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Continuing Medical Education Exam 2: June 2007
2578
CME ACTIVITY
GASTROENTEROLOGY Vol. 132, No. 7
Question 3: A 51-year-old man sees his primary care physician for his annual health examination. His physician recommends a colonoscopy because there is a family history of colon cancer. There are several clinics and hospitals that offer screening colonoscopy in his community. According to the current study, where should this primary care physician recommend that his or her patient have his colonoscopy to maximize the chance of cecal intubation?
a. In a private office performed by a gastroenterologist. b. In a community hospital performed by a high-volume gastroenterologist. c. In an academic hospital performed by a low-volume surgeon. d. In a community hospital performed by a moderatevolume gastroenterologist. e. In a private office performed by a surgeon.
Exam 2: Two-year Combination Antibiotic Therapy With Clarithromycin, Rifabutin, and Clofazimine for Crohn’s Disease Selby W, et al, Authors Test ID No.: gast0053
Contact hours: 1
Expiration Date: June 30, 2008
Question 1: A 32-year-old woman, Ms CD, has had symptoms of active small bowel Crohn’s disease over the last 2 weeks. She has been taking azathioprine at a dose of 150 mg/d for 2 years, but is not on any other medications (weight, 60 kg). She is reluctant to have a course of corticosteroids because of her previous experiences with them, particularly the psychological effects. She has heard that antibiotic therapy has been used in the treatment of Crohn’s disease and is seeking your advice. Based on the paper by Selby et al, you advise her that:
CME ACTIVITY
a. If she took a 16-week course of clarithromycin, rifabutin, and clofazimine, it may be of benefit; 66% of patients who took these antibiotics went into remission compared with only 50% of those on placebo. b. Only 1 in every 6 people who take clarithromycin, rifabutin, and clofazimine for 16 weeks in addition to corticosteroids benefits from their addition. c. Adding clarithromycin, rifabutin, and clofazimine to corticosteroids adds to the risks of treatment and results in more people stopping therapy because of side effects. d. Adding any antibiotics to a course of corticosteroids improves response rates. The combination of metronidazole and ciprofloxacin has also been shown to be effective. e. Clarithromycin, rifabutin, and clofazimine are of benefit in active Crohn’s disease because they decrease inflammation as measured by significant falls in C-reactive protein.
Question 2: The combination of antibiotics (clarithromycin, rifabutin, and clofazimine) used in the trial of Selby et al was chosen:
a. Because they each have proven activity against Mycobacterial avium subspecies paratuberculosis (MAP). b. Because uncontrolled trials suggested that they were effective used in patients suffering from Crohn’s disease. c. Because of the risk of developing antibiotic resistance. d. Because of their safety profile for long-term use. e. All of the above.
June 2007
CME ACTIVITY
2579
Question 3: Which of the following statements regarding antibiotic use for the treatment of Crohn’s disease is true?
a. A significant short-term response to antibiotics can be seen in patients with active disease using a variety of different combinations or even monotherapy. b. Multiple antibiotics are more effective at inducing and maintaining remission than monotherapy with a single antibiotic. c. Treatment should be continued for at least 12 months if a patient shows a significant response in the first 16 weeks of therapy for that response to be maintained. d. Large, placebo-controlled trials have demonstrated a significant carry-over effect once antibiotic therapy is ceased, lasting up to 2 years or even longer. e. If endoscopic remission is achieved by antibiotic therapy, then the likelihood of a sustained response is increased.
Question 4: a. If she continues antibiotics for 2 years, there is an approximately 90% chance that she will still be in remission. b. While she continues to use the antibiotics, for any time period, the likelihood that she will need to use corticosteroids is very low. c. Even though she is in remission, there is no need to continue the antibiotics because continued treatment does not significantly alter the likelihood she will relapse in the next 1–2 years. d. Now that she is in remission, she could stop azathioprine because the antibiotic therapy has reduced her chances of relapsing once immunomodulators are stopped. e. She should stop the antibiotics because of the increasing possibility of side effects with prolonged use. CME ACTIVITY
A 32-year-old woman has active colonic Crohn’s disease. She is on azathioprine (100 mg/d) but no other therapy. She has previously responded to oral corticosteroids but does not like their side effects. Based on the findings of Selby et al, published in this issue of the GASTROENTEROLOGY, you start her on the combination of clarithromycin 750 mg/d, rifabutin 450 mg/d, and clofazimine 50 mg/d in addition to 60 mg of prednisolone in a tapering dose. After 16 weeks she is in remission and off corticosteroids. What is the correct advice to give her at this stage?
