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The Curbsiders Internal Medicine Podcast


Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Feb 4, 2019

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!).

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

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