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Vol. 66, No. 4 2015
Northeast Florida Medicine
DCMS online
. org
CME
with ileal disease.
19
Hence, patients with Crohn’s disease
should be strongly encouraged to stop smoking.
20,21
On the other hand, smoking cessation appears to be
detrimental in ulcerative colitis. The increased risk of
UC can start two years after quitting and last up to 20
years.
20
Nicotine patches may help symptoms of UC,
but a recent study failed to show significant benefit to
smoking in UC.
21
Given the adverse cardio pulmonary
effects of smoking, patients with UC should nevertheless
be encouraged to quit, and discouraged from starting.
ClostridiumDifficile Infection (CDI) and IBD
Infections with Clostridium difficile (CDI) and other
enteric pathogens, account for about 10 percent of IBD
flares and relapses.
22
Concurrent with the nationwide epi-
demic of CDI, many institutions are reporting an increase
in CDI in patients with IBD.These patients are at increased
risk for hospitalizations and complications.
23
One study
showed a colectomy rate of about 20 percent.
23
Risk factors
for CDI include antibiotic use and recent hospitalization.
CDI cannot be distinguished from IBD endoscopically;
diagnosis is based on stool testing. Immunosuppressive
drugs should be withheld until stool studies are negative
for pathogens. When diagnosed, CDI should be treated
with metronidazole or vancomycin, according to current
recommendations.
24
Some patients will develop recurrent
CDI, which can be difficult to eradicate. Reports about the
safety and efficacy of a novel treatment, Fecal Microbiota
Transplantation (FMT) in immunocompromised patients
are encouraging.
25
The study included patients with IBD
on immunosuppressive therapy.
Conclusion
In conclusion, the diagnosis and treatment of IBD re-
mains complex and multifaceted. PCPs play an important
role in the management of these patients to enable the best
outcomes. Patients with symptoms and signs suggestive
of IBD should be referred to a gastroenterologist. Those
patients should be screened for bone loss, depression,
anxiety, abnormal body image and nutritional deficiencies.
Smoking should be discouraged and the use of NSAIDs
and antibiotics should be minimized.
v