DDSEP® 8 Quick Quiz

January 2017 Quiz 2

Publish date: January 3, 2017

Q2: A 23-year-old woman with a history of Crohn’s disease presents to a GI clinic stating that she took a pregnancy test, and it is positive. She is concerned because she takes azathioprine and is worried about the risk of birth defects. She asks about alternative medications she could take. She also asks if she could have an endoscopy while pregnant, and if it is normal, she wants to consider stopping the azathioprine. She is doing well and has no complaints. Her Crohn’s disease appears to be in clinical remission.

Which of the following presents the highest risk for poor obstetric and fetal outcomes during pregnancy?

Flexible sigmoidoscopy

Azathioprine therapy

Prednisone therapy

Infliximab therapy

Flare of Crohn’s disease

Q2: Answer: E

Objective: Recall that the major risk to pregnant patients with inflammatory bowel disease (IBD) is a flare of IBD.

Rationale: The most important factor in a successful pregnancy is the maintenance of IBD in a quiescent state. Most of the medications typically used to treat IBD are considered relatively safe in pregnancy. In fact, the risk of a flare of disease during pregnancy usually outweighs the risk of these medications.

Endoscopic procedures are generally well tolerated when proper precautions are taken, but should be deferred until the second trimester if possible, and performed only when there is a strong indication. The decision to proceed with endoscopy should be made in consultation with an obstetrician, regardless of gestational age.

References

1. Schulze H., Esters P., Dignass A. Review article: The management of Crohn’s disease and ulcerative colitis during pregnancy and lactation. Aliment Pharmacol Ther. 2014;40:991-1008.

2. ASGE Standard of Practice Committee. Shergill A.K., Ben-Menachem T., Chandrasekhara V., et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012:76:18-24.

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January 2017 Quiz 1