7/18 Morning Report w/ Morgan and Dr. Shlager:

A young man w/ Crohn’s disease presents with complex peri-rectal disease c/b inadequate response to anti-TNF therapy and c. diff, ultimately requiring surgical intervention.

Standard of care for characterizing complex peri-rectal disease:

-Pelvic MRI – particularly in young patients to avoid radiation exposure!!

Bad prognosticators for Crohn’s:

-Deep ulcerations at time of endoscopy

-Young presentation

-Intraabdominal abscess

-CRP > 5



What to do if a patient is not responding to infliximab:

-Check a trough level

-Also check antibody – human anti-chimeric antibody (HACA)

-Can consider dual therapy with an immunomodulator like Remicade – must counsel patients on long term risk of lymphoma

C. Diff and IBD

-C. Diff is very common in these patients, and you must ALWAYS rule out C. Diff!

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