A 10 year old boy with Down’s syndrome. Presented with pain abdomen for 6 months. CT abdomen showed jejunal and ileo-cecal thickening. Colonoscopy showed ileal stricture. Biopsy showed chronic active inflammation, no granuloma. Mantoux test, TB Quantiferon - negative. Next step? Anti-tubercular therapy trial Start oral steroids Start biologics Do enteroscopic biosy from jejunal thickening

A 56 years old female with history go bleeding PR for last 2 years. She was diagnosed to have ulcerative pan-colitis. Steroid dependent, put on Azathioprine - persistent symptoms. Started on Infliximab - initially responded to treatment for 6 months. Now recurrent symptoms (see colonoscopy picture) Next step? Vedolizumab Colectomy Do colonoscopic biopsy - rule out CMV/C. Difficile Fecal microbiota transplant

A 21 year old male who received anti-TB therapy for ileal stricture and later underwent right hemi-colectomy (operative biopsy showed Crohn’s disease) - was on Azathioprine. Now he developed peri-anal fistula. After incision and drainage there is persistent fistula discharge. Colonoscopy showed rectal ulcers with mild luminal narrowing, Trnas-rectal USG/MRI showed trans-sphincteric fistula with small (1x 1 cm) abscess. Next step? Biologics EUA+ seton followed by infliximab Antibiotics Azathioprine

An 18 years old boy presented with intestinal obstruction and underwent ileo-cecal resection Operative biopsy showed chronic active inflammation favouring TB Did not respond to anti-TB drugs over 4 months- developed oral ulcers - responded initially to steroid but had persistent pain abdomen even after steroid and Azathioprine (see Colonoscopy picture) What is the next step? Biologics + ganciclovir IHC for CMV Ganciclovir Ganciclovir/valganciclovir + steroids

This oral enteroscopypicture is from proximal jejunum This 50 years old lady presented with recurrent pain abdomen for last 1 year with associated vomiting and weight loss Biopsy picture is on the left showing non caseating granuloma What is the next option? Steroids Biologics Jejunal resection and anastomosis Endoscopic dilatation of stricture

This colonoscopy picture is of a patient with history of ileo-anal pouch anastomosis 1 year back. He is having persistent loose, blood mixed stools not responding multiple courses of antibiotics What is the next option? Budesonide 5-ASA Biologics Pouch excision

The colonoscopy picture is of a 53 years old male with history of Ulcerative colitis for last 17 years He was asymptomatic for last 5 years and was on irregular follow up and medications Currently he is symptomatic for constipation for last 6 months What is the probable diagnosis? What should be the next investigation? What is the further management?