CME ACTIVITY
GASTROENTEROLOGY Vol. 132, No. 7
Question 3: A 51-year-old man sees his primary care physician for his annual health examination. His physician recommends a colonoscopy because there is a family history of colon cancer. There are several clinics and hospitals that offer screening colonoscopy in his community. According to the current study, where should this primary care physician recommend that his or her patient have his colonoscopy to maximize the chance of cecal intubation?
a. In a private office performed by a gastroenterologist. b. In a community hospital performed by a high-volume gastroenterologist. c. In an academic hospital performed by a low-volume surgeon. d. In a community hospital performed by a moderatevolume gastroenterologist. e. In a private office performed by a surgeon.
Exam 2: Two-year Combination Antibiotic Therapy With Clarithromycin, Rifabutin, and Clofazimine for Crohn’s Disease Selby W, et al, Authors Test ID No.: gast0053
Contact hours: 1
Expiration Date: June 30, 2008
Question 1: A 32-year-old woman, Ms CD, has had symptoms of active small bowel Crohn’s disease over the last 2 weeks. She has been taking azathioprine at a dose of 150 mg/d for 2 years, but is not on any other medications (weight, 60 kg). She is reluctant to have a course of corticosteroids because of her previous experiences with them, particularly the psychological effects. She has heard that antibiotic therapy has been used in the treatment of Crohn’s disease and is seeking your advice. Based on the paper by Selby et al, you advise her that:
CME ACTIVITY
a. If she took a 16-week course of clarithromycin, rifabutin, and clofazimine, it may be of benefit; 66% of patients who took these antibiotics went into remission compared with only 50% of those on placebo. b. Only 1 in every 6 people who take clarithromycin, rifabutin, and clofazimine for 16 weeks in addition to corticosteroids benefits from their addition. c. Adding clarithromycin, rifabutin, and clofazimine to corticosteroids adds to the risks of treatment and results in more people stopping therapy because of side effects. d. Adding any antibiotics to a course of corticosteroids improves response rates. The combination of metronidazole and ciprofloxacin has also been shown to be effective. e. Clarithromycin, rifabutin, and clofazimine are of benefit in active Crohn’s disease because they decrease inflammation as measured by significant falls in C-reactive protein.
Question 2: The combination of antibiotics (clarithromycin, rifabutin, and clofazimine) used in the trial of Selby et al was chosen:
a. Because they each have proven activity against Mycobacterial avium subspecies paratuberculosis (MAP). b. Because uncontrolled trials suggested that they were effective used in patients suffering from Crohn’s disease. c. Because of the risk of developing antibiotic resistance. d. Because of their safety profile for long-term use. e. All of the above.
June 2007
CME ACTIVITY
2579
Question 3: Which of the following statements regarding antibiotic use for the treatment of Crohn’s disease is true?
a. A significant short-term response to antibiotics can be seen in patients with active disease using a variety of different combinations or even monotherapy. b. Multiple antibiotics are more effective at inducing and maintaining remission than monotherapy with a single antibiotic. c. Treatment should be continued for at least 12 months if a patient shows a significant response in the first 16 weeks of therapy for that response to be maintained. d. Large, placebo-controlled trials have demonstrated a significant carry-over effect once antibiotic therapy is ceased, lasting up to 2 years or even longer. e. If endoscopic remission is achieved by antibiotic therapy, then the likelihood of a sustained response is increased.
Question 4: a. If she continues antibiotics for 2 years, there is an approximately 90% chance that she will still be in remission. b. While she continues to use the antibiotics, for any time period, the likelihood that she will need to use corticosteroids is very low. c. Even though she is in remission, there is no need to continue the antibiotics because continued treatment does not significantly alter the likelihood she will relapse in the next 1–2 years. d. Now that she is in remission, she could stop azathioprine because the antibiotic therapy has reduced her chances of relapsing once immunomodulators are stopped. e. She should stop the antibiotics because of the increasing possibility of side effects with prolonged use. CME ACTIVITY
A 32-year-old woman has active colonic Crohn’s disease. She is on azathioprine (100 mg/d) but no other therapy. She has previously responded to oral corticosteroids but does not like their side effects. Based on the findings of Selby et al, published in this issue of the GASTROENTEROLOGY, you start her on the combination of clarithromycin 750 mg/d, rifabutin 450 mg/d, and clofazimine 50 mg/d in addition to 60 mg of prednisolone in a tapering dose. After 16 weeks she is in remission and off corticosteroids. What is the correct advice to give her at this stage?