E161 - Elizabeth Squirrell on Crohns Disease, Part 2

Cold Steel: Canadian Journal of Surgery Podcast

On this episode, Dr. Elizabeth Squirrell joined us to talk about Crohns disease. Dr. Squirrell is a staff gastroenterologist at Queen’s University and has a special expertise in inflammatory bowel disease. In this two part series, we first talk about the diagnosis of crohns disease and the different patterns of its presentation. In part 2, we talk about the changing landscape of medical therapy for Crohns disease and how Dr. Squirrell approaches the treatment of Crohns. Make sure to check out the links below for all the papers that are discussed in both part 1 and part 2 of this series.

Links:

1. Is there an optimal sequence of biologic therapies for inflammatory bowel disease? – Brian Bressler: https://journals.sagepub.com/doi/10.1177/17562848231159452
2. Vedolizumab as Induction and Maintenance Therapy for Crohn's Disease – Sandborn et al. - https://www.nejm.org/doi/full/10.1056/NEJMoa1215739
   • They measured Clinical remission at week 6 and did have a significant result in one of their groups (p=0.02) but had a remission rate of 14.5% in the double-blind group and 17.7% in the open label group. Contrasted to the ustekinumab study (below) where they measured at 8 weeks and record 40.2% remission in biologic naïve patients and 20.9% remission in prior TNF exposed patients (the vedo study was a mix of bio exposed and bio naïve so would expect somewhere between).
3. Ustekinumab as Induction and Maintenance Therapy for Crohn’s Disease – Feagan et al. - https://nejm.org/doi/full/10.1056/NEJMoa1602773#APPNEJMoa1602773SUP
4. ECCO-ESCP Consensus on Surgery for Crohn’s Disease – Bemelman et al. - https://academic.oup.com/ecco-jcc/article/12/1/1/3813784
5. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis – Ytterberg et al. - https://www.nejm.org/doi/full/10.1056/NEJMoa2109927
6. ACG Clinical Guideline: Management of Crohn's Disease in Adults – Lichtenstein et al. - https://journals-lww-com.proxy.queensu.ca/ajg/Fulltext/2018/04000/ACG_Clinical_Guideline__Management_of_Crohn_s.10.aspx
7. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Luminal Crohn’s Disease – Panaccione et al. - https://www.cag-acg.org/images/publications/CAG-CPG-Luminal-Crohns-Disease-JCAG-July2019.pdf