وصف
In the diagnosis, management, and therapy of inflammatory bowel disease, endoscopy is essential (IBD). Esophagogastroduodenoscopy, flexible sigmoidoscopy, and colonoscopy have long been employed in the treatment of IBD patients. The application of endoscopy in IBD has grown as a result of the development of instruments including endoscopic ultrasonography, capsule endoscopy, and balloon-assisted enteroscopy. Chromoendoscopy has also improved our capacity to recognise dysplasia in IBD. We will concentrate on the functions, uses, and restrictions of these technologies in IBD in this review study. We will also go through the most popular endoscopic grading methods and unique considerations for patients who have just undergone surgery. Finally, we'll talk about how endoscopy is used to diagnose and treat fistulas and strictures.
ملخص
- A 37-year-old female with a history of ulcerative colitis presented with altered bowel habits, predominantly loose stools (6-8 times daily), often with blood or mucus, and abdominal pain lasting about a year. Initial evaluation revealed normal blood counts, but significant anemia, elevated CRP (58.8) and ESR (101), and a slightly low albumin level (3.1).
- Fecal calprotectin was markedly elevated (over 1000), indicating significant inflammation. Prior endoscopy revealed disease extending into the transverse colon, classifying it as E3 or pancholitis. Sigmoidoscopy showed severely inflamed mucosa with ulcerations, spontaneous bleeding, and pseudopolyp formation. Biopsy confirmed severe ulcerative colitis, without evidence of CMV infection.
- Initial treatment included IV hydrocortisone, azathioprine (already on), systemic and topical mesalamine, blood transfusion, and low molecular weight heparin for thromboprophylaxis. After three days, there was no clinical improvement, and lab values showed persistent anemia and declining albumin.
- Due to the lack of response to steroids, surgical consultation for total proctocolectomy was considered. Alternatively, the patient was started on tofacitinib (10 mg twice daily), an oral small molecule biological agent, leading to dramatic improvement within days.
- Pre-treatment screening for latent tuberculosis, lipid profile monitoring, ANA testing, infection exclusion, and varicella vaccination (though potentially less relevant in endemic regions) are crucial. Tofacitinib has potential adverse effects including varicella, thromboembolism, hyperlipidemia, transaminitis, TB/hepatitis B reactivation, neutropenia, and lymphoma.
- Tofacitinib offers advantages like low cost and rapid action compared to other biologics. Clinical trials (OPTAE 1 & 2) demonstrated its efficacy in inducing remission in moderate to severe ulcerative colitis. It is recommended in recent guidelines for patients intolerant to conventional therapy or biologic-naïve.
نموذج شهادة
حول المتحدثين
الدكتور سي جي سريدهار
جراح الجهاز الهضمي، مدير عيادات Edusurg | مومباي ونافي مومباي
تعليقات
تعليقات
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