14 Hospital Physician Board Review Manual www.turner-white.com
on these medications, they can usually be con-
tinued.62 Cyclosporine may be used during preg-
nancy to induce remission in severe disease, but
breastfeeding should be stopped if it is used in the
Anti-TNF agents can be used during pregnancy
with a few caveats. Infliximab is known to cross
the placenta starting at some point during the
second trimester, and fetal serum infliximab levels
rise through the third trimester. It is recommended
that infliximab and adalimumab be stopped 8 to
10 weeks prior to anticipated delivery and can be
resumed at the time of delivery and continued during breastfeeding.63 Certolizumab pegol does not
cross the placenta, and so is thought to be safe
during pregnancy. Natalizumab appears to be safe
during pregnancy, although data is limited.64
The presence of active perianal disease is an in-
dication for Cesarean section; otherwise the mode
of delivery should be determined as it would be
outside the setting of IBD.65
CD is a chronic inflammatory condition caused
by an incompletely understood combination of ge-
netics, environmental exposure, and dysregulated
immune response. There is a widely variable spec-
trum of disease involving the gastrointestinal tract
with frequent extraintestinal manifestations. CD
generally follows an unpredictable relapsing and
remitting course characterized by periods of active
and quiescent disease. Appropriate management
includes careful characterization of the extent of
involvement, and treatment often requires a multi-
disciplinary approach. The introduction of biologic
therapies has dramatically changed the way in
which CD is managed. Patients typically require
immunosuppressants to control their disease, and
they must be monitored closely for disease com-
plications and side effects of therapy.
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with time, based on systematic review. Gastroenterology
2. Jostins L, Ripke S, Weersma RK, et al. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature 2012;491:119–24.
3. Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet
4. Cho I, Blaser MJ. The human microbiome: at the interface
of health and disease. Nat Rev Genet 2012;13:260–70.
5. Peyrin-Biroulet L, Loftus EVJ, Colombel J, Sandborn WJ.
The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol 2010;105:289–97.
6. Satsangi J, Silverberg MS, Vermeire S, Colombel JF.
The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut
7. Gasche C, Scholmerich J, Brynskov J, et al. A simple classification of Crohn’s disease: report of the Working Party
for the World Congresses of Gastroenterology, Vienna
1998. Inflamm Bowel Dis 2000;6:8– 15.
8. Thia KT, Sandborn WJ, Harmsen WS, et al. Risk factors
associated with progression to intestinal complications of
Crohn’s disease in a population-based cohort. Gastroenterology 2010;139:1147–55.
9. Cosnes J, Cattan S, Blain A, et al. Long-term evolution of
disease behavior of Crohn’s disease. Inflamm Bowel Dis
10. Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn’s disease in adults. Am J Gastroenterol
11. Beaugerie L, Seksik P, Nion-Larmurier I, et al. Predictors of
Crohn’s disease. Gastroenterology 2006;130:650– 6.
12. Solberg IC, Vatn MH, Høie O, et al. Clinical course in
Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol
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