Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-BO Bincy Abraham

BO Bincy Abraham_Severe CD Hospitalized patient

Pdf Summary

The document provides comprehensive guidelines for managing severe hospitalized Crohn's disease patients. The main objectives are to assess disease severity, manage using a specific algorithm, and prevent or manage complications. Key points include:<br /><br />1. **Inpatient Care**: Initial steps involve obtaining a GI panel to rule out infections like C. difficile before starting corticosteroids (maximum 40-60 mg IV daily of methylprednisolone). Nutrition is crucial, with options for a clear liquid diet, TPN for severe malnutrition, and IV iron. Thromboembolism prophylaxis, involving unfractionated or low-molecular-weight heparin and early mobilization post-op, is emphasized. Regular monitoring through labs and imaging is advised, alongside early surgical consultations.<br /><br />2. **Multidisciplinary Approach**: Collaborations with radiology, colorectal surgery, infectious disease specialists, dieticians, and case managers are essential. This approach aids in elective, urgent, or emergent surgeries and discharge planning.<br /><br />3. **Indications for Surgery**: Surgery may be required for perforation, hemorrhage, fibrotic strictures, cancer, intractable disease, and other complications. The importance of pre-operative management, including nutritional support and anemia correction, is highlighted to improve outcomes and reduce complications.<br /><br />4. **Perioperative Management**: Focus on minimizing corticosteroid use due to risk of post-operative complications. The safety of biologics like vedolizumab and anti-TNFs has been supported by recent studies, suggesting no need to delay surgery if patients are on these medications.<br /><br />5. **Fistula Management**: Infliximab has shown significant efficacy in managing fistulas, while corticosteroids show no benefit and could be detrimental. The use of antibiotics may reduce drainage but not heal.<br /><br />6. **Thromboembolism Prevention**: Pre-operative and post-operative measures are emphasized due to increased VTE risk in these patients.<br /><br />The guidelines stress the importance of a multidisciplinary approach, close monitoring, and individualized therapeutic strategies to ensure effective management of hospitalized Crohn’s disease patients.

Keywords

Crohn's disease

hospitalized patients

disease severity

corticosteroids

nutrition

multidisciplinary approach

surgery indications

perioperative management

fistula management

thromboembolism prevention