Questions on the GI Board Exam by coll.
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Data do not show an increased risk of colon cancer in this setting versus healthy controls, and the colonoscopy is likely to be endoscopically normal. Nonetheless, segmental biopsies are warranted to screen for underlying microscopic colitis, including collagenous and lymphocytic colitis. IBD is not more common versus controls in this setting, despite the general overlap between IBS and IBD symptoms. It's probably worth checking an erythrocyte sedimentation rate (ESR) or CRP level in patients with IBS-D, because an elevated level has a nearly 100% positive predictive value for underlying IBD.
We present the scheme in Figure 11-1 to help organize the diverticular terminology as it pertains to inflammatory complications (in contrast to bleeding complications, which isn't the subject of this discussion; from Strate, Modi, Cohen, Spiegel. Am J Gastroenterol. 2012;107:1486-1493). “Diverticulosis” is merely the presence of colonic diverticula; these may, or may not, be symptomatic or complicated. “Diverticular disease” is clinically significant and symptomatic diverticulosis; this may be from true diverticulitis or from other less understood manifestations (eg, visceral hypersensitivity in the absence of verifiable inflammation).
Rather than be concerned about vaccinating in this setting, the major concern should be not vaccinating. The HPV vaccine can reduce the risk of cervical dysplasia and cervical intraepithelial neoplasia (CIN) from high-risk HPV variants (eg, 16 and 18) in these women. Pap smears should continue even after the HPV vaccination is administered. What if there's evidence of dysplasia on a Pap smear? If there's dysplasia, then it becomes more difficult to justify continuing AZA/6-MP. In this case, you should ensure the HPV has been serotyped, if present.