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INFLAMMATORY BOWEL DISEASE

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INFLAMMATORY BOWEL DISEASE

INFLAMMATORY BOWEL DISEASE

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  • 1. Inflammatory Bowel Disease
  • 2. INTRODUCTION • IBD is an idiopathic disease , probably involving an immune reaction of the body to its own intestinal tract • Crohn’s disease (CD) • Ulcerative colitis (UC)
  • 3. INTRODUCTION • CD is a condition of chronic granulomatous inflammation potentially involving any location of the GIT from mouth to anus. • UC is an non granulomatous inflammatory disorder that affects the rectum and extends proximally to affect variable extent of the colon.
  • 4. EPIDEMIOLOGY • UC: 15-40 yrs (Young adults) No variation between between men and women or between socioeconomic group High incidence areas: USA and northern-western Europe More common in non-smokers
  • 5. EPIDEMIOLOGY CD 1st peak 15-30 years of age, 2nd peak around 60 y Marginally more common in females High incidence areas: North America, UK,northern Europe More common in smokers
  • 6. ETIOLOGY • Immunology • Initiating pathogen • Environmental Factors • Genetic factors
  • 7. SYMPTOMS UC: • Rectal bleeding or bloody diarrhea • Pain of colonic origin, often left sided and related to defecation CD: • Diarrhea • Recurrent abdominal pain • Anorectal lesions, Anorexia, Anemia • Malnutrition (weight loss) • Fever
  • 8. INVESTIGATIONS • Endoscopy • Colonoscopy • Histopathology • Radiology • Hematological tests and microbiological stool test for infection
  • 9. UC CD ESR elevation Hypoalbuminemia Anaemia Electrolyte imbalance Leucocytosis ESR ↑ Hypoalbuminemia Anaemia LABORATORY INVESTIGATION
  • 10. Feature UC CD Location Only colon GIT Anatomic distribution Continuous, begins distally Skip lesions Rectal involvement Involved in >90% Rectal spare Gross bleeding Universal Only 25% Peri-anal disease Rare 75% Fistulization No Yes Granulomas No 50-75% DISTINGUISHING CHARACTERISTICS OF CD AND UC
  • 11. Feature CD UC Transmural inflammation Yes Uncommon Granulomas 50-75% No Fissures Common Rare Fibrosis Common No Submucosