ASGE Annual GI Advanced Practice Provider Course (Virtual) - Clinical Case-Based Learning (Day Two) | April 2023-Evaluation and Management of IBD

Pdf Summary

The document discusses the evaluation and management of inflammatory bowel disease (IBD), specifically Crohn's Disease (CD) and Ulcerative Colitis (UC). The objectives of this article include identifying the differentiating features of IBD, exploring the guiding principles of IBD management, reviewing therapeutic agents used for treatment, discussing therapeutic drug monitoring (TDM), and highlighting health disparities in IBD.<br /><br />IBD is a chronic inflammatory disease that affects millions of people in the United States. It is diagnosed in the second to fourth decades of life and remains a significant cost to the healthcare system. Therapeutics, comorbidities, and emergency room visits are the biggest drivers of costs in IBD patients.<br /><br />CD and UC have differentiating features in terms of location, inflammation pattern, symptoms, complications, and extraintestinal manifestations. The document also provides information on endoscopic and histologic features of CD and UC.<br /><br />Diagnostic tests such as fecal calprotectin, C-reactive protein, hemoglobin, albumin, CT enterography, MR enterography, colonoscopy, and capsule endoscopy are useful in assessing disease activity and severity in IBD.<br /><br />The guiding principles of IBD management include early treatment, treating to target, differentiating disease activity and severity, risk stratification, and choosing the appropriate pharmacological management based on the severity of the disease.<br /><br />The document also discusses the various pharmacological management options for IBD, including corticosteroids, aminosalicylates, immunomodulator therapy (thiopurines, methotrexate), biologics (TNF inhibitors, anti-integrin, anti-interleukin), small-molecule JAK inhibitors, and sphingosine 1-phosphate receptor modulators.<br /><br />Therapeutic drug monitoring (TDM) is important in optimizing treatment outcomes in IBD. Reactive and proactive TDM approaches have been shown to be effective in guiding treatment decisions and improving therapeutic outcomes.<br /><br />The document highlights the importance of addressing health disparities in IBD, as incidence rates have increased among non-white races and ethnicities. It emphasizes the role of advanced practice providers in recognizing and addressing these disparities to ensure equitable healthcare for all IBD patients.<br /><br />Lastly, the document presents a case study on the management of UC using Vedolizumab and demonstrates the importance of treat-to-target strategies, monitoring response to treatment, and optimizing patient outcomes.<br /><br />Overall, the document provides a comprehensive overview of the evaluation and management of IBD, highlighting key considerations and strategies for healthcare providers.

Asset Subtitle

Kimberly Kearns, MS, APN-BC

Keywords

inflammatory bowel disease

Crohn's Disease

Ulcerative Colitis

IBD management

therapeutic agents

therapeutic drug monitoring

health disparities

diagnostic tests

pharmacological management

treat-to-target strategies