# Inflammatory Bowel Disease — GCMD Library living collection

Everything in the library about inflammatory bowel disease — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 62 cited statements

## Episodes
### Evidence & Research
- [Journal of Pediatric Surgery Article Review:  May 2023, CAPS Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077) — podcast · 11:17 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077.md)
- [Quick Literature Updates Episode 15](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927) — video · 4:12 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927.md)

### Case-Based Learning
- [Colorectal Quiz Episode 26: Perianal Crohn's Disease](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890) — podcast · 23:58 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890.md)

## Chapters
- [0:05](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=5) Introduction and case presentation setup (Ep 1)
- [1:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=109) Case presentation and diagnostic workup discussion (Ep 1)
- [5:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=312) Imaging workup and biologic risks (Ep 1)
- [7:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=471) Surgical planning and timing (Ep 1)
- [11:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=681) Operative findings and surgical technique (Ep 1)
- [15:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=922) Postoperative course and endoscopic findings (Ep 1)
- [16:46](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1006) Biologic therapy timing and seton management (Ep 1)
- [21:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1312) Summary and closing (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=0) Introduction and Episode Overview (Ep 2)
- [1:33](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=93) Hirschsprung-Associated Inflammatory Bowel Disease (Ep 2)
- [3:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=231) COVID-19 Pandemic Impact on Pediatric Appendicitis (Ep 2)
- [7:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=451) Critical Airway Response Team for Button Battery Removal (Ep 2)
- [10:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=601) Summary and Closing (Ep 2)
- [0:09](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=9) Introduction and First Paper Overview (Ep 3)
- [0:59](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=59) Hirschsprung-Associated IBD Risk Factors (Ep 3)
- [1:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=104) Choledochal Cyst Resection Outcomes (Ep 3)
- [2:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=170) Solid Organ Injury Discharge Criteria (Ep 3)
- [3:56](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=236) Closing (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The Hirschsprung-associated IBD study was retrospective, looked at data from 2000 to 2021 at 17 institutions" — Cecilia Gigena (clinical) [Ep 2 · 1:33](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=93)
- "55 patients were included in the Hirschsprung study, 50% had long segment disease" — Cecilia Gigena (clinical) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=125)
- "Enterocolitis was reported in 68% of Hirschsprung patients after pull-through" — Cecilia Gigena (clinical) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=125)
- "The most common presentation was colonic or small bowel inflammation resembling IBD" — Cecilia Gigena (clinical) [Ep 2 · 2:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=137)
- "Three risk factors for Hirschsprung-associated IBD: trisomy 21, history of enterocolitis following surgery, and long segment disease" — Jacob Langer (clinical) [Ep 2 · 2:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=144)
- "Biologic therapy is powerful and most likely to be effective for Hirschsprung-associated IBD" — Sonia Butterworth (clinical) [Ep 2 · 2:33](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=153)
- "Hirschsprung-associated IBD is very poorly defined and presents in a number of different ways" — Jacob Langer (clinical) [Ep 2 · 3:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=185)
- "Hirschsprung enterocolitis that persists past age 5 or is unresponsive to typical treatment under age 5 should prompt consideration of this diagnosis" — Sonia Butterworth (clinical) [Ep 2 · 3:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=198)
- "The COVID-19 study assessed patients from February 2018 to June 2019 as pre-pandemic control and mid-February 2020 to June 2021 as COVID period" — Em Tombash (epidemiological) [Ep 2 · 4:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=272)
- "1100 patients total: 44% in pre-pandemic group, 56% in COVID-19 group" — Em Tombash (epidemiological) [Ep 2 · 4:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=295)
- "A larger proportion of complicated appendicitis occurred during COVID-19 compared to pre-pandemic period" — Em Tombash (epidemiological) [Ep 2 · 4:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=295)
- "Complicated appendicitis was defined as: perforated appendicitis, clear purulent peritonitis, or small bowel obstruction from appendicitis" — Greta Bercher (clinical) [Ep 2 · 5:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=318)
- "Symptom duration at presentation and length of stay were not significantly different between pre-pandemic and COVID groups" — Em Tombash (epidemiological) [Ep 2 · 5:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=328)
