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Managing Pain in Patients With IBD

Managing Pain in Patients With IBD

Among patients with inflammatory bowel disease (IBD), abdominal pain is a common and frustrating symptom with multifaceted pathophysiology and can be associated with significant emotional suffering, disability, and high medical costs. “One of the challenges with managing pain in IBD is that many overlapping factors influence patients’ perception of pain in IBD,” explains Arvind Iyengar Srinath, MD. “These include inflammatory, obstructive, psychological, psychosocial, and neurobiological factors.” Abdominal pain has traditionally been attributed to gut inflammation during a disease flare. However, studies suggest that many patients have disabling abdominal pain even while they are in remission. “We are currently learning more and more about the complex nature of pain in IBD,” says Dr. Srinath. “Considering the multifaceted causes of abdominal pain in patients with IBD and its potentially devastating consequences, it is essential that individualized management approaches be utilized to address the various contributions of each of these factors.” Caring for Patients: IBD vs IBS Dr. Srinath recommends that all clinicians recognize and appreciate the potential overlap of symptoms between IBD and irritable bowel syndrome (IBS). “Pain management should be customized,” he says. “There has been an influx of improved medical treatments for disease activity in IBD, but there is also a growing recognition of functional abdominal pain, as in IBS, within the IBD population.” Currently, there is a paucity of data on pharmacologic, behavioral, and procedural methods to alleviate abdominal pain in IBD. However, Dr. Srinath notes that there is a wide spectrum of potential treatments that can be considered in patients depending on the contributions of factors that are associated with abdominal pain perception in IBD (Figure 1)....

Migraine Prevalence, Celiac Disease, & IBD

When compared with healthy controls, patients with celiac disease, gluten sensitivity (GS), and inflammatory bowel disease (IBD) appear to have a higher prevalence of migraine. Investigators from New York noted that migraine was graded as severe by 72% of patients with celiac disease, compared with 60% for those with GS and 30% for those with IBD. Abstract: Headache, November 5, 2012...
CRC Surveillance in Patients With IBD

CRC Surveillance in Patients With IBD

Certain patients with inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn’s disease of the colon, have an increased risk of developing colorectal cancer (CRC) when compared with patients without IBD. While IBD is relatively rare in the general population, it remains one of the important high-risk conditions predisposing patients to CRC. The majority of patients with IBD will not develop CRC, but two factors that increase CRC risk have been identified: 1) CRC risk increases after 8 to 10 years of having ulcerative colitis, and 2) the more extensive the colonic involvement, the higher the CRC risk. Patients with disease limited to the rectum do not have an increased risk of CRC, while patients with ulcerative proctosigmoiditis or left sided colitis have an intermediate risk. The greatest risk is for those whose entire colon is diseased. The risks are similar for those with extensive Crohn’s colitis. An individualized and sensible approach to CRC surveillance in patients with IBD is essential. In the February 2010 issue of Gastroenterology, the American Gastroenterological Association (AGA) released a medical position statement and technical review on the diagnosis and management of colorectal neoplasia in IBD. The goal of the statement was to ensure that patients receive the highest level of treatment. The recommendations were designed to help identify high-risk individuals and develop individualized surveillance plans based on each patient’s unique situation. Assessing Risks The AGA position statement provides important information on assessing CRC risk in IBD patients. Disease duration, more extensive disease, severity of inflammation, primary sclerosing cholangitis, and a family history of sporadic CRC have all been associated with an increased risk...
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