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ACG PRACTICE GUIDELINES

Continuing Medical Education Questions: March 2010

DeVault, Kenneth R MD; Kim, Karen C MD; Wang, Ying Hong MD; Atreja, Ashish MD; Chiang, Dian Jung MD

American Journal of Gastroenterology: March 2010 - Volume 105 - Issue 3 - p 524
doi: 10.1038/ajg.2010.30
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QUESTIONS:

1. Which one of the following statements is true with regard to the management of severe ulcerative colitis?

A. Infliximab 5m/kg is indicated for the patient who may not require immediate hospitalization but who continues to have severe symptoms despite optimal doses of oral steroid, oral aminosalicylates, and topical medications.

B. Th e mainstay of therapy for those patients requiring hospitalization is high-dose IV steroid (up to 300 mg of methylprednisolone) if the patient has received steroids in the previous month.

C. Empirical antibiotics should always be given for the potential infections, especially in the setting of highdose IV steroids use.

D. Patients with severe UC flares should be given NPO for bowel rest and administered TPN as early as possible for nutritional support.

2. Which one of the followings is true with regard to the complications that could develop after the ileal pouch–anal anastomosis surgery?

A. It has been shown that primary sclerosing cholangitis, preoperative extraintestinal manifestations, and smoking history are risk factors for pouchitis.

B. Characteristic endoscopical and histological features are required for the diagnosis of pouchitis in addition to the typical clinical presentations.

C. The rate of post-operative surgical complications is approximately 50%, requiring re-operations. The most frequent are anastomotic leak, pelvic sepsis/abscess, anastomotic stricture, and bowel obstruction.

D. Infertility and sexual dysfunction are common complaints from both female and male patients who underwent IPAA surgery.

3. Which one of the following is true with regard to the cancer risk surveillance and management in patients with UC?

A. After 10 years of pan-colonic disease, the cancer risk has been reported in the range of 0.5–1% per year. Annual or biannual surveillance colonoscopy with multiple biopsies at regular intervals should be performed after 8 years.

B. Patients with primary sclerosing cholangitis (PSC) complicating UC have an increased risk of colorectal cancer. Ursodeoxycholic acid should be given to reduce the risk of colorectal neoplasia and cholangiocarcinoma in these patients.

C. Mesalamine has not been found to have chemopreventive effect, although patients often stay on the regimen, as it is usually part of their initial therapy.

D. Low-grade dysplasia in a mass lesion that does not resemble a typical sporadic adenoma and cannot be resected endoscopically is often an indication for colectomy. However, low-grade dysplasia in flat mucosa may be safely followed up by biannual colonoscopy surveillance.

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