When choosing an initial therapy for Crohn disease, need to take into account
🔺disease ACTIVITY
🔻disease SEVERITY
@JillGaidosMD "I want first and foremost for your symptoms to improve. I also want your inflammation to resolve."
Even when inflammatory activity is low, intestinal damage can continue to progress. We should target disease severity early, ideally at time of diagnosis.
Treatment options in Crohn disease.
1. Give treatments enough time 2. Optimize dose
Selecting Crohn disease treatment
Treatment of Crohn disease by patient characteristics
Shared decision making is important in selecting #IBD therapy
Case conclusions
Need to continue long-term monitoring for objective measures of inflammation. This allows for dose optimization or switching therapies, to prevent steroids, hospitalization, surgery, and other complications.
💎s from @JillGaidosMD on selecting therapy for Crohn disease
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Pyridostigmine & neostigmine
⚡️cholinesterase inhibitors
🧠pyrido should not cross the blood-brain barrier
🚽evidence in chronic idiopathic constipation and acute colonic pseudo-obstruction
🫄pregnancy class C; excreted in breastmilk
🫀cholinergic side effects, esp bradycardia
Acotiamide
⚡️inhibits cholinesterase and enhances ACh release via muscarinic receptors
🎈enhances gastric emptying and accommodation
🔥NERD & FD
🫄no safety data
💊side effects: nausea, abdominal distension, constipation
I gave a talk on inpatient bowel regimens today for the @YaleMed@YaleIMed residents and students, with additional 💎s on outpatient #constipation. Here are the slides!
💨The gut microbiota generates ~0.2L–1.5L of gas per day
💨>99%: hydrogen (H2), carbon dioxide (CO2), & methane (CH4)– *odorless*
💨foul smell of gas from <1%: sulfur–containing gases hydrogen sulfide (H2S), methanethiol (CH3SH), dimethyl sulfide [(CH3)2S] + volatile compounds
🦠bacteria in the colon ferment substrates that are not digested or absorbed in the upper GI tract (e.g. carbohydrates, proteins, fats)
🦠produce short-chain fatty acids, branched-chain fatty acids, ammonia, N-nitro compounds, phenolic and indolic compounds, and various gases