Clinical Dilemmas in Inflammatory Bowel Disease (eBook)

Peter Irving, Centre for Gastroenterology, Institute of Celland Molecular Science, Barts and the London, Queen Mary School ofMedicine and Dentistry, London, UK. David Rampton, Professor of Clinical Gastroenterology atthe Centre for Gastroenterology, Institute of Cell and MolecularScience, Barts and the London, Queen Mary School of Medicine andDentistry, London, UK. Fergus Shanahan, Professor and Chair of the Department ofMedicine, National University of Ireland Cork, Cork UniversityHospital, Cork, Eire.

Clinical Dilemmas in: Inflammatory Bowel Disease 5
Contents 7
List of Contributors 10
Preface 15
Part 1 Investigating IBD in the 21st Century 17
1 Capsule endoscopy: do we need it? 17
2 Pathology reports – pitfalls for the unwary 21
3 Non-invasive diagnosis and assessment 24
4 What is the best way to image perianal Crohn's disease? 27
5 Surveillance colonoscopy in UC: alternatives and ways to improve outcome 31
6 Abnormal liver tests – what should we do about them? 34
Part 2 Medical Treatment: Making the Most of What We've Got – 5-ASA drugs 37
5-ASA drugs 37
7 Is monitoring necessary? 37
8 Do they have a role in Crohn's disease? 41
Steroids 44
9 Steroids in Crohn's: are they obsolete? 44
Antibiotics for Crohn’s disease 48
10 Antibiotics: which, when, and for how long? 48
11 M ycobacterium av ium paratuberculosis in Crohn's disease: player or spectator? 52
Immunomodulators 56
12 TPMT testing: is it essential? 56
13 6-Mercaptopurine or azathioprine? 61
14 Thiopurines: how long should we use them for? 64
15 Making the most of methotrexate 67
16 Cyclosporine: balancing risk and benefit 71
Infliximab 75
17 Contraindications – absolute or relative? 75
18 How can we prevent tuberculosis? 79
19 Dealing with infusion reactions 83
20 Use in ulcerative colitis 86
21 Infliximab and surgery: health or hazard? 90
Nutritional therapy for Crohn’s disease 93
22 Nutritional therapy for Crohn's disease: is it for adults? 93
Part 3 Medical Treatment: What's Round the Corner? 97
23 Trials and tribulations – interpreting clinical trials in IBD 97
24 Genetics – clinical and therapeutic applications 101
25 Probiotics – separating science from snakeoil 105
26 Worms 109
27 Smoking and nicotine – poison for Crohn's, potion for colitis? 112
28 Heparin 116
29 Leukocytapheresis: filtering out the facts 121
30 Appendectomy for ulcerative colitis – a therapeutic option? 124
31 Biologic treatments in IBD 127
32 Stem cell transplantation for IBD 132
33 Complementary and alternative therapy – the way forward or a step back? 137
Part 4 Common Clinical Challenges: Beyond the Text Book 141
34 Functional problems 141
35 Psychological stress: something to worry about? 145
36 Drugs to avoid 149
37 NSAIDs and COX-2 selective agents: cause or cure of pain in IBD? 152
38 Iron replacement – is it safe and effective? 155
39 Hepatitis B and C viruses – how do they affect management of IBD? 158
40 Pregnancy: what drugs can we use? 162
41 How to prevent growth failure in children 166
42 Predicting outcome in severe UC 169
43 Refractory proctitis 172
44 CMV co-infection – does it matter? 175
45 Treatment of oral Crohn's disease 180
46 Pathophysiologic approach to treatment of diarrhea in Crohn's disease 184
47 Short bowel 187
48 Management of internal fistulae 191
49 What is indeterminate colitis? 195
50 Pouches for indeterminate colitis? 198
51 Colitis-associated cancer: what's the risk to your patients? 201
52 What to do with dysplasia, DALMs, and adenomas 205
Part 5 Managing IBD Outside the Gut 209
53 Pyoderma gangrenosum 209
54 Arthritides – helping the joints without harming the gut 213
55 Prevention and treatment of osteoporosis 217
56 Sclerosing cholangitis – what to do? 221
57 Thromboembolic disease: an under-recognized complication? 225
58 Pulmonary manifestations: rare but real 229
Part 6 Are You Sure it's IBD? 233
59 Intestinal infections: mimics and precipitants of relapse 233
60 Microscopic colitis 238
61 Diverticular colitis 242
Part 7 The IBD Service: Time for a Rethink? 245
62 Outpatient services – do doctors still have a role? 245
63 Shared care: tactical team selection 249
64 Databases – are they worth the bother? 253
Index 257

"I particularly enjoyed the chapter on managing inflammatory boweldisease in the context of hepatitis B and C, and the pithy andinformed reviews on probiotics, heparin and the role of stress,which will be of value to all doctors (and surgeons) managing thesedesease...This volume will provide a useful synopsis andintroduction to the literature for many of the problems that areencountered on a daily basis whether in the clinic or on theward."
Gut

"This book is a successful compendium of clinical wisdom andcommon sense approaches...the editors have achieved admirably theirgoal of a "user-friendly" IBD resource for the busyclinician dealing with the demands of an IBD patient."
Gastroenterology

"It is a fantastic book...to have in a busy clinic or on theward which will also provide references for further reading aroundthe subject at a more leisurely ace away from the busyworkplace."
TiGs

"This concise and very readable text is great for allinvolved in looking after IBD patients from GPs and practisenurses, to nurse practitioners and SpRs. It highlights many currenthot topics and provides the evidence for the conclusions drawn.Each chapter is easily read between patients and references theplaces to go for a more extensive review of the topics in question.A great summary of subjects in the field, it doesn't pretend to bea comprehensive text."
Doctor on Amazon.co.uk

"Everyone...will doubtless learn about several important points[...] and this is probably an ideal invitation to further deepenhis knowledge. A very pleasant, modern book which will beappreciated by established and trainee gastroenterologists,colorectal surgeons, radiologists, dieticians and in general by alldoctors involved in the care of IBD patients."
Digestive and Liver Disease

"It is well written, with a useful 'Learning Points'section at the beginning of each chapter. The topics have beenchosen to give broad coverage across the spectrum of IBD,incorporating problems such as nutrition, pathology interpretationand service provision. Many of these will be helpful to juniorsencountering specific difficulties for the first time and willperhaps persuade old hands to review the way they practice. Somewill amuse as well as educate, such as the chapter on the use ofworms in IBD.

This is a book to dip in and out of. Pick it up and see whatinterests you that day. There will be sections that youhaven't thought about in ages. Spending ten minutes to read achapter on the evidence for management of DALMs may affect what youdo in the endoscopy room that afternoon."
Doctors.net.uk