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Inflammatory Bowel Disease
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Chewing gum in school-aged patients generates saliva that goes down GI tract, stimulating bowel function and gas passage; it is a cheap addition to ERAS protocol Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016 · 43:00
Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016
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Dr. Kurt Heiss discusses enhanced recovery after surgery programs (ERAS). This presentation includes discussion of enhanced healing mechanisms through means of nutrition, electrolyte consumption, decreasing the length of stay, no narcotics,
video44:22 · Jan 2019
Health literacy is defined as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. — Connie Chow, Best of the Best Gen Surg - Limited Health Literacy is Associated with Reduced Adherence to ERP Components. - Dr. Shao · 0:24
Best of the Best Gen Surg - Therapeutic Effect of Oridonin against Inflammatory Bowel Disease Involves Inhibition of Intestinal Fibrosis via NF-kB and p38STAT1 Pathways - Dr. Mao
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Listen to Rui-Min Mao gave her presentation of "Therapeutic Effect of Oridonin against Inflammatory Bowel Disease Involves Inhibition of Intestinal Fibrosis via NF-kB and p38STAT1 Pathways" at the first ever Best of the Best in General Surg
video11:56 · Sep 2022
Best of the Best Gen Surg - Limited Health Literacy is Associated with Reduced Adherence to ERP Components. - Dr. Shao
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Listen to Connie Shao gave her presentation of "Limited Health Literacy is Associated with Reduced Adherence to ERP Components" at the first ever Best of the Best in General Surgery event.
video9:23 · Sep 2022
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing 3 articles from May 2023, the CAPS issue, with editor Dr. Sonia Butterworth and authors Drs. Jacob Langer, Reto Baert
podcast11:17 · Aug 2023
Quick Literature Updates Episode 15
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We’re back with fifteenth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most inte
video4:12 · Jan 2024
Making a large cruciate incision and packing a perianal abscess in a child with undiagnosed Crohn's disease may result in non-healing and potentially require colostomy or ileostomy. — Jason Frischer, Colorectal Quiz Episode 26: Perianal Crohn's Disease · 13:12
Colorectal Quiz Episode 26: Perianal Crohn's Disease
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In this week's episode, Dr. Levitt and Dr. Frischer discuss perianal Crohn's disease with Dr. Lisa McMahon, director of the IBD center at Phoenix Children's Hospital and pediatric surgery fellow, Dr. Cristine Velazco.
We'll go over how to a
podcast23:58 · Jan 2022
Expert statements from the recordings in this collection.
Colorectal Quiz Episode 26: Perianal Crohn's Disease
In pediatric patients, unlike adult patients, the first presenting factor for Crohn's disease can often be perianal disease.
Jason Frischer9:29
Male gender over the age of 10, and presence of a fistula are risk factors with much higher incidence of Crohn's disease being diagnosed in patients presenting with perianal lesions to the emergency room.
Jason Frischer9:00
The mucosa heals first compared to skin in perianal disease, so leaving a mucosal opening without a seton risks recurrent abscess when biologics heal the mucosa.
Jason Frischer12:31
Making a large cruciate incision and packing a perianal abscess in a child with undiagnosed Crohn's disease may result in non-healing and potentially require colostomy or ileostomy.
Jason Frischer13:12
The highest risk factors for lymphoma with biologic therapy are male gender, teenage age, and combination therapy with methotrexate.
Jason Frischer6:52
Real risks of biologic agents include infectious complications such as tuberculosis and risk of lymphoma.
Cristine Velazco6:29
When the colonoscope cannot intubate the terminal ileum, capsule endoscopy or fecal calprotectin can be used to aid diagnosis.
Cristine Velazco3:47
If terminal ileum cannot be intubated, gastroenterologists may treat presumptively and re-scope after a few months of treatment when inflammation has decreased.
Jason Frischer4:36
Setons should remain in place for at least 6 months to allow the inflammatory tract to become non-inflammatory.
Lisa McMahon17:54
Before removing a seton, the bottom must look better, drainage must be better, the patient must be symptom-free, and they must have reached steady state of biologic (loading dose plus at least 3 more doses, typically 2-3 months from start).
Jason Frischer19:23
Inflammatory markers including fecal calprotectin, ESR, and CRP should be checked before removing a seton to ensure systemic disease is under control.
Jason Frischer19:55
The initial Remicade paper from 1998 or 1999 in the New England Journal of Medicine was on perianal disease and demonstrated improved healing time and improved length of time between recurrence when combination of seton and infliximab is used versus either separately.
Jason Frischer20:49
Remicade (infliximab) has the most literature on healing perianal disease; Humira also has good evidence but less literature; Stelara and vedolizumab are sometimes used with less information available.
Lisa McMahon20:27
Literature shows about a 10% response rate for perianal fistulas even without biologics if a seton is placed and removed, with much better outcomes with biologics.
Lisa McMahon19:12
Source control of infection must be achieved before starting immunosuppressive therapy including steroids and biologics.
Jason Frischer17:17
If an abscess is not adequately drained, reimaging should be performed before giving biologics or steroids.
Jason Frischer17:17
Hydrogen peroxide is preferred over methylene blue for identifying fistula tracts because it is neater; 3% hydrogen peroxide in a syringe with 16-20 gauge angiocath is used with a speculum in the anus.
Jason Frischer14:15
When a fistula opening cannot be found despite hydrogen peroxide testing, a seton should not be placed at that time to avoid creating a hole where there isn't one.
Jason Frischer14:54
For recurrent patients requiring repeat seton placement, repeat imaging should be obtained before seton removal.
Lisa McMahon18:45
It is common to have perianal disease in Crohn's; this patient had a delay in diagnosis and had perianal disease for quite some time with multiple skin tags and fissures.
Lisa McMahon7:24
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
The Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.
50% of Hirschsprung-associated IBD patients had long segment disease.
Enterocolitis was reported in 68% of Hirschsprung patients after pull-through.
The most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.
Three risk factors for Hirschsprung-associated IBD are trisomy 21, a history of enterocolitis following pull-through surgery, and long segment disease.
Jacob Langer2:24
Biologic therapy is most likely to be effective for treating Hirschsprung-associated IBD.
Sonia Butterworth2:33
Hirschsprung's associated IBD is very poorly defined, presents in a number of different ways, and the reason why it happens is unknown.
Jacob Langer3:05
Hirschsprung's enterocolitis that persists past age 5, or that is unresponsive to typical treatment under age 5, should prompt consideration of Hirschsprung-associated IBD diagnosis.
Sonia Butterworth3:18
The COVID-19 appendicitis study assessed patients from February 2018 to June 2019 (pre-pandemic control) and mid-February 2020 to June 2021 (COVID period).
The study included 1100 patients total: 44% in pre-pandemic control group and 56% in COVID-19 group.