Table of Contents

Dedication About the Editors Contributing Authors Preface Introduction Section I Diagnosis and Prognosis Question 1 How Can We Assess Prognosis in Crohn's Disease? Carolina Palmela, MD and Joana Torres, MD, PhDQuestion 2 How Do You Evaluate and Treat Mid-­Proximal Small BowelCrohn's Disease? Jean A. Donet, MD and Mark Lazarev, MDQuestion 3 What Is Your First-­Line Approach to the Diagnosis andTreatment of Patients With Perianal Crohn's Disease? Baldeep S. Pabla, MD, MSCI and David A. Schwartz, MDQuestion 4 What Is the Updated Role of Capsule Endoscopy in IBD? Shabana F. Pasha, MD and Jonathan A. Leighton, MDQuestion 5 How Should We Be Using Fecal Markers in Our Patients? Anthony Buisson, MD, PhD and David T. Rubin, MDQuestion 6 What Endpoints Should We Aim for in IBD Medical Therapy? Maia Kayal, MD and Jean-Frederic Colombel, MD Section II Medical Treatment Question 7 When Should We Be Using 5-­Aminosalicylic Acids in IBD?How Do You Optimize Their Use? Stephen B. Hanauer, MD and Madeline Bertha, MDQuestion 8 What Is Ste­roid Dependence and How Is It Managed? David B. Sachar, MDQuestion 9 What Are the New Approaches to Using and Minimizing Ste­roids? Irving Levine, MD and Brian P. Bosworth, MDQuestion 10 Should You Use Concomitant Immunomodulators With BiologicalTherapies in IBD? Remo Panaccione, MDQuestion 11 If, When, and How Should Thiopurines Be Used in IBD? Jennie Clough, MBBS and Peter M. Irving, MBBS, MA, MDQuestion 12 How Should Methotrexate Be Used in IBD? Hans Herfarth, MD, PhD and Edward L. Barnes, MD, MPHQuestion 13 What Is the Evolving Role of Calcineurin Inhibitors in IBD? Ralley Prentice, MBBS and Britt Christensen, BSc, MBBS (Hons), MPH, PhDQuestion 14 What Preparations Should Occur Before Initiating Biologic Therapy? Akriti P. Saxena, MD and Mark T. Osterman, MD, MSCEQuestion 15 Where Should Anti-­Integrin Therapy Be Placed in the TherapeuticAlgorithm for Crohn's Disease and Ulcerative Colitis? Rachel W. Winter, MD, MPH and Sonia Friedman, MDQuestion 16 Where Should Anti–Interleukin 23 Therapy Be Placed in the TherapeuticAlgorithm for Crohn's Disease and Ulcerative Colitis? Joel Pekow, MDQuestion 17 What Should Clinicians and Patients Know About Biosimilars? Ferdinando D'Amico, MD, PhD and Silvio Danese, MD, PhDQuestion 18 What Are Janus Kinase Inhibitors andWhen Should They Be Used in IBD? Roni Weisshof, MD and David T. Rubin, MDQuestion 19 What Is the Approach for Loss of Response to Biological Therapy? Konstantinos Papamichael, MD, PhD and Adam Cheifetz, MDQuestion 20 How Should Proactive Therapeutic Drug Monitoring Be Considered inOur Patients? Joseph D. Feuerstein, MD and William T. Clarke, MD, MScQuestion 21 What Are the Risks of Biologic Therapies and How Do YouCommunicate Them to Patients? Susan Connor, MBBS (Hons 1), B Med Sci, PhD and Yang (Clare) Wu, MBChBQuestion 22 When Should We Consider Deescalation of Therapy? Seth R. Shaffer, MD, MS and David T. Rubin, MDQuestion 23 Can You Restart a Biological Therapy ­After a Drug Holiday?How Do You Do This? Filip J. Baert, MD, PhD and David Drobne, MD, PhDQuestion 24 How Can I Get My Patients With IBD the Therapy They Need? Shivani A. Patel, PharmD, BCPS and Toni M. Zahorian, PharmD, BCACP Section III Alternative Treatments Question 25 What Is the Role of Probiotics for Patients With IBD? Kerri Glassner, DO and Bincy P. Abraham, MD, MSQuestion 26 What Do I Tell My Patient With IBD Who Is Asking AboutCannabis as Therapy? Jami Kinnucan, MD and Arun Swaminath, MD Section IV Special Populations