- "Median symptom duration was 1 day pre-COVID and 2 days during pandemic, though not statistically significant" — Sonia Butterworth (epidemiological) [Ep 2 · 5:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=355)
- "There was a clinically significant difference in symptom duration despite lack of statistical significance" — Sonia Butterworth (opinion) [Ep 2 · 6:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=378)
- "Increased rate of perforation occurred during pandemic versus pre-pandemic" — Sonia Butterworth (epidemiological) [Ep 2 · 6:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=416)
- "Patients during pandemic stayed in hospital longer and had increased risks of complications" — Sonia Butterworth (epidemiological) [Ep 2 · 7:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=423)
- "Ontario government made it mandatory that all patients below 18 years of age had to be treated at a pediatric hospital during pandemic" — Greta Bercher (guideline) [Ep 2 · 7:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=428)
- "The button battery study evaluated if implementation of a clinical algorithm shortened time from diagnosis to removal" — Cecilia Gigena (clinical) [Ep 2 · 7:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=474)
- "The algorithm was based on the national database algorithm and implemented in October 2019" — Cecilia Gigena (clinical) [Ep 2 · 8:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=489)
- "The institution already had a CART (critical airway response team) that activated all stakeholders except gastroenterology" — Katerina Dukleska (clinical) [Ep 2 · 8:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=500)
- "Time from chest X-ray to button battery removal was shortened from 73 to 35 minutes after implementing the protocol" — Cecilia Gigena (clinical) [Ep 2 · 8:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=525)
- "Even 73 minutes was a very impressive target before protocol implementation" — Sonia Butterworth (opinion) [Ep 2 · 9:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=550)
- "Button battery ingestions are not common events" — Katerina Dukleska (epidemiological) [Ep 2 · 9:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=585)
- "Anticipated decrease in major complications for button battery patients with faster removal times" — Katerina Dukleska (opinion) [Ep 2 · 9:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2023-caps-issue-7077?t=585)
- "The Hirschsprung-associated IBD study was retrospective, gathering patients from 2000 to 2021 at 17 institutions" — Cecilia Gigena (epidemiological) [Ep 3 · 0:59](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=59)
- "The study identified 55 Hirschsprung patients, with 50% having long segment disease" — Cecilia Gigena (epidemiological) [Ep 3 · 1:14](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=74)
- "68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis" — Cecilia Gigena (epidemiological) [Ep 3 · 1:19](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=79)
- "10% of the Hirschsprung patients had trisomy 21" — Cecilia Gigena (epidemiological) [Ep 3 · 1:19](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=79)
- "Long segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 are potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through" — Cecilia Gigena (clinical) [Ep 3 · 1:19](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=79)
- "The choledochal cyst study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018" — Ellen Encisco (epidemiological) [Ep 3 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=131)
- "The majority of choledochal cyst patients underwent open resection" — Ellen Encisco (epidemiological) [Ep 3 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=141)
- "Patients who underwent open choledochal cyst resection were more likely to have a Roux-en-Y hepaticojejunostomy" — Ellen Encisco (clinical) [Ep 3 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=141)
- "Patients who underwent laparoscopic choledochal cyst resection were more likely to have a hepaticoduodenostomy" — Ellen Encisco (clinical) [Ep 3 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=141)
- "Patients who underwent open choledochal cyst resection had longer length of hospital stay compared to laparoscopic resection" — Ellen Encisco (clinical) [Ep 3 · 2:36](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=156)
- "Patients who underwent open choledochal cyst resection had more complications compared to laparoscopic resection" — Ellen Encisco (clinical) [Ep 3 · 2:36](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=156)
- "Patients who underwent open choledochal cyst resection had higher total costs compared to laparoscopic resection" — Ellen Encisco (clinical) [Ep 3 · 2:36](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=156)
- "The solid organ injury study was retrospective and conducted in South Carolina" — Cecilia Gigena (epidemiological) [Ep 3 · 3:09](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=189)
- "The study gathered 262 patients with isolated solid organ injuries, grades 1 to 3" — Cecilia Gigena (epidemiological) [Ep 3 · 3:19](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=199)
- "148 patients had solid organ injuries grades 1 or 2, and none required acute intervention" — Cecilia Gigena (clinical) [Ep 3 · 3:26](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=206)
- "Of 114 patients with grade 3 solid organ injuries, only 3 required acute intervention" — Cecilia Gigena (clinical) [Ep 3 · 3:34](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=214)
