Clinical Dilemmas in Inflammatory Bowel Disease E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 617

Veröffentlichungsjahr: 2011

Beschreibung

The second edition of Clinical Dilemmas in Inflammatory Bowel Disease: New Challenges, is a practical, up-to-date handbook providing expert guidance on specific clinical dilemmas and areas of difficulty that the gastroenterologist regularly faces in day-to-day practice. In this new edition, 75% of the "dilemmas" are brand new dilemmas facing the IBD specialist concerning emerging treatment therapies, such as the use of cannabinoids and Viagra for Crohn's disease. The remaining 25% of the dilemmas are fully updated from the previous edition, incorporating the latest clinical thinking. Each of the 57 evidence-based chapters contains clear learning points, addresses different topics, and provides sound guidance on subjects ranging from optimizing current management through to special management problems and novel treatments. This book is suitable for all medical professionals involved in the care of patients with IBD: established and trainee gastroenterologists, colorectal surgeons, pathologists, radiologists, specialist nurses, pharmacists, dieticians and counselors.

Leseprobe

Contents

Cover

Title Page

Copyright

Contributors

Preface

Part I: Genes and Phenotype in IBD

Chapter 1: Which will take us further in IBD—study of coding variation or epigenetics?

Gene expression: sequence variation versus epigenetic factors

Genetic variation in IBD

Regulation of gene expression in IBD

Limitations of current studies of epigenetic mechanisms in IBD

Conclusions

Chapter 2: IBD in different ethnic groups: same or different?

Introduction

Genotype

Phenotype

Dysplasia in UC

Extraintestinal Manifestations

Conclusions

Part II: Bugs and IBD—Good, Bad, or Indifferent?

Chapter 3: How does the risk of infection influence management of IBD around the world?

Introduction

Acute bacterial and parasitic infections mimicking IBD flare

Influence of IBD therapies on the risk of infection

Conclusion

Chapter 4: Traveling with IBD

Introduction

IBD, infections, and vaccination

Pretravel preparation

Chapter 5: What to do about hepatitis B and hepatitis C in patients with IBD

Introduction

IBD and chronic viral hepatitis

Effect of treatment for IBD on viral hepatitis

Treatment of IBD in patients with HBV

Treatment of IBD in patients with HCV

Treatment of viral hepatitis—effect of interferon on IBD

Conclusions

Chapter 6: CMV in IBD—passenger or pathogen?

Introduction

Diagnosis of CMV infection

Conclusions and recommendations

Chapter 7: Clostridium difficile in IBD: impact, prevention, and treatment

Introduction

Prevalence and impact

Presentation and assessment

Diagnosis

Prognosis

Treatment

Prevention

Conclusions

Chapter 8: Prebiotics and synbiotics: panacea or placebo

Introduction: the pathogenesis of inflammatory bowel disease (IBD)

The microbiota in IBD

Probiotics in IBD

Prebiotics and synbiotics: introduction

Conclusions

Chapter 9: Worms: light at the end of their burrow

Introduction

Hygiene hypothesis/rational for helminthic therapy

Conclusion

Chapter 10: Do we really need to vaccinate all patients with IBD?

What constitutes immunocompromised status?

Conclusion

Part III: Investigating IBD

Chapter 11: Biomarkers in IBD: myth or marvel?

Introduction

Classical biomarkers

Fecal biomarkers

Emerging serological biomarkers

Conclusions

Chapter 12: Radiation exposure in IBD: how do we minimize the dangers?

Introduction

Radiation exposure in IBD

Radiation exposure and CT

Alternative imaging strategies for minimizing radiation exposure

Improving referral practices

Conclusion

Chapter 13: Surveillance colonoscopy in UC: what is the best way to do it?

Introduction

Risk stratification

Surveillance colonoscopy

Dysplasia management

Conclusion

Part IV: Medical Therapy

5-ASA

Chapter 14: New 5-ASAs for ulcerative colitis: a tiny step or giant stride forward?

Introduction

Mechanism of action and pharmacology of different formulations

Efficacy and safety of aminosalicylates for UC

Conclusion

Chapter 15: Do 5-ASAs prevent cancer?

Introduction

How might 5-ASAs protect against CRC in UC?