Question 27 How Do You Treat Pouchitis and What Do You Do for Recurrent orRefractory Pouchitis? Iris Dotan, MD and Idan Goren, MDQuestion 28 My Patient With IBD Is Complaining of Joint Pain. What Should I Do? Abha G. Singh, MD and Arthur Kavanaugh, MDQuestion 29 What Are the Diagnostic and Therapeutic Approaches to thePatient With IBD With Pain? Emily Weaver, LCSW and Eva Szigethy, MD, PhDQuestion 30 My Patient on Tumor Necrosis ­Factor Alpha Therapy Has a Rash.What Should I Do? Oluwakemi Onajin, MD and Diana Bolotin, MD, PhDQuestion 31 What Is the Approach to Primary Sclerosing Cholangitis in IBD? Bilal Hameed, MD and Norah Terrault, MD, MPHQuestion 32 What Is the Best Medical Therapy for IBD in Older Patients? Seymour Katz, MDQuestion 33 How Should Clinicians Treat Men With IBD? What Are theUnique Concerns? Aoibhlinn O'Toole, MD and Sonia Friedman, MDQuestion 34 What Is the Updated Approach to IBD Medical Therapy in Pregnancy and What Is Known About Neonatal Outcomes in Babies Bornto Mothers With IBD? Muhammad Bader Hammami, MD and Uma Mahadevan, MD Section V Infection and Malignancy Prevention Question 35 How Do You ­Handle a Patient With IBDWith Clostridioides difficile Infection? Alexander N. Levy, MD and Jessica R. Allegretti, MD, MPHQuestion 36 How Do You Treat IBD in the Setting of Current or Previous Cancer? Steven H. Itzkowitz, MD and Jordan E. Axelrad, MD, MPHQuestion 37 What Is the Updated Approach to Surveillance and Colorectal CancerPrevention in IBD? Jimmy K. Limdi, MBBS and Francis A. Farraye, MD, MSc Section VI Surgical Treatment Question 38 What Is the Appropriate Evaluation of the PreoperativePatient With IBD? (Malnutrition, Steroids, Smoking) Amy L. Lightner, MDQuestion 39 My Patient With Crohn's Disease Has an Ileal Abscess.What Is the Appropriate Management and Timing of Medical andSurgical Therapies? Victor G. Chedid, MD, MSc and Sunanda V. Kane, MD, MSPHQuestion 40 What Is the Updated Approach to Monitoring and Prevention in aPatient With Crohn's Disease After an Ileocecectomy andPrimary Anastomosis? Ashwin N. Ananthakrishnan, MD, MPHQuestion 41 How Does Perioperative Immune Suppression Affect Surgical Outcomesin IBD? Shintaro Akiyama, MD, PhD; Akihiro Yamada, MD, PhD; andAtsushi Sakuraba, MD, PhDQuestion 42 Does the Type of Surgical Anastomosis (End-­to-­End Versus Side-­to-­Side)Make a Difference in Long-­Term Crohn's Disease Outcomes andin Recurrence? Jana G. Hashash, MD, MSc; Andrew R. Watson, MD, MLitt; andDavid G. Binion, MD Section VII Health Maintenance Question 43 What Is the Most Successful Strategy to Promote Smoking Cessationin Patients With Crohn's Disease? Michael Buie, BHSc and Gilaad G. Kaplan, MD, MPHQuestion 44 Which Vaccines Should Patients With IBD Receive? Freddy Caldera, DO, MS and Francis A. Farraye, MD, MScQuestion 45 How Can Gastroenterologists Address IBD-Related Health Maintenance in Clinical Practice? Erica R. Cohen, MD and Gil Y. Melmed, MD, MSQuestion 46 How Should We Screen Our Patients With IBD forDepression and Anxiety? Alyse Bedell, PhD and Laurie Keefer, PhDQuestion 47 What Is the Role of Diet in the Treatment of IBD and How Do I Discuss This With My Patients? James D. Lewis, MD, MSCE and Tamar Pfeffer Gik, RD, MScQuestion 48 What Advice Should I Give the Patient With IBD Who Is Traveling? Kay Greveson, BA, MSc and Shomron Ben-­Horin, MDQuestion 49 How Should We Approach the Diagnosis and Evaluation ofSexual Dysfunction in Patients With IBD? Punyanganie S. de Silva, MBBS, MPH and Sonia Friedman, MDFinancial Disclosures Index

