1. Inflammatory Bowel Disease Treatment

2. Epidemiology Clinical Laboratory Imaging Pathology Response to treatment IBD

3. GOALS OF THERAPY

4. CONVENTIONAL DRUG THERAPIES

5. ULCERATIVE COLITIS THERAPY

6. CROHN’S DISEASE THERAPY

7. Medications 5-Aminosalicylic acid

8. SULFASALAZINE

9. SULFASALAZINE METABOLISM

10. AMINOSALICYLATES

11. AMINOSALICYLATE DISTRIBUTION

12. Sulfasalazine Versus 5-ASA Therapy

13. Oral vs Combination 5-ASA Treatment in UC Active DiseaseMaintenance

14. Dose Response to Oral Mesalamine in Active Crohn’s Disease

15. 5-aminosalicylate Versus Sulfasalazine Toxicity

16. Medications Antibiotics

17. METRONIDAZOLE

18. CIPROFLOXACIN AND METRONIDAZOLE VERSUS METHYLPREDNISOLONE IN ACTIVE CROHN’S DISEASE

19. Medications Corticosteroids

20. STEROID PREPARATIONS

21. SYSTEMIC CORTICOIDS

22. TOPICAL CORTICOIDS

23. RESULTS OF CORTICOSTEROID THERAPY FOR CROHN’S DISEASE

24. Ideal Anti-inflammatory Drug For Targeted Treatment Of IBD Delivery targeted to the inflammatory site Dissolves well in the lumen Extensive mucosal uptake, distribution and retention High intrinsic activity No local inactivation Extensive systemic (liver) inactivation

25. Budesonide Pharmacology High topical potency High intrinsic activity Moderately high water solubility Affinity for glucocorticoid receptor –200x hydrocortisone –15x prednisolone

26. Hypothalamic-Pituitary Adrenal Axis

27. Oral Budesonide In Active Crohn’s Disease

28. Oral Budesonide As Maintenance Therapy For Crohn’s Disease

29. Issues Post-surgery prevention Steroid switching Effect in children - growth etc Side effects - bone Quality of life Activity in UC

30. Medications Immunomodulators

31. AZATHIOPRINE AND 6- MERCAPTOPURINE

32. 6-mercaptopurine in Active Crohn’s Disease

33. 6-mercaptopurine and Azathioprine as Maintenance Therapy in Crohn’s Disease

34. 6-mercaptopurine as Maintenance Therapy for Ulcerative Colitis

35. ADVERSE EFFECTS OF 6- MP/AZATHIOPRINE

36. Methotrexate for Active Crohn’s Disease

37. Methotrexate as Maintenance Therapy for Crohn’s Disease

38. Medications Cyclosporine-A

39. Cyclosporine in Active UC

40. TOXICITY OF CYCLOSPORINE

41. Medications Biologicals Including Anti-TNF

42. ANTIBODIES TO TNF

43. Infliximab (Remicade) Chimeric IgG1 anti–TNF-α antibody Contains antigen-binding region of the mouse antibody and the constant region of the human antibody Binds to soluble and membrane-bound TNF- α with high affinity, impairing the binding of TNF- α to its receptor Kills cells that express TNF- α through antibody-dependent and complement-dependent cytotoxicity.

44. INFLIXIMAB IN ACTIVE CROHN’S DISEASE

45. INFLIXIMAB AS MAINTENANCE THERAPY FOR CROHN’S DISEASE

46. INFLIXIMAB FOR FISTULIZING CROHN’S DISEASE

47. Anti-TNF for Active UC Moderate-to-severe ulcerative colitis Despite therapy with corticosteroids and/or immunomodulators Randomized to receive infliximab 5 mg/kg, 10 mg/kg, or placebo at O, 2w, 6w, and every 8 weeks ACT 1 - 46w ACT 2 - 30w Rutgeerts et al. N Engl J Med 2005

48. Rutgeerts et al. N Engl J Med, 2005 Anti-TNF for Maintenance in UC

49. Infliximab as Rescue Therapy 45 fulminant or severe UC (Seo index) Day 0–3 colonoscopy - extent and severity of disease All patients IV steroids Day 4 to 8 if still severe colitis patients randomized to infliximab 5mg/kg /placebo Janerot et al. Gastroenterology 2005

50. Infliximab as Rescue Therapy Results Janerot et al. Gastroenterology 2005

51. ADVERSE EFFECTS OF INFLIXIMAB

53. Medications Emerging Treatments

54. EMERGING TREATMENTS FOR IBD-2002

55. TESTED UNCONVENTIONAL THERAPIES

56. GUIDELINES FOR PREGNANCY

57. NUTRITIONAL THERAPY IN IBD

58. INDICATIONS FOR SURGERY IN ULCERATIVE COLITIS

59. SURGICAL OPTIONS IN ULCERATIVE COLITIS

60. ILEAL POUCH-ANAL ANASTOMOSIS

61. LONG-TERM ADVERSE OUTCOMES OF ILEAL POUCH ANAL ANASTOMOSIS

62. POUCHITIS

63. TREATMENT OPTIONS FOR POUCHITIS

64. INDICATIONS FOR SURGERY IN CROHN’S DISEASE

65. SURGICAL OPTIONS FOR INTRA-ABDOMINAL DISEASE IN CROHN’S DISEASE

66. STRICTUROPLASTY (HEINEKE-MIKULICZ)

67. POST-OPERATIVE RECURRENCE RATES IN CROHN’S DISEASE

68. CROHN’S DISEASE POST- OPERATIVE PROPHYLAXIS

69. MEDICAL TREATMENT OPTIONS FOR PERINEAL DISEASE

70. SURGICAL TREATMENT OPTIONS FOR PERINEAL CROHN’S DISEASE

71. THE DEAD SEA AND CROHN’S DISEASE – Treatment of Fistuli