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New Insights into the Diagnosis and Treatment of Refractory IBD

Dr. David George Binion discusses the approach to the very sick patient with inflammatory bowel disease.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Discuss the implications of Clostridium difficile as the most common infectious complication contributing to severe and refractory IBD
  • Discuss remission for Crohn’s disease patients with either azathioprine or infliximab monotherapy
  • Describe how severe and refractory IBD can be linked to infectious complications (C difficile, CMV), iatrogenic drug reactions, congenital immunodeficiency including hypogammaglobulinemia, comorbidities with depression and chronic pain, and unrecognized stenosis requiring surgery

Reading Resources:

  1. Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Ananthakrishnan AN, McGinley EL, Binion DG. Gut. 2008 Feb;57(2):205-10. Epub 2007 Sep 28. PMID:17905821
  2. Infliximab, azathioprine, or combination therapy for Crohn's disease. Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, Lichtiger S, D'Haens G, Diamond RH, Broussard DL, Tang KL, van der Woude CJ, Rutgeerts P; SONIC Study Group. N Engl J Med. 2010 Apr 15;362(15):1383-95. PMID:20393175
  3. Narcotic use in patients with Crohn's disease. Cross RK, Wilson KT, Binion DG. Am J Gastroenterol. 2005 Oct;100(10):2225-9. PMID:16181373
  4. Cytomegalovirus infection in patients with inflammatory bowel disease. Original Contribution American Journal of Gastroenterology (1999) 94, 1053–1056; doi:10.1111/j.1572-0241.1999.01013.x
  5. Cytomegalovirus infection in patients with inflammatory bowel disease.  Vega R,  Bertrán X, Menacho M, Domènech E, Moreno de Vega V, Hombrados  M, Cabré E, Ojanguren I, Gassull MA. Am J Gastroenterol. 1999; 94, 1053–1056.
  6. Increased rates of early adverse reaction to azathioprine in patients with Crohn's disease compared to autoimmune hepatitis: a tertiary referral center experience. Bajaj JS, Saeian K, Varma RR, Franco J, Knox JF, Podoll J, Emmons J, Levy M, Binion DG. Am J Gastroenterol. 2005 May;100(5):1121-5. PMID:15842588


Dr. Binion has financial interests with the following proprietary entity or entities producing health care goods or services as indicated below:

  • Grant/Research Support: Janssen
  • Consultant: Cubist, Takeda, UCB Pharma, Janssen

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 0.50 AMA PRA Category 1 CreditsTM. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to 0.50 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.edu and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 11/30/2012 | Last Modified On: 5/6/2014 | Expires: 5/6/2015



David George Binion, MD

David George Binion, MD University of Pittsburgh Physicians
Division of Gastroenterology, Hepatology & Nutrition
Office Address(es):
Digestive Disorders Center
200 Lothrop Street, 3rd Floor
Pittsburgh, PA 15213
Phone: (412) 647-8666
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