LECTURE 8 Inflammatory Bowel Disease (IBD): Ulcerative Colitis (UC) & Crohn Disease (CD) National O. Bogomolets Medical University Faculty Surgery Department N1 Kyiv 2008 Prof. Kucher M.
Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. The main forms of IBD are ulcerative colitis (UC) and Crohn's disease (CD). UC CD
The main difference between Crohn's disease and UC is the location and nature of the inflammatory changes . Crohn's can affect any part of the gastrointestinal tract, from mouth to anus (skip lesions), although a majority of the cases start in the terminal ileum. Ulcerative colitis, in contrast, is restricted to the colon and the rectum.
Microscopically, ulcerative colitis is restricted to the mucosa (epithelial lining of the gut), while Crohn's disease affects the whole bowel wall .
Finally, Crohn's disease and ulcerative colitis present with extra-intestinal manifestations (such as liver problems, arthritis, skin manifestations and eye problems) in different proportions.
Rarely, a definitive diagnosis of neither Crohn's disease nor ulcerative colitis can be made because of idiosyncrases in the presentation. In this case, a diagnosis of indeterminate colitis may be made
The incidence of ulcerative colitis in North America is 10-12 cases per 100,000 ,
a peak incidence of ulcerative colitis occurring between the ages of 15 and 25.
second peak in incidence occurring in the 6th decade of life. The disease affects females more than males
The geographic distribution of ulcerative colitis and Crohn's disease is similar worldwide, with highest incidences in the United States, Canada, the United Kingdom , and Scandinavia. Higher incidences are seen in northern locations compared to southern locations in Europe and the United States.
As with Crohn's disease, ulcerative colitis is thought to occur more commonly among Ashkenazi Jewish people than non-Jewish people.
UC is a mucosal inflammation: crypt abscesses erosion ulcer
A key feature of UC is: -- continuous involvement of rectum &colon -- does not involve ileum Inflammatory pseudopolyps Flat displasia
Mild disease correlates with fewer than four stools daily, with or without blood, no systemic signs of toxicity, and a normal erythrocyte sedimentation rate (ESR). There may be mild abdominal pain or cramping.
Moderate disease correlates with more than four stools daily, but with minimal signs of toxicity. Patients may display anemia (not requiring transfusions), moderate abdominal pain, and low grade fever, 38 to 39 °C (99.5 to 102.2 °F).
Severe disease , correlates with more than six bloody stools a day, and evidence of toxicity as demonstrated by fever, tachycardia, anemia or an elevated ESR.
Mercaptopurine, ( 6-Mercaptopurine, 6-MP and Purinetho ) l.
Azathioprine, ( Imuran, Azasan or Azamun, which metabolises to 6-MP ) .
Methotrexate, which inhibits folic acid
Helminthic Therapy ( There are currently two closely related treatments available, either inoculation with Necator americanus, commonly known as hookworms, or Trichuris Suis Ova, (TSO) commonly known as Pig Whipworm Eggs.)
Crohn's disease (also known as regional enteritis) is a chronic, episodic, inflammatory bowel disease (IBD) that affects any part of the entire wall of the bowel or intestines. Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus; as a result, the symptoms of Crohn's disease vary among afflicted individuals. The disease is characterized by areas of inflammation with areas of normal lining between in a symptom known as skip lesions.
Microscopic Colitis (MC) is the term used to cover two types of bowel inflammation that affect the colon (large bowel) called Collagenous Colitis and Lymphocytic Colitis. Both these conditions cause watery diarrhoea. MC is classified as a type of Inflammatory Bowel Disease (IBD), but is different from and not usually as severe as the better known types of IBD, Crohn’s Disease and Ulcerative colitis (UC). However, MC appears to be more common than was previously believed, but this may simply be due to greater awareness and better diagnosis of the condition.
MC gets its name because the large bowel lining looks normal or nearly normal to the naked eye during colonoscopy (a test to look inside your large bowel) and normal on x-ray examination and can only be seen when tissue samples are taken from the colon and examined under the microscope.
What is the difference between Collagenous and Lymphocytic Colitis?
There is not much difference between Collagenous Colitis and Lymphocytic Colitis and they tend to have the same symptoms.
Collagenous Colitis (CC) is the term used when a thickened band of tissue made of a protein, called collagen, often together with an increased number of white blood cells called lymphocytes, are found just beneath the lining of the colon. Lymphocytes are part of the body’s defence system to fight infection and disease. The condition was first described in 1976 by a Swedish pathologist, Dr CG Lindstrom.
A few years later Dr NW Read described a similar type of colitis, which came to be called Lymphocytic Colitis (LC) by Dr AJ Lazenby. It is similar to CC having a large number of lymphocytes, but there is no continuous band of thickened collagen.
There has been some debate about whether these two conditions are individual diseases or two stages of one disease. There have been several cases where over time the diagnosis has changed from one to the other.
How does Microscopic Colitis affect the working of the colon?
When the colon becomes inflamed with MC it becomes less efficient at absorbing the liquid from the stools, resulting in a larger volume of watery stools. At the same time the inflamed colon cannot hold as much waste as normal, leading to more frequent bowel actions.