About the Author

David T. Rubin, MD, is the Joseph B. Kirsner Professor of Medicine; Chief of the Section of Gastroenterology, Hepatology, and Nutrition; and the Co-Director of the Digestive Diseases Center at the University of Chicago Medicine. He earned a medical degree with honors at the University of Chicago Pritzker School of Medicine and completed his residency in internal medicine and fellowships in gastroenterology and clinical medical ethics at the University of Chicago, where he served as Chief Resident and Chief Fellow. He also currently serves as an associate faculty member at the MacLean Center for Clinical Medical Ethics, an associate investigator at the University of Chicago Comprehensive Cancer Center, and is a member of the University of Chicago Committee on Clinical Pharmacology and Pharmacogenomics. He is the chair of the National Scientific Advisory Committee of the Crohn’s and Colitis Foundation, where he also serves as a Board of Trustees member. Prior to these appointments, Dr. Rubin served as the Director of the Fellowship in Gastroenterology, Hepatology, and Nutrition at the University of Chicago for 11 years.

Dr. Rubin is a Fellow of the American Gastroenterological Association (AGA), the American College of Gastroenterology (ACG), the American Society for Gastrointestinal Endoscopy (ASGE), the American College of Physicians (ACP), and the Royal College of Physicians (Edinburgh). He is on the Board of Trustees for the ACG. Among numerous awards and honors, Dr. Rubin was chosen by his peers as a member of Best Doctors (recognized for superior clinical ability) and America’s Top Physicians (gastroenterology). Additionally, he twice received the ACG’s Governor’s Award of Excellence in Clinical Research (2003 and 2013), and the UChicago Postgraduate Teaching Award in recognition of significant contributions for fellowship education (2006). In 2012, he received the Crohn’s and Colitis Foundation’s Rosenthal Award, a national leadership award bestowed upon a volunteer who has contributed in an indisputable way to the quality of life of patients and families. In 2020, Dr. Rubin received the Sherman Prize for Excellence in Crohn’s and Colitis. He is an Associate Editor of the journal Gastroenterology and Editor-in-Chief of the ACG On-Line Education Universe. In 2018, Dr. Rubin completed the Harvard T.H. Chan School of Public Health Leadership Development Course for Physicians.

In addition to Curbside Consultation in IBD, Dr. Rubin is an associate editor of the 11th edition of Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, and an author or coauthor of more than 450 articles on treatment and management of IBD, cancer in IBD and novel paradigms, as well as the first author of the 2019 ACG Guidelines for ulcerative colitis. His current research is in the area of biosensor monitoring of IBD, prevention of progressive complications from uncontrolled inflammation, and a variety of collaborative studies related to the causes of IBD and its complications. He is also a featured media contact for issues related to IBD, appearing on satellite radio, television, and print media and maintains a popular and verified Twitter feed @IBDMD.