What is the clinical and observational evidence?

Might other drugs be chemopreventive?

Conclusion

Chapter 16: Why do we still use 5-ASAs in Crohn's disease?

Introduction

Role in inducing remission

Role in maintaining remission

Role in maintaining remission in postoperative patients

Role in chemoprevention for colorectal cancer (CRC) prevention

Conclusions

Steroids

Chapter 17: Steroids in Crohn's disease: do the benefits outweigh the dangers?

Introduction

Benefits of steroids

Limitations of therapeutic effects of steroids

Adverse effects of steroids

Co-administration of immunomodulators with steroids

Role of anti-TNF therapies

The place of steroids in treatment of Crohn's disease

Immunomodulators

Chapter 18: Thioguanine nucleotide measurement: nonadherent, underdosed, shunter, or refractory?

Introduction

Thiopurine metabolism and the role of metabolite monitoring

Indications for the measurement of thiopurine metabolites

Conclusions

Chapter 19: Thiopurines and the sun: what should be done?

Introduction

Thiopurines and the sun: what is the risk?

Molecular mechanisms of thiopurine-associated skin cancer

What should be done?

Conclusions

Acknowledgements

Chapter 20: Do thiopurines worsen risk and prognosis of cervical neoplasia?

Introduction

Thiopurines and cancer risk

The risk of cervical cancer in thiopurine-treated IBD

The prognosis of cervical cancer in thiopurine-treated IBD

AZA in patients with a history of cervical cancer

Conclusion

Minimizing risks

Chapter 21: Optimizing use of methotrexate

Introduction

Lessons from pharmacology of methotrexate [1,2]

Efficacy in IBD

Adverse effects

Conclusions (Table 21.1)

Chapter 22: Which calcineurin inhibitor and when?

Introduction

Cyclosporine in UC

Tacrolimus in UC

Pharmacology

Toxicity

When to start a calcineurin inhibitor

Conclusions

Biologics

Chapter 23: Are all anti-TNF agents the same?

Introduction

Structure and function

Pharmacokinetic properties

Immunogenicity

Clinical efficacy

Conclusions

Chapter 24: One drug or two: do patients on biologics need concurrent immunomodulation?

Introduction

Efficacy of combination therapy

Conclusion

Chapter 25: How do we identify patients needing early aggressive therapy and what should we use?

Introduction

Clinical factors identifying complicated disease

Biomarkers for predicting complicated disease

Genetic markers of complicated disease

What should we use in patients identified as requiring early aggressive therapy?

Conclusion

Chapter 26: What is the role of biologics in UC?

Introduction

When to initiate a biologic for UC

Which drug(s) to initiate

The use of biologics around the time of surgery

Conclusions

Chapter 27: What can we do with Crohn's patients who fail or lose response to anti-TNF therapy?

Treat the patient earlier in their disease course

Use concomitant immune modulation and commit to maintenance therapy

Confirm active inflammation

Defining primary nonresponse to anti-TNF therapy

Management of the Patient with Primary Nonresponse to TNF inhibitors

Management of the patient with secondary loss of response or simple relapse

Conclusions

Chapter 28: Which extraintestinal manifestations of IBD respond to biologics?

Musculoskeletal EIMs

Skin manifestations

Oral manifestations

Ocular complications of IBD

Hepatobiliary complications of IBD

Conclusion

Chapter 29: Use and abuse of biologics in pregnancy

Use of biologics during pregnancy

Use of biologics and breastfeeding (see Chapter 20)

Use of biologics and newborn management

Conclusions

Chapter 30: Is anti-TNF therapy safe to use in people with a history of malignancy?

Introduction

What is the risk of malignancy in patients treated with anti-TNF antibodies?

What is the risk of cancer recurrence or progression after anti-TNF therapy?

Should patients with previous malignancy be treated with anti-TNF therapy?

Chapter 31: The risks of immunomodulators and biologics: what should we tell patients?

Introduction

What to tell patients about possible side effects

How to tell patients about the risk of side effects

Conclusion

Chapter 32: When, how, and in whom should we stop biologics?

