Inflammatory Bowel Disease - Dr. Lounsbury

CORE CONCEPTS
•Incidence of CT scan ordering for IBD patients has more than doubled in the past 10 years.
•Patients with Crohn’s disease are much more likely to have critical findings.
•Patients with IBD are at increased risk of malignancy from radiation.
•Take into account certain characteristics, ESR, & CRP when considering imaging.


IBD Review

   Crohn's Disease - transmural inflammation, affects whole GI tract, skip lesions

   Ulcerative colitis - involves colon only


Do We Image?

--Yarur et al found that 93% of people with IBD in the ED with GI complaints had abnormal CT scan and in Crohn's disease 1/3 had clinically actionable findings and 12% of UC had clinically actionable findings.


--Mo' CTs, Mo' Problems..

   $$$$ - $1000 per CT scan
   Radiation - 1 in 1500 risk of death from malignancy from 50 mSv.  

--Keep in mind

   - IBD folks tend to be young with baseline increased risk of cancer from rapidly multiplying cells and immunsuppressive meds

-- How to decide who to scan

    - Yarur et al - underweight, biologics use, previous IBD surgery, black race and HR > 90 were associated with increased risk for clinically actionable CT findings for Crohn's patients; salicylate use was protective.

    - proposed prediction models - PA+ model = ESR + (5xCRP); if less than 10, then no scan - 97% sensitivity

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