Symptom Management in Inflammatory Bowel Disease

The document from April 23, 2015, provides a detailed review of symptom management in patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). It emphasizes the importance of prompt symptom management to prevent permanent sequelae and improve quality of life. The review discusses the multifactorial nature of symptoms, which can arise from active disease, medication side effects, immunosuppression, extraintestinal manifestations, or concomitant autoimmune disorders. Specific symptoms such as diarrhea, abdominal pain, joint pain, nausea/vomiting, fatigue, psychological issues, dyspnea, neurological symptoms, and alopecia are addressed, with various management strategies outlined for each. The document highlights the need for gastroenterologists to differentiate the causes of symptoms and suggests that future gut-targeted therapies may reduce complications. It also stresses the importance of regular monitoring for nutritional deficiencies and vaccinations as preventive strategies. The review includes discussions on the prevalence of Clostridium difficile infection in hospitalized IBD patients, the impact of C. difficile colitis on health outcomes, and the management of IBD-related symptoms, including the use of antibiotics, prebiotics, probiotics, and fecal microbiota transplantation. It also covers the effects of drugs on ileostomy output, bile acid malabsorption treatments, pain management strategies, the association of nonsteroidal anti-inflammatory drugs with IBD flare-ups, the use of narcotics, and the prevalence of opioid use and extraintestinal manifestations in IBD patients. Lastly, it reviews the efficacy and adverse effects of various IBD treatments and addresses misconceptions in the diagnosis and management of anemia in IBD patients.