Sonia Friedman, MD, is Associate Professor of Medicine at Harvard Medical School and an Associate Physician at Brigham and ­Women’s Hospital in Boston, Mas­sa­chu­setts. She is an Adjunct Professor of Clinical Epidemiology at the University of Southern Denmark in Odense, Denmark. Dr. Friedman completed her undergraduate degree in biology at Stanford University and her MD at Yale Medical School. She did her medical internship and residency at University of Pennsylvania and her gastroenterology fellowship at Mount Sinai Medical Center in New York City. She specialized in IBD during her fellowship and now has a large IBD practice in the gastroenterology division of Brigham and ­Women’s Hospital. She has been at Brigham and ­Women’s for the past 21 years and is Director of ­Women’s Health at the Center for Crohn’s and Colitis.

Dr. Friedman’s research interests include reproductive health and the safety of medi­cations taking during conception and/or during pregnancy in patients with IBD. Her clinical interests are the care of patients with Crohn’s disease and ulcerative colitis. She specializes in the management of infertility and pregnancy in patients with IBD. Dr. Friedman is a frequent speaker and invited regional and national lecturer on the management of IBD. She has authored or co-­authored papers on cancer in Crohn’s disease, adherence to surveillance colonoscopy, management of polyps and cancer in IBD, medical management of IBD, fertility, sexual function, pregnancy, and men’s health in IBD, as well as the long-­term outcomes of ­children exposed to IBD and IBD medi­cations in utero.

Dr. Friedman is the Deputy Editor of the journal Inflammatory Bowel Diseases and is on the Gastroenterology and Digestive Diseases and Sciences editorial boards. She is a member of the National Academies of Sciences, Engineering, and Medicine Committee on Assessment of NIH Research on Autoimmune Diseases as well as the Crohn’s and Colitis Foundation Unbiased Peer Review Task Force. She is a member of the Crohn’s and Colitis Foundation Clinical Research Alliance and is a member of the organ­izing committee of the Crohn’s and Colitis Foundation Congress. She has received a recent Crohn’s and Colitis Foundation Se­nior Research Award as well as an American College of Gastroenterology Clinical Research Award to continue her work on reproductive health in IBD.

Francis A. Farraye, MD, MSc, is a Professor of Medicine at the Mayo Clinic School of Medicine and Director of the Inflammatory Bowel Disease Center at the Mayo Clinic in Jacksonville, Florida. ­After graduating from the State University of New York (SUNY) at Stony Brook, Dr. Farraye earned his medical doctorate from Albert Einstein College of Medicine in New York, New York, and his master’s degree in epidemiology from the Harvard School of Public Health in Boston, Mas­sa­chu­setts. He completed an internal medicine residency and gastroenterology fellowship at the Beth Israel Hospital in Boston.

Dr. Farraye is a clinical investigator with an active academic practice managing patients with IBD. A frequent speaker and invited lecturer on topics on the diagnosis and management of IBD, Dr. Farraye has authored or co-­authored more than 450 original scientific manuscripts, chapters, reviews, and abstracts. He is the series editor for the text Curbside Consultation in Gastroenterology and co-­wrote the texts Curbside Consultation in IBD and GI Emergencies: A Quick Reference Guide. His newest books for patients are Questions and Answers About Ulcerative Colitis and Questions and Answers About Crohn’s Disease. He is the Editor-in-Chief for IBD Journal Scan, published weekly by the American Society of Gastrointestinal Endoscopy.

Dr. Farraye is a Fellow of the American College of Physicians, American Society of Gastrointestinal Endoscopy, and American Gastroenterological Association and a Master in the American College of Gastroenterology. He has served on numerous national and international committees and currently is the Chair of the North Florida Chapter Medical Advisory Committee for the Crohn’s and Colitis Foundation. The New ­England Crohn’s and Colitis Foundation named Dr. Farraye Humanitarian of the Year in 2003. In 2009, the American College of Gastroenterology awarded Dr. Farraye the William Carey Award for ser­vice to the college. In 2020, Dr. Farraye was a recipient of the Life Time Achievement Award from the New ­England Crohn’s and Colitis Foundation.