- "Isolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the emergency department" — Cecilia Gigena (clinical) [Ep 3 · 3:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=224)
- "In pediatric patients, unlike adult patients, the first presenting factor for Crohn's disease can often be perianal disease." — Jason Frischer (clinical) [Ep 1 · 9:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=569)
- "Male gender over the age of 10, and presence of a fistula are risk factors with much higher incidence of Crohn's disease being diagnosed in patients presenting with perianal lesions to the emergency room." — Jason Frischer (epidemiological) [Ep 1 · 9:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=540)
- "The mucosa heals first compared to skin in perianal disease, so leaving a mucosal opening without a seton risks recurrent abscess when biologics heal the mucosa." — Jason Frischer (clinical) [Ep 1 · 12:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=751)
- "Making a large cruciate incision and packing a perianal abscess in a child with undiagnosed Crohn's disease may result in non-healing and potentially require colostomy or ileostomy." — Jason Frischer (clinical) [Ep 1 · 13:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=792)
- "The highest risk factors for lymphoma with biologic therapy are male gender, teenage age, and combination therapy with methotrexate." — Jason Frischer (clinical) [Ep 1 · 6:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=412)
- "Real risks of biologic agents include infectious complications such as tuberculosis and risk of lymphoma." — Christine Velasco (clinical) [Ep 1 · 6:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=389)
- "When the colonoscope cannot intubate the terminal ileum, capsule endoscopy or fecal calprotectin can be used to aid diagnosis." — Christine Velasco (clinical) [Ep 1 · 3:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=227)
- "If terminal ileum cannot be intubated, gastroenterologists may treat presumptively and re-scope after a few months of treatment when inflammation has decreased." — Jason Frischer (clinical) [Ep 1 · 4:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=276)
- "Setons should remain in place for at least 6 months to allow the inflammatory tract to become non-inflammatory." — Lisa McMahon (clinical) [Ep 1 · 17:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1074)
- "Before removing a seton, the bottom must look better, drainage must be better, the patient must be symptom-free, and they must have reached steady state of biologic (loading dose plus at least 3 more doses, typically 2-3 months from start)." — Jason Frischer (clinical) [Ep 1 · 19:23](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1163)
- "Inflammatory markers including fecal calprotectin, ESR, and CRP should be checked before removing a seton to ensure systemic disease is under control." — Jason Frischer (clinical) [Ep 1 · 19:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1195)
- "The initial Remicade paper from 1998 or 1999 in the New England Journal of Medicine was on perianal disease and demonstrated improved healing time and improved length of time between recurrence when combination of seton and infliximab is used versus either separately." — Jason Frischer (clinical) [Ep 1 · 20:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1249)
- "Remicade (infliximab) has the most literature on healing perianal disease; Humira also has good evidence but less literature; Stelara and vedolizumab are sometimes used with less information available." — Lisa McMahon (clinical) [Ep 1 · 20:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1227)
- "Literature shows about a 10% response rate for perianal fistulas even without biologics if a seton is placed and removed, with much better outcomes with biologics." — Lisa McMahon (epidemiological) [Ep 1 · 19:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1152)
- "Source control of infection must be achieved before starting immunosuppressive therapy including steroids and biologics." — Jason Frischer (clinical) [Ep 1 · 17:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1037)
- "If an abscess is not adequately drained, reimaging should be performed before giving biologics or steroids." — Jason Frischer (clinical) [Ep 1 · 17:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1037)
- "Hydrogen peroxide is preferred over methylene blue for identifying fistula tracts because it is neater; 3% hydrogen peroxide in a syringe with 16-20 gauge angiocath is used with a speculum in the anus." — Jason Frischer (clinical) [Ep 1 · 14:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=855)
- "When a fistula opening cannot be found despite hydrogen peroxide testing, a seton should not be placed at that time to avoid creating a hole where there isn't one." — Jason Frischer (clinical) [Ep 1 · 14:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=894)
- "For recurrent patients requiring repeat seton placement, repeat imaging should be obtained before seton removal." — Lisa McMahon (clinical) [Ep 1 · 18:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1125)
- "It is common to have perianal disease in Crohn's; this patient had a delay in diagnosis and had perianal disease for quite some time with multiple skin tags and fissures." — Lisa McMahon (clinical) [Ep 1 · 7:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=444)

## Changelog
- Sep 7: 3 items added automatically

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