Introduction

Reasons for stopping anti-TNF

Available studies on anti-TNF treatment cessation in IBD

Practical considerations when stopping anti-TNF treatment in CD

Conclusions

Part V: Other Treatments

Chapter 33: Avoiding drug interactions

Introduction

Drug interactions

Warfarin

Smoking cessation

Conclusion

Chapter 34: Is there still a role for ursodeoxycholic acid treatment in patients with inflammatory bowel disease associated with primary sclerosing cholangitis?

Introduction

The PSC–IBD relationship

Effectiveness of UDCA in PSC

Chemopreventive effect of UDCA

Conclusions

Chapter 35: Stem cell transplantation for Crohn’s: will it fulfill its promise?

Introduction

What are stem cells?

Rationale for stem cell transplantation in Crohn's disease

Hematopoietic stem cell transplantation

Safety of HSCT in Crohn's disease

Mesenchymal stem cell transplantation

Conclusions

Chapter 36: Complementary therapy: is there a needle in the haystack?

How often and why is CAM used in IBD?

Conclusions

Part VI: Surgical Dilemmas in IBD

Chapter 37: Optimizing IBD patients for surgery and recovery

Introduction

Preoperative care

Operative care

Postoperative care

Chapter 38: Is surgery the best initial treatment for limited ileocecal Crohn's disease?

Introduction

Conclusion

Chapter 39: Laparoscopic or open surgery for IBD?

Introduction

Laparoscopy for Crohn's disease

Conclusion

Chapter 40: Optimizing management of perianal Crohn's disease

Introduction

Skin tags and hemorrhoids

Strictures

Fissures

Perianal abscesses

Fistulizing disease

Conclusions

Chapter 41: Does anti-TNF therapy increase the risk of complications of surgery?

Introduction

Crohn's Disease

Combined cohorts

Conclusion

Chapter 42: Pouches for indeterminate colitis and Crohn's disease: act now, pay later?

Indeterminate colitis

Crohn's disease

Conclusion

Chapter 43: Dealing with pouchitis

Introduction

Investigation

Treatment (see Figure 43.1 [3])

Preventing initial onset of pouchitis

Implications of use of antibiotics in patients with pouchitis

Part VII: Unsolved Issues in IBD

Chapter 44: Mucosal healing in IBD: does it matter?

Crohn's disease

Ulcerative colitis

Conclusions

Chapter 45: Vitamin D in IBD: from genetics to bone health via cancer and immunology

Vitamin D In IBD: from genetics to bone health via cancer and immunology

Conclusion

Chapter 46: Got milk? Medication use and nursing in women with IBD

Introduction

Effect of nursing on course of IBD

Problems and unresolved issues

Chapter 47: Does stress matter?

Introduction

Plausible mechanisms by which stress can increase gut inflammation

Conclusion

Chapter 48: IBS is common in IBD: fact or fallacy?

Introduction

What is IBS?

Chapter 49: So where is all the cancer?

Colorectal cancer in IBD remains an unsolved issue

Conclusion

A glance into the future

Part VIII: Nutrition in IBD

Chapter 50: What should patients with IBD eat?

Intervention studies

Malnutrition in IBD

“Best current advice”

Need for future work

Chapter 51: Enteral nutrition in Crohn’s—who for, when, how and which formula?

Diet and risk of IBD

Conclusions

Chapter 52: Optimizing treatment of iron deficiency anemia

Introduction

Anemia in IBD

Screening

Diagnostics

Therapy

Intravenous iron supplementation

Further therapy options

Conclusion

Part IX: Management Process

Chapter 53: IBD Standards: will they enhance patient care?

Quality of care: an overview

Quality of IBD care

Defining IBD standards: structure, process, and outcomes

Current efforts to define IBD standards

Future directions: using quality measures to enhance care

Chapter 54: Your treatment will not work if the patient does not take it

Introduction

Nonadherence to maintenance treatment in IBD

The perceptions and practicalities approach (PPA) [9]

Implications for practice

Conclusion

Chapter 55: Inflammatory bowel disease: what to tell your emergency department (ED) team

