IBD Knowledge 5 — Questions and Answers
Question 1: Which of the following extraintestinal manifestations of IBD is classified as 'independent' of disease activity?
- Peripheral arthropathy type 1 (large joint)
- Primary sclerosing cholangitis (Correct answer)
- Erythema nodosum
- Episcleritis
Correct answer: Primary sclerosing cholangitis
PSC runs an independent course from IBD activity, often progressing even after colectomy, unlike type 1 peripheral arthropathy which tracks with gut inflammation.
Question 2: What is the recommended first-line treatment for mild-to-moderate left-sided ulcerative colitis?
- Oral prednisolone
- Topical (rectal) mesalamine suppositories or enemas combined with oral mesalamine (Correct answer)
- Infliximab infusion
- Azathioprine monotherapy
Correct answer: Topical (rectal) mesalamine suppositories or enemas combined with oral mesalamine
Combined topical and oral mesalamine is more effective than either alone and is the evidence-based first-line approach for left-sided UC.
Question 3: A patient with Crohn's disease develops a low-output enterocutaneous fistula after surgery. What is the initial management priority?
- Immediate reoperation to close the fistula
- Optimization of nutrition, skin care, control of sepsis, and delineation of anatomy (Correct answer)
- Starting high-dose corticosteroids immediately
- Initiating anti-TNF therapy within 24 hours
Correct answer: Optimization of nutrition, skin care, control of sepsis, and delineation of anatomy
The SNAP approach (Sepsis control, Nutrition, Anatomy definition, Procedure) guides initial fistula management before considering surgical or biologic intervention.
Question 4: In pediatric IBD, which pattern is more common compared to adult-onset IBD?
- Isolated proctitis in UC
- More extensive disease at diagnosis, including pancolitis in UC and upper GI involvement in Crohn's (Correct answer)
- Predominantly fibrostenotic Crohn's disease
- Lower rates of extraintestinal manifestations
Correct answer: More extensive disease at diagnosis, including pancolitis in UC and upper GI involvement in Crohn's
Children with IBD typically present with more extensive disease; pediatric UC frequently involves the entire colon and pediatric Crohn's more often involves the upper GI tract.
Question 5: What is the role of fecal microbiota transplantation (FMT) in IBD as of current evidence?
- Established first-line therapy for UC induction
- Promising experimental therapy with evidence in UC but not yet standard of care (Correct answer)
- Approved maintenance therapy for Crohn's disease
- Contraindicated in all IBD patients
Correct answer: Promising experimental therapy with evidence in UC but not yet standard of care
Multiple RCTs show FMT can induce remission in mild-to-moderate UC, but it lacks regulatory approval for IBD and is not yet standard of care.
Question 6: Which of the following best defines 'mucosal healing' as a treatment target in IBD?
- Resolution of abdominal pain and normalization of CRP
- Endoscopic absence of ulceration and erosions with restored mucosal integrity (Correct answer)
- Normal stool frequency for three consecutive weeks
- Negative fecal occult blood test
Correct answer: Endoscopic absence of ulceration and erosions with restored mucosal integrity
Mucosal healing, defined endoscopically as absence of ulcers and erosions, is the key treat-to-target endpoint associated with improved long-term outcomes in IBD.
Question 7: Strictureplasty in Crohn's disease is performed primarily to achieve what goal?
- Remove diseased bowel to induce remission
- Widen a narrowed intestinal segment while preserving bowel length (Correct answer)
- Create a bypass around an inflamed segment
- Close a fistulous tract surgically
Correct answer: Widen a narrowed intestinal segment while preserving bowel length
Strictureplasty widens fibrous strictures without resecting bowel, preserving intestinal length and reducing the risk of short bowel syndrome in patients with multiple Crohn's strictures.
IBD Knowledge 5
Which of the following extraintestinal manifestations of IBD is classified as 'independent' of disease activity?