✳️ NSAIDs use in IBD patients
▶️ Current ACG guidelines recommend viewing routine NSAID use with caution in Crohn's disease patients, noting they may exacerbate disease activity.
▶️ British Society of Gastroenterology guidelines (BSG) indicate short-term use is relatively safe when IBD is well-controlled, with approximately 20% relapse risk, and that selective COX-2 inhibitors show no difference from placebo in meta-analyses.
▶️ NSAIDs should be avoided in acute severe ulcerative colitis, as they have been associated with IBD-related hospitalizations and disease relapses.
▶️ When pain management is needed, consider acetaminophen as an alternative, though one study found it was also associated with active Crohn's disease (possibly as a marker of subclinical disease activity rather than causation).
▶️ If NSAIDs are necessary, consider selective COX-2 inhibitors or low-dose aspirin as potentially safer alternatives for short-term use in patients with well-controlled disease.
▶️ Current ACG guidelines recommend viewing routine NSAID use with caution in Crohn's disease patients, noting they may exacerbate disease activity.
▶️ British Society of Gastroenterology guidelines (BSG) indicate short-term use is relatively safe when IBD is well-controlled, with approximately 20% relapse risk, and that selective COX-2 inhibitors show no difference from placebo in meta-analyses.
▶️ NSAIDs should be avoided in acute severe ulcerative colitis, as they have been associated with IBD-related hospitalizations and disease relapses.
▶️ When pain management is needed, consider acetaminophen as an alternative, though one study found it was also associated with active Crohn's disease (possibly as a marker of subclinical disease activity rather than causation).
▶️ If NSAIDs are necessary, consider selective COX-2 inhibitors or low-dose aspirin as potentially safer alternatives for short-term use in patients with well-controlled disease.
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ACG_clinical_guideline_update__preventive_care_in.15.pdf
661.7 KB
ACG Guideline Clinical Update : Preventive Care in Inflammatory Bowel Disease
July 2025
Functional dyspepsia 2026.pdf
3.9 MB
Functional dyspepsia
NEJM jan.2026
Appendectomy in UC remission versus JAk inhibitors .pdf
5.6 MB
Appendicectomy versus switching to a JAK inhibitor in inducing remission in patients with active ulcerative colitis after biologic therapy failure (COSTA): 1-year results of
a multicentre, prospective, cohort study
✴️ Conclusion : Appendicectomy as an adjunct to advanced therapy in biologic-exposed patients with active ulcerative colitis was associated with higher clinical remission rates at 12 months compared with switching to a JAK inhibitor, suggesting potential effectiveness, and the procedure can be performed safely in this patient group.
a multicentre, prospective, cohort study
✴️ Conclusion : Appendicectomy as an adjunct to advanced therapy in biologic-exposed patients with active ulcerative colitis was associated with higher clinical remission rates at 12 months compared with switching to a JAK inhibitor, suggesting potential effectiveness, and the procedure can be performed safely in this patient group.
The lancet gastro&Hep 2025
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✳️ Practical guidelines on endoscopic treatment for
Crohn's disease strictures:
▶️ Endoscopic Ballon Dilatation(EBD) is efficacious and safe for primary or anastomotic strictures <4-5 cm in length.
▶️ EBD is more efficacious and safer for a small number of strictures (n<4) in close proximity to each other than for multiple stricutres (n>4).
▶️ EBD should be avoided for strictures with deep ulcerations.
▶️ EBD might be less effective for strictures with prestenotic luminal dilation.
▶️ EBD is not recommended for patients with concurrent fistulae or abscesses adjacent to the intestinal strictures.
▶️ Avoid injection of steroids or anti-TNF.
▶️ Endoscopic electroincision can be done in patients with EBD-refractory strictures in centres with the necessary technical capabilities.
▶️ Electroincision can be particularly useful for anorectal strictures in patients with Crohn's disease.
▶️ Electroincisions can be made using various knives with an endoscopic retrograde cholangiopancreatography power setting (ie, Endocut mode).
▶️ Fully covered removable metal stents can be used for refractory strictures in selected patients if EBD and endoscopic electroincision are unsuccessful.
Crohn's disease strictures:
▶️ Endoscopic Ballon Dilatation(EBD) is efficacious and safe for primary or anastomotic strictures <4-5 cm in length.
▶️ EBD is more efficacious and safer for a small number of strictures (n<4) in close proximity to each other than for multiple stricutres (n>4).
▶️ EBD should be avoided for strictures with deep ulcerations.
▶️ EBD might be less effective for strictures with prestenotic luminal dilation.
▶️ EBD is not recommended for patients with concurrent fistulae or abscesses adjacent to the intestinal strictures.
▶️ Avoid injection of steroids or anti-TNF.
▶️ Endoscopic electroincision can be done in patients with EBD-refractory strictures in centres with the necessary technical capabilities.
▶️ Electroincision can be particularly useful for anorectal strictures in patients with Crohn's disease.
▶️ Electroincisions can be made using various knives with an endoscopic retrograde cholangiopancreatography power setting (ie, Endocut mode).
▶️ Fully covered removable metal stents can be used for refractory strictures in selected patients if EBD and endoscopic electroincision are unsuccessful.
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