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Learn expert tips for the diagnosis and management of inflammatory bowel disease (IBD) from Dr. Adam Ehrlich, Assistant Professor of Medicine and co-director of the Inflammatory Bowel Disease Program at Temple University Hospital. In this episode, we learn about the initial work-up, general principles of management, and important primary care considerations for Crohn’s disease and ulcerative colitis (ie endoscopic surveillance, immunizations, bone health/osteoporosis, and more!).
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Credits Written and produced by: Paul Williams MD Edited by: Matthew Watto MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Adam Ehrlich MD Sponsor Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.
Time Stamps 00:00 Sponsor: MKSAP 18 00:32 Disclaimer, Intro, guest bio 04:05 Guest one-liner, Adam’s movie rec - RBG (documentary), career advice, Paul’s movie rec - Edge of Tomorrow 09:25 Sponsor: ACP’s MKSAP 18 11:25 Definitions and pathophysiology of inflammatory bowel disease (IBD) Ulcerative Colitis 13:40 A case of ulcerative colitis; Classic symptoms; Initial approach and basic differential diagnosis 19:10 Smoking and ulcerative colitis 21:17 Initial workup for suspected IBD; Fecal calprotectin 25:50 A bit more on CRP and IBD 26:55 When to refer for colonoscopy 27:58 Back to the case; a typical colonoscopy reports in ulcerative colitis (UC) 30:33 Extraintestinal manifestations of UC 34:50 Initial counseling for newly diagnosed IBD; natural history of IBD, prognosis 39:50 Treatment of ulcerative colitis 43:02 Some specifics on steroids, plus topical therapies Crohn’s disease 47:05 A case of Crohn’s disease; initial approach and differential diagnosis 50:25 Initial diagnostic testing; colonoscopy findings in Crohn’s; IBD trivia 53:58 Treatment of Crohn’s disease 58:26 Specifics about biologic therapy for IBD; Endpoints 62:25 Steroid sparing agents, immunomodulators like azathioprine, 6-mercaptopurine 64:48 Can drug therapy be stopped or tapered in IBD? 66:50 Prognosis in Crohn’s and initial patient counseling Primary Care considerations 68:35 Surveillance endoscopy, 71:47 Do diet and lifestyle changes for IBD work? What about pregnancy? 76:31 Immunizations 79:25 Bone health, osteoporosis and IBD, screening for iron and nutritional deficiencies 82:27 Take home points 86:28 Outro