Master the board step 3

Master the Boards: USMLE Step 3
Ulcerative Colitis
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ASCA: Negative
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ANCA: Positive
CD
UC
ASCA Positive Negative
ANCA Negative Positive
Treatment
Treatment for inflammatory bowel disease is as follows:
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Best initial therapy for both CD and UC: Mesalamine
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Sulfasalazine is not the best initial therapy for either CD or UC because of
the following adverse effects:
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Rash
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Hemolytic anemia
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Interstitial nephritis
Infliximab reactivates
tuberculosis. Screen with
a PPD prior to its use in
fistulizing CD.
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Steroids: Budesonide is a glucocorticoid that can be used to control acute
exacerbations of IBD. It has extensive first-pass effect in the liver and, therefore,
has limited systemic adverse effects.
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Azathioprine and 6-mercaptopurine: These are used in patients with
severe disease who have recurrent symptoms when the steroids are
stopped. Azathioprine and 6MP are used to wean a patient off of steroids.
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Infliximab: This is a TNF inhibitor that is most useful in controlling CD
that is associated with fistula formation. TNF is what maintains a granuloma
in place. Plant a PPD and give isoniazid if the PPD is positive prior to the use
of infliximab. Remember to screen for tuberculosis; infliximab can reactivate
tuberculosis by releasing dormant TB from granulomas.
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Metronidazole and ciprofloxacin: These antibiotics are used for perianal
involvement in CD.
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Surgery: This can be curative in UC by removing the colon. However, CD
will recur at the site of the surgery. Occasionally, you must do surgery in CD,
despite the risk of recurrence, if there is a stricture and obstruction.
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