Introduction

The scale of the problem

Reasons for ER attendance

Approach to the patient with IBD presenting as an emergency

Non-IBD related attendances to ER

How to improve emergency care for patients with IBD

Chapter 56: Transitioning from pediatric to adult care

Introduction

Barriers

The transition process

Conclusion

Chapter 57: Medicolegal pitfalls in inflammatory bowel disease care

Introduction

Conclusions

Index

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Library of Congress Cataloging-in-Publication Data

Clinical dilemmas in inflammatory bowel disease : new challenges / edited by Peter Irving ... [et al.]. – 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-4443-3454-8 (pbk. : alk. paper) ISBN-10: 1-4443-3454-9 (pbk. : alk. paper) ISBN-13: 978-1-4443-4254-3 (ePDF) ISBN-13: 978-1-4443-4257-4 (e-ISBN-10: : Wiley Online Library) [etc.] 1. Inflammatory bowel diseases. 2. Inflammatory bowel diseases–Decision making. I. Irving, Peter, 1970- [DNLM: 1. Inflammatory Bowel Diseases. WI 420] RC862.I53C553 2011 616.3′44–dc22 2011007515

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9781444342543; Wiley Online Library 9781444342574; ePub 9781444342550; Mobi 9781444342567

Contributors

Ashwin N. Ananthakrishnan MD, MPH Instructor in Medicine Harvard Medical School Gastrointestinal Unit Massachusetts General Hospital Boston, MA, USA

Donna Appleton MD, MRCS Specialist Registrar Department of General and Colorectal Surgery Stafford General Hospital Stafford, UK

Judith E. Baars MSc, PhD Medical Student Erasmus University Rotterdam, The Netherlands Department of Gastroenterology and Hepatology Erasmus MC Hospital Rotterdam, The Netherlands

Jacques Belaiche PhD Professor of Gastroenterology Department of gastroenterology CHU Liège and GIGA Research University of Liège Liège, Belgium

David G. Binion MD Visiting Professor of Medicine Division of Gastroenterology, Hepatology, and Nutrition University of Pittsburgh School of Medicine Pittsburgh, PA, USA

Wojciech Blonski MD, PhD Research Scholar Division of Gastroenterology University of Pennsylvania Philadelphia, PA, USA; Department of Gastroenterology Medical University Wroclaw, Poland

Brian Bressler MD, MS, FRCPC Clinical Assistant Professor of Medicine Division of Gastroenterology University of British Columbia Vancouver, BC, Canada

Emma Calabrese MD, PhD University of Rome “Tor Vergata” Rome, Italy

Adam S. Cheifetz MD Assistant Professor of Medicine; Clinical Director, Center for Inflammatory Bowel Disease Division of Gastroenterology Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA, USA

Dorothy K.L. Chow MBChB, MD, MRCP Clinical Assistant Professor (Honorary) Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong SAR, China

Miranda Clark BSc(Hons) Clinical Trials Coordinator University Hospital Queen’s Medical Centre Nottingham, UK

Norman R. Clark III MD Division of Gastroenterology Vanderbilt University Medical Center Nashville, TN, USA

Morven Cunningham MA(Hons), MBBS, MRCP Clinical Research Fellow Blizard Institute of Cell and Molecular Science Barts and The London School of Medicine and Dentistry Queen Mary, University of London UK

Andrew S. Day MB,ChB, MD, FRACP, AGAF Associate Professor Department of Paediatrics University of Otago Dunedin, Otago, New Zealand; Pediatric Gastroenterology Christchurch Hospital Christchurch, New Zealand

Alan N. Desmond MB, BCh, BAO, BMedSc, MRCPI Specialist Registrar Department of Gastroenterology and General Internal Medicine Cork University Hospital Wilton, Cork, Ireland

Shane M. Devlin MD, FRCPC Clinical Assistant Professor Division of Gastroenterology Inflammatory Bowel Disease Clinic The University of Calgary Calgary, AB, Canada

Geert D’Haens MD, PhD Professor of Medicine Academic Medical Centre Amsterdam, The Netherlands

Axel Dignass MD, PhD, FEBG, AGAF Professor of Medicine Head, Department of Medicine I Markus Hospital Frankfurt/Main, Germany

Glen A. Doherty MB, PhD, MRCPI Consultant Gastroenterologist Centre for Colorectal Disease St Vincent’s University Hospital/University College Dublin Dublin, Ireland

