Medical Management of IBD

UC Remission:
- Aminosalicylates:
- can give oral or topically or combined
- Pentasa has earlier release in stomach and SB vs. Asacol and sulfasalazime which are activated more in the colon
- ensure that patient has had an adequate dose prior to declaring the patient has failed on this treatment
- Steroids:
- Immunomodulators:
- cyclosporine: small percentage of the population who have fulminant disease as a bridge to early surgery
- azathioprine/6-MP: steroid refractory patients

CD remission:
- 5-ASA
- Antibiotics
- Steroids: Budesonide - 9 mg: long-term therapy has fewer cushingoid SE but still at risk of osteoporosis

infliximab:
- SE: lymphoma, TB, death
- Present, Et al NEJM 1999; infliximab for fistulizing crohn's disease
Methotrexate:
- complication profile is significant and not generally used often

Indications for surgery:
- failure of medical management: make sure pt just doesn't need better monitoring of taking meds
- obstruction
- bleeding
- perforation
- CD: not operating for cure; managing complications and QOL

Risk of Malignancy:
- UC after 10 years needs 4 quadrant biopsy every 10 cm
- DALM: unless adenoma like then likely requires resection.