Gastroenterology

Inflammatory Bowel Disease

Questions discussed in this category

How would you approach the treatment of an SLE patient with refractory mucocutaneous ulcerations and lichenoid skin eruption despite treatment with MMF, Aza, Benlysta, Saphnelo, Rituximab, and JAK inhibitors?

The patient was diagnosed on the basis of ANA 1:1,280, strongly positive Smith, Sm-RNP, dsDNA, pericarditis, inflammatory arthritis, and discoid lupus...

3 Answers available

What diet do you recommend for patients with inflammatory bowel disease?

2 Answers available

How do you incorporate intestinal ultrasound in the care of patients with inflammatory bowel disease?

2 Answers available

What is your advice to patients with IBD who are on biologic therapies and planning for pregnancy?

Do any special adjustments need to be made for any particular biologic therapies?

1 Answer available

Would you consider chemo-RT for duodenal adenocarcinoma s/p resection with at least 1 cm positive margin in a patient with a history of Crohn's disease?

Of note, there is ~150 cc small bowel left and no further surgery was offered.

1 Answer available

When and how should we use biomarkers (i.e., CRP, stool calprotectin, mAb levels) to guide or optimize medical management of Crohn’s disease or ulcerative colitis?

1 Answer available

How would you manage a patient with Crohn's disease on a biologic and presents with non-bloody diarrhea, normal-appearing mucosa on sigmoidoscopy but severe colitis on biopsy with a positive CMV stain?

Would you send a CMV DNA PCR in blood, and if you elect to treat with anti-CMV medication, how long would you treat and what parameters would you use,...

1 Answer available

What is your approach to choosing a particular advanced therapy based on patient or disease factors when initiating treatment for moderate-severe IBD?

1 Answer available

How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?

7 Answers available

Do you feel comfortable using Jak inhibitors in patients with a strong family history of CAD, but no other risk factors?

How do you counsel patients in this scenario?

1 Answer available

How would you manage a patient with highly active ankylosing spondylitis, iritis and Crohn’s, controlled with weekly adalimumab with co-morbid IgG4RD and intolerance of azathioprine due to elevated LFTs?

IgG4 manifestations include autoimmune pancreatitis and periaortic soft tissue mass.

2 Answers available

Do you have concerns with the use of oral contraceptives in patients on JAK inhibitors given the black box warning for thromboembolic events?

How has this impacted your counseling and management?

2 Answers available

Do you consider anti-viral prophylaxis in patients taking JAK inhibitors who have recurrent uncomplicated Zoster infection, but would prefer not changing therapy?

2 Answers available

How would you approach additional workup and management of a patient with active Crohn’s disease, who has multiple lung and brain nodules, with lung pathology demonstrating necrotizing granulomatous inflammation and brain biopsy with granulomatous inflammation and medium-large vessel vasculitis?

The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...

1 Answer available

Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?

1 Answer available

Do you stop TNF inhibitors during the third trimester of pregnancy?

2 Answers available

Which biologics are you comfortable combining with vedolizumab for spondyloarthritis or psoriatic arthritis patients in the setting of well-controlled inflammatory bowel disease?

2 Answers available

What is your approach to continuing or altering therapy when inheriting a patient with combined biologic immunosuppression that is in excess of guidelines?

How do you approach de-escalation or justify therapy maintenance? Do you have tiers of medications that you attempt to de-escalate first? In one parti...

1 Answer available

Would you be comfortable using a JAK inhibitor in a patient with baseline thrombocytosis?

Would the etiology of the thrombocytosis play a role in your decision-making?

1 Answer available

How do you counsel patients about the malignancy risk associated with azathioprine?

1 Answer available

How do you approach the continued use of TNF inhibitors in a patient with inflammatory arthritis who develops a positive dsDNA without clinical evidence of drug-induced lupus?

2 Answers available

Is there a role for regular hepatitis and TB screening in patients on chronic immunosuppressive therapy in the absence of new risk factors or exposures?

1 Answer available

How would you approach new-onset large vessel vasculitis in a young patient with Crohn's disease?

3 Answers available

Is prophylactic anticoagulation indicated in patients with frequent ulcerative colitis flares?

If so, what agent(s) do you prefer?

1 Answer available

How do you approach screening for inflammatory bowel disease prior to starting IL-17 inhibitors?

1 Answer available

Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?

If so, how would positive levels guide your management?

3 Answers available

Would you use an IL-17 inhibitor for a psoriatic arthritis patient with inactive inflammatory bowel disease?

1 Answer available

Would you hold all immunosuppressive medications for the first month of LTBI treatment, or just biologics?

1 Answer available

Do you avoid any specific biologic therapies in HIV positive patients?

1 Answer available

How do you counsel patients who ask if there are any dietary modifications they can make to help control their autoimmune disease?

This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet

1 Answer available

Is it okay to use COX-2 selective NSAIDs in patients with IBD-associated arthritis when the IBD is in remission?

1 Answer available

Would you re-challenge patients who have had a TNF-associated paradoxical adverse event (such as inflammatory bowel disease) with a different TNF inhibitor?

1 Answer available

Is it necessary to hold immunotherapy during a 4-6wk steroid taper after resolution of immunotherapy related toxicity?

Would you ever considering re-starting immunotherapy before completing the taper? According to the new guildelines on managing immunotherapy related ...

1 Answer available