categories of biologics......Page 113
Tumor necrosis factor inhibitors......Page 114
Infliximab......Page 115
Soluble tumor necrosis factor-receptor fusion proteins......Page 116
CDP870......Page 117
Why all tumor necrosis factor inhibitors may not be the same: an immunologic perspective......Page 118
Other cytokine inhibitors......Page 119
Anti-inflammatory cytokines: interleukin-10......Page 120
Natalizumab......Page 121
Antisense oligonucleotide to intercellular adhesion molecule-1 (Isis 2302)......Page 122
Anti-interleukin-2 receptor (CD25) antibodies......Page 123
Signal transduction pathway inhibitors......Page 124
Hematopoietic growth factors......Page 125
References......Page 126
Incidence and prevalence......Page 131
Environmental factors......Page 132
Clinical features......Page 133
Complications......Page 134
Colorectal cancer......Page 135
Management of colitis......Page 136
Aminosalicylates......Page 137
Immunosuppressives......Page 139
Summary......Page 140
References......Page 141
Crohn’s disease: future anti-tumor necrosis factor therapies beyond infliximab......Page 145
A brief review of tumor necrosis factor and strategies for interfering with tumor necrosis factor function......Page 146
Regulation of tumor necrosis factor-alpha......Page 147
Thalidomide......Page 148
Pentoxifylline......Page 150
Etanercept......Page 151
CDP-571......Page 152
Adverse events......Page 154
References......Page 157
Mesalamine derivatives in the treatment of Crohn’s disease......Page 162
Active disease......Page 164
Maintenance......Page 165
Active disease......Page 166
The optimal dose......Page 167
Active disease......Page 168
Maintenance......Page 169
Aminosalicylates as first-line therapy for Crohn’s disease......Page 171
References......Page 172
Establishing accurate diagnosis, disease extent, and disease severity......Page 177
Identifying and managing complications of inflammatory bowel disease......Page 178
Excluding and treating enteric infections......Page 179
Optimizing medication doses......Page 181
Combination and sequential treatment......Page 182
Understanding mechanisms of drug resistance and failure......Page 183
Identifying drug intolerances and side-effects......Page 184
Discontinuing nonsteroidal anti-inflammatory drugs......Page 185
Addressing other important potential factors......Page 186
References......Page 187
Treatment of inflammatory bowel disease with antibiotics......Page 193
Active therapy......Page 194
Fistulous disease......Page 197
Postoperative recurrence......Page 198
Pouchitis......Page 199
Summary......Page 200
References......Page 201
Medical management of postoperative recurrence in Crohn’s disease......Page 204
Assessment of postoperative recurrence......Page 205
Location and disease phenotype......Page 206
Smoking habits......Page 207
Prevention of lesions at the site of the ileocolonic anastomosis......Page 208
Prevention of clinical recurrence......Page 209
Aminosalicylates: sulfasalazine and mesalamine......Page 210
Purine analogues......Page 211
Nitroimidazole antibiotics......Page 212
Algorithm for management of clinical recurrence of Crohn’s disease after curative resection......Page 213
Strategies for the future: where to go from here?......Page 214
References......Page 215
Inheritance......Page 218
Fertility......Page 219
The effects of pregnancy on the course of inflammatory bowel disease......Page 220
The effects of inflammatory bowel disease on the course and outcome of pregnancy......Page 221
Radiologic studies......Page 222
Gastrointestinal endoscopy......Page 223
Aminosalicylates......Page 224
Antibiotics......Page 225
Corticosteroids......Page 227
Azathioprine and 6-mercaptopurine......Page 228
Tacrolimus......Page 229
Infliximab......Page 230
Nonspecific symptomatic agents......Page 231
Summary......Page 233
References......Page 234
Treatment of luminal and fistulizing Crohn’s disease with infliximab......Page 243
Background......Page 244
Pharmacology......Page 245
Approved gastrointestinal indications......Page 246
Other reported uses......Page 249
Toxicity......Page 251
Special considerations......Page 254
Cost......Page 256
References......Page 258
Methotrexate in inflammatory bowel disease......Page 263
Adverse event profile......Page 264
Induction of remission......Page 265
How do these results compare with those obtained with the purine antimetabolites?......Page 269
Use of methotrexate with infliximab......Page 270
Methotrexate for the treatment of ulcerative colitis......Page 271
Methotrexate in clinical practice......Page 272
Summary......Page 273
References......Page 274
Treatment of fistulizing Crohn’s disease......Page 277
Metronidazole......Page 279
6-Mercaptopurine and azathioprine......Page 280
Methotrexate......Page 281
Cyclosporine A......Page 282
Infliximab......Page 283
Novel therapies......Page 285
Simple fistula and fistula in ano......Page 286
Complex fistulas......Page 288
Mucosal advancement flap......Page 290
Enterocutaneous fistula......Page 292
Enteroenteric fistulas......Page 295
Rectovaginal fistula......Page 296
Enterovesical fistula......Page 299
Summary......Page 302
References......Page 303