Marla C. Dubinsky MD Associate Professor of PediatricsDirector, Pediatric IBD Center Cedars Sinai Medical Center Los Angeles, CA, USA

Tim Elliott MBBS, FRACP Specialist Registrar Department of Gastroenterology Guys and St Thomas’ Hospitals London, UK

Marc Ferrante MD, PhD Consultant Gastroenterologist Department of Gastroenterology University Hospital Gasthuisberg Leuven, Belgium

Laurie N. Fishman MD Assistant Professor of Pediatrics Center for Inflammatory Bowel Disease Division of Gastroenterology and Nutrition Children’s Hospital Boston Harvard Medical School Boston, MA, USA

Phillip Fleshner MD, FACS, FASCRS Program Director, Colorectal Surgery Residency Los Angeles, CA, USA; Clinical Professor of Surgery UCLA School of Medicine Los Angeles, CA, USA

Anna Foley MBBS(Hons), FRACP Consultant Gastroenterologist Department of Gastroenterology and Hepatology Box Hill Hospital Melbourne, VIC, Australia

Graham R. Foster FRCP, PhD Professor of Hepatology Blizard Institute of Cell and Molecular Science Barts and The London School of Medicine and Dentistry Queen Mary, University of London London, UK

Richard B. Gearry MB, ChB, PhD, FRACP Associate Professor of Medicine Consultant Gastroenterologist Department of Medicine University of Otago Dunedin, Otago, New Zealand; Department of Gastroenterology Christchurch Hospital Christchurch, New Zealand

Peter Gibson MD, FRACP Professor of Medicine and Consultant Gastroenterologist Department of Gastroenterology and Hepatology Eastern Health Clinical School Monash University, Melbourne VIC, Australia

James Goodhand BSc(Hons), MBBS, MRCP Clinical Research Fellow Barts and the London School of Medicine and Dentistry Queen Mary’s University of London London, UK

Richard J. Grand MD Professor of Pediatrics Harvard Medical School Director Emeritus, Center for Inflammatory Bowel Diseases Division of Gastroenterology and Nutrition Children’s Hospital Boston Boston, MA, USA

Gauree Gupta MD Staff Physician Department of Medicine Cedars Sinai Medical Center and David Geffen School of Medicine at UCLA Los Angeles, CA, USA

Elizabeth J. Hait MD, MPH Center for Inflammatory Bowel Disease Division of Gastroenterology and Nutrition Children’s Hospital Boston Harvard Medical School Boston, MA, USA

Stephen B. Hanauer MD Professor of Medicine and Clinical Pharmacology Section of Gastroenterology, Hepatology, and Nutrition University of Chicago Medical Center Chicago, IL, USA; Chief, Section of Gastroenterology, Hepatology, and Nutrition University of Chicago Medical Center Chicago, IL, USA

Catherine A. Harwood Centre for Cutaneous Research Blizard Institute of Cell and Molecular Science Barts and The London School of Medicine and Dentistry Queen Mary University of London London, UK

Christopher J. Hawkey DM, FRCP Professor of Gastroenterology University Hospital Queen’s Medical Centre Nottingham University Hospitals NHS Trust Nottingham, UK

A. Barney Hawthorne DM, FRCP Consultant Gastroenterologist Department of Medicine University Hospital of Wales Cardiff, UK

Michael Hershman DHMSA, MSc(Hons), MS(Hons), FRCS (Eng, Ed, Glas & Irel), FICS Consultant Surgeon Department of General Surgery Stafford Hospital Stafford, UK

Rob Horne Professor of Behavioural Medicine Director, Centre for Behavioural Medicine The School of Pharmacy University of London London, UK

Peter M. Irving MD, MRCP Consultant Gastroenterologist Department of Gastroenterology Guy’s and St Thomas’ Hospitals London, UK

Jennifer L. Jones MD, MSc, FRCPC Director, MDIBD Clinic and IBD Clinical Trials Assistant Professor Departments of Medicine and Community Health Sciences and Epidemiology University of Saskatchewan Royal University Hospital Saskatoon, SK, Canada

