{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 14, Ep 3 of 3: Pouch Dysplasia EIM Pregnancy","html":"","width":"100%","height":180,"duration":988,"description":"The long-arc complications of IBD after induction and maintenance: the ileal pouch and its inflammations, dysplasia surveillance in long-standing colitis, the extraintestinal manifestations, and pregnancy. The unifying board move is that active disease, not active medication, is the threat, so biologics usually continue through delivery. Localization, timing of surveillance, and whether a manifestation tracks bowel activity are what get tested.\n \nTopics covered\n\nIleal pouch-anal anastomosis and pouchitis\nCuffitis and the Crohn's-like pouch\nChronic antibiotic-dependent vs refractory pouchitis\nDysplasia surveillance in colitis\nChromoendoscopy and dysplasia management\nExtraintestinal manifestations of IBD\nPre-biologic vaccination timing\nPregnancy and biologics in IBD\n \n \nKey decisions\n\nPouch patient with new bleeding and a normal-appearing pouch body is cuffitis: treat with topical mesalamine, not systemic escalation.\nFor antibiotic-refractory chronic pouchitis, vedolizumab carries the strongest randomized evidence and is the favored biologic; clear C. diff, CMV, ischemia, NSAIDs, and celiac before escalating.\nSurveillance colonoscopy in extensive UC or Crohn's colitis begins 8 to 10 years after symptom onset (not date of diagnosis), but begins immediately at diagnosis of primary sclerosing cholangitis.\nResectable visible dysplasia with clear margins is removed endoscopically; non-resectable visible dysplasia and invisible high-grade dysplasia both go to proctocolectomy; confirm all dysplasia with a second pathologist.\nLive vaccines (MMR, varicella, yellow fever, oral typhoid, intranasal flu) are contraindicated during biologics and for 3 months after, so give at least 4 weeks before starting; infant live/rotavirus vaccines are deferred until in-utero biologic clears, except certolizumab.\nContinue most biologics in pregnancy; stop methotrexate and JAK inhibitors; certolizumab crosses the placenta minimally and is preferred late in pregnancy.\n \n \nThis is an...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}