The long-arc complications of IBD after induction and maintenance: the ileal pouch and its inflammations, dysplasia surveillance in long-standing colitis, the extraintestinal manifestations, and pregnancy. The unifying board move is that active disease, not active medication, is the threat, so biologics usually continue through delivery. Localization, timing of surveillance, and whether a manifestation tracks bowel activity are what get tested. Topics covered Ileal pouch-anal anastomosis and pouchitis Cuffitis and the Crohn's-like pouch Chronic antibiotic-dependent vs refractory pouchitis Dysplasia surveillance in colitis Chromoendoscopy and dysplasia management Extraintestinal manifestations of IBD Pre-biologic vaccination timing Pregnancy and biologics in IBD Key decisions Pouch patient with new bleeding and a normal-appearing pouch body is cuffitis: treat with topical mesalamine, not systemic escalation. For antibiotic-refractory chronic pouchitis, vedolizumab carries the strongest randomized evidence and is the favored biologic; clear C. diff, CMV, ischemia, NSAIDs, and celiac before escalating. Surveillance colonoscopy in extensive UC or Crohn's colitis begins 8 to 10 years after symptom onset (not date of diagnosis), but begins immediately at diagnosis of primary sclerosing cholangitis. Resectable visible dysplasia with clear margins is removed endoscopically; non-resectable visible dysplasia and invisible high-grade dysplasia both go to proctocolectomy; confirm all dysplasia with a second pathologist. Live vaccines (MMR, varicella, yellow fever, oral typhoid, intranasal flu) are contraindicated during biologics and for 3 months after, so give at least 4 weeks before starting; infant live/rotavirus vaccines are deferred until in-utero biologic clears, except certolizumab. Continue most biologics in pregnancy; stop methotrexate and JAK inhibitors; certolizumab crosses the placenta minimally and is preferred late in pregnancy. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Introduction: the longer arc of IBD (00:58) - The pouch and pouchitis (03:10) - Chronic pouchitis, cuffitis, and the Crohn's-like pouch (05:22) - Dysplasia surveillance in long-standing colitis (06:54) - Chromoendoscopy and managing dysplasia (08:57) - Extraintestinal manifestations (14:23) - Vaccinations before biologics (15:34) - Pregnancy in IBD

Ask this episode

“What did the council decide on item 42?” — answered with the speaker and the moment.

Transcript

Related