Ahmed Kandiel MD, MPH Staff Gastroenterologist Department of Gastroenterology and Hepatology Digestive Disease Institute Cleveland Clinic Cleveland, OH, USA

Sunanda Kane MD, MSPH Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA

Gilaad Kaplan MD, MPH, FRCPC Assistant Professor Departments of Medicine and Community Health Sciences Teaching Research and Wellness Center University of Calgary Calgary, AB, Canada

Michael D. Kappelman MD, MPH Assistant Professor Division of Pediatric Gastroenterology Department of Pediatrics University of North Carolina Chapel Hill Chapel Hill, NC, USA

Louise Langmead BSc(Hons), MD Consultant Gastroenterologist Endoscopy Unit Barts and the London NHS Trust The Royal London Hospital London, UK

Bret Lashner MD, MPH Professor of Medicine Department of Gastroenterology and Hepatology Digestive Disease Institute Cleveland Clinic Cleveland, OH, USA

Joanna K. Law MD, MA [Ed], FRCP(C) Clinical Instructor, Division of Gastroenterology University of British Columbia Vancouver, BC, Canada

Ian Craig Lawrance MBBS(Hons), PhD, FRACP Professor, School of Medicine and Pharmacology University of Western Australia Perth, WA, Australia; Director, Centre for Inflammatory Bowel Diseases Fremantle Hospital Fremantle, WA, Australia

Keith Leiper MD, FRCP Consultant Gastroenterologist Royal Liverpool University Hospital Liverpool, UK

Rupert W.L. Leong MBBS, MD, FRACP Associate Professor of Medicine (Conjoint) The University of New South Wales Sydney, NSW, Australia; Director of Endoscopy Department of Gastroenterology and Liver Services Sydney South West Area Health Service Concord and Bankstown Hospitals Sydney, NSW, Australia

John Leung MD Instructor Division of Gastroenterology Tufts Medical Center Boston, MA, USA

L. Campbell Levy MD Assistant Professor of Medicine Dartmouth Medical School Section of Gastroenterology and Hepatology Dartmouth–Hitchcock Medical Center Lebanon, NH, USA

Gary R. Lichtenstein MD Professor of Medicine Division of Gastroenterology University of Pennsylvania Philadelphia, PA, USA

Ming Valerie Lin MD Department of Internal Medicine Pennsylvania Hospital University of Pennsylvania Health System Philadelphia, PA, USA

Keith D. Lindor MD Professor of Medicine Division of Gastroenterology and Hepatology Mayo Clinic Rochester, MN, USA; Dean, Mayo Medical School Mayo Clinic Rochester, MN, USA

James O. Lindsay PhD, FRCP Consultant and Senior Lecturer in Gastroenterology, Digestive Diseases Clinical Academic Unit Barts and the London NHS Trust The Royal London Hospital Whitechapel, London, UK

Richard Logan, MB, ChB, MSc, FFPH, FRCP Professor of Clinical Epidemiology/Consultant Gastroenterologist Division of Epidemiology and Public Health Queens Medical Centre Nottingham University Hospitals Nottingham, UK

Edouard Louis MD, PhD Professor of Gastroenterology Department of Gastroenterology CHU Liège and GIGA Research University of Liège Liège, Belgium

Mark Lust MBBS, FRACP, PhD Senior Clinical Fellow in Gastroenterology Translational Gastroenterology Unit John Radcliffe Hospital Oxford, UK

Michael M. Maher MD Professor Department of Radiology Alimentary Pharmabiotic Centre University College Cork National University of Ireland Cork, Ireland

Robert G. Maunder MD Associate Professor and Staff Psychiatrist Mount Sinai Hospital and University of Toronto Toronto, ON, Canada

Jane M. McGregor MA, MB BChir, FRCP, MD Senior Lecturer and Honorary Consultant Dermatologist Barts and the London NHS Trust London, UK; Centre for Cutaneous Research Blizard Institute of Cell and Molecular Science Barts and The London School of Medicine and Dentistry Queen Mary University of London, London, UK

Simon D. McLaughlin MD, MRCP Consultant Gastroenterologist Department of Gastroenterology Royal Bournemouth Hospital Bournemouth, UK

