True or False: Smoking causes IBD flares; peak IBD onset occurs in 3rd decade; UC affecting the rectum increases risk of colon cancer; plus 3 more.
1. True or False: Smoking exacerbates both Crohn disease and ulcerative colitis and leads to worse outcomes.
Answer: True. Smoking tobacco cigarettes can trigger flares of IBD. Counseling on smoking cessation as well as prescribing nicotine replacement can help reduce morbidity and improve clinical outcomes.
2. True or False: Tofacitinib is approved for the treatment of rheumatoid arthritis, but can be used off-label for ulcerative colitis.
Answer: False. Tofacitinib is approved for moderate to severe ulcerative colitis (May 2018). It is the first oral JAK inhibitor approved in the US for this indication.
Answer: True. UC is most commonly diagnosed between ages 15 and 25 with a second peak of onset seen in the 6th decade of life.
4. True or False: Patients with ulcerative colitis affecting only the rectum are not at increased risk for colorectal cancer.
Answer: True. When UC involves more than the rectum, surveillance colonoscopy is recommended after 8-10 years of disease. Patients with UC affecting only the rectum are not at increased risk for colon cancer and do not require the testing.
Answer: True. When the index of suspicion is high, VCE is the preferred diagnostic tool for small bowel Crohn disease. A pre-VCE patency capsule evaluation is recommended for patients with obstructive symptoms to decrease risk of capsule retention.
For more True/False questions on diagnosis and management of IBD, see:Inflammatory Bowel Disease: True or False? Part 1.
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