Tina A. Mehta Department of Gastroenterology Bristol Royal Infirmary Bristol, Avon, UK

Gil Y. Melmed MD, MS Assistant Clinical Professor of Medicine Cedars Sinai Medical Center and David Geffen School of Medicine at UCLA Los Angeles, CA, USA

Owen J. O’Connor MD, FFR(RCSI), MRCSI Radiology Lecturer Department of Radiology University College Cork National University of Ireland Cork, Ireland

Tom resland MD, PhD Professor Department of GI Surgery Akershus University Hospital University of Oslo Lrenskog, Norway

Helen M. Pappa MD, MPH Instructor in Pediatrics Harvard Medical School Staff, Center for Inflammatory Bowel Diseases Division of Gastroenterology and Nutrition Children’s Hospital Boston Boston, MA, USA

Miles Parkes MA, DM, FRCP Consultant Gastroenterologist Addenbrooke’s Hospital and University of Cambridge Cambridge, UK

Kiran K. Peddi MBBS, MRCP (UK) Department of Gastroenterology Specialist Registrar and Fellow in Gastroenterology Fremantle Hospital Fremantle, WA, Australia

Conal M. Perrett MB, ChB, MRCP(UK), PhD Consultant Dermatologist and Honorary Senior Lecturer University College London Hospitals London, UK

Chris S.J. Probert MD, FRCP, FHEA Professor of Gastroenterology Bristol Royal Infirmary Bristol, UK

David S. Rampton DPhil, FRCP Professor of Clinical Gastroenterology Centre for Digestive Diseases Barts and The London School of Medicine and Dentistry London, UK

Catherine Reenaers MD, PhD Department of Gastroenterology CHU Liège and GIGA Research University of Liège Liège, Belgium

Jonathan M. Rhodes MD, FRCP, FMedSci Division of Gastroenterology School of Clinical Sciences University of Liverpool and Royal Liverpool University Hospital Liverpool, UK

Emile Richman BSc(Hons), MSc, PGCE Specialist Gastroenterology Dietitian Department of Nutrition and Dietetics Royal Liverpool University Hospital Liverpool, UK

David T. Rubin MD Associate Professor of Medicine Codirector, Inflammatory Bowel Disease Center Program Director, Fellowship in Gastroenterology, Hepatology, and Nutrition University of Chicago Medical Center Chicago, IL, USA

Matthew D. Rutter MBBS, MD, FRCP Consultant Gastroenterologist and Trust Endoscopy Lead University Hospital of North Tees Stockton-on-Tees, Cleveland, UK; Clinical Director, Tees Bowel Cancer Screening Centre University Hospital of North Tees Stockton-on-Tees, Cleveland, UK

Jeremy D. Sanderson MBBS, MD, FRCP Consultant Gastroenterologist Department of Gastroenterology St Thomas’ Hospital London, UK; Senior Clinical Research Fellow Nutritional Sciences Research Kings College London London, UK

Hermann Schulze Dr.med. Frankfurter Diakonie-Kliniken Markus-Krankenhaus Frankfurt, Germany

David A. Schwartz MD Associate Professor of Medicine Director, IBD Center Division of Gastroenterology Vanderbilt University Medical Center Nashville, TN, USA

Ernest G. Seidman MDCM, FRCPC, FACG Professor of Medicine and Pediatrics Division of Gastroenterology McGill University Health Center Faculty of Medicine McGill University Montreal, QC, Canada

Christian P. Selinger MRCP Salford Royal Hospital Department of Gastroenterology Salford, UK

Raanan Shamir MD Chairman, Institute of Gastroenterology, Nutrition, and Liver Diseases Schneider Children’s Medical Center Petach-Tikva, Israel; Professor of Pediatrics Sackler Faculty of Medicine Tel-Aviv University Tel-Aviv, Israel

Fergus Shanahan MD Professor and Chair Department of Medicine Director, Alimentary Pharmabiotic Centre University College Cork National University of Ireland Cork, Ireland

Bo Shen MD Professor of Medicine Department of Gastroenterology Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland, OH, USA; Staff Gastroenterologist Department of Gastroenterology Cleveland ClinicCleveland, OH, USA

Corey A. Siegel MD, MS Assistant Professor of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School Director, Inflammatory Bowel Disease Center Dartmouth–Hitchcock Medical Center Section of Gastroenterology and Hepatology Lebanon, NH, USA

Emmanouil Sinakos MD Research Fellow Division of Gastroenterology and Hepatology Mayo Clinic Rochester, MN, USA

Melissa A. Smith BSc(Hons), MB, ChB, MA, MRCP Specialist Registrar Department of Gastroenterology St Thomas’ Hospital Guy’s and St Thomas’ NHS Foundation Trust London, UK

Ing Shian Soon MD Resident Division of Gastroenterology Department of Pediatrics and Community Health Sciences University of Calgary Calgary, AB, Canada

Miles Sparrow MBBS, FRACP Consultant Gastroenterologist Department of Gastroenterology The Alfred Hospital Melbourne, VIC, Australia

A. Hillary Steinhart MD, FRCP(C) Inflammatory Bowel Disease Centre Mount Sinai Hospital Toronto, ON, Canada; Associate Professor of Medicine University of Toronto Toronto, ON, Canada

Venkataraman Subramanian MD, DM, MRCP (UK) Academic Clinical Lecturer (Gastroenterology) Nottingham Digestive Diseases Centre Queens Medical Centre Nottingham University Hospitals NHS Trust Nottingham, UK

Simon Travis DPhil, FRCP Consultant Gastroenterologist Translational Gastroenterology Unit John Radcliffe hospital Oxford, UK

William J. Tremaine MD Maxine and Jack Zarrow Professor Division of Gastroenterology and Hepatology Mayo Clinic Rochester, MN, USA

C. Janneke van der Woude MD, PhD Gastroenterologist Department of Gastroenterology and Hepatology Erasmus MC Hospital Rotterdam, The Netherlands

Séverine Vermeire MD, PhD Assistant Professor Department of Gastroenterology University Hospital Gasthuisberg Leuven, Belgium

Joel V. Weinstock MD Professor in Gastroenterology Division of Gastroenterology Tufts Medical Center Boston, MA, USA

Jonathan M. Wilson MBCh B, FRCS(Edin), PhD Specialist Registrar in Colorectal Surgery Department of Colorectal Surgery University College London Hospitals London, UK

Alastair Windsor MD, FRCS, FRCS (Ed), FRCS (Glas) Consultant SurgeonUniversity College London Hospitals London, UK

Henit Yanai MD University of Chicago Medical Center Chicago, IL, USA

Preface

In 2006, three of us published a short book containing about 60 pithy and sometimes provocative chapters on controversial topics in IBD. These were selected with the aim of covering areas that commonly cause clinicians difficulties in decision-making. The book was well received but because of its subject matter has inevitably, at least in some chapters, become a bit out of date. Therefore, we have now produced a new book guided by the same principles as the first. A few of the chapters in this book are updates of their predecessors, but most are entirely new, reflecting the changing challenges faced by gastroenterologists at the beginning of the millennium’s second decade. Our authors are almost all acknowledged experts in their fields and work wherever IBD is common in the world. To help widen the appeal of the book, for this edition we have engaged both a US coeditor (CS) and more US-based contributors than previously.

As before, we have deliberately chosen some tricky topics, and should point out that as editors we do not necessarily agree with all that is written here; if we did the book might be dull. Again, we hope the book will appeal both to senior and trainee gastroenterologists, as well as other members of the IBD team, and that readers will find that it provides a useful distillation and analysis of a wide range of current management dilemmas.

We are very grateful to all our coauthors, almost all of whom delivered their chapters on time and with minimal hassling. We are particularly grateful too to the team at Blackwell’s, especially Oliver Walter for his support for the project and Jennifer Seward for her editorial work.

PMI, CS, DSR, FS July 2011

Part I

Genes and Phenotype in IBD

1

Which will take us further in IBD—study of coding variation or epigenetics?

Miles Parkes

Department of Gastroenterology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK

LEARNING POINTS

Genome-wide association scans have revealed many genetic risk factors for Crohn's disease and ulcerative colitis.As with environmental risk factors, some of the genetic risk is shared and some is specific to either Crohn's disease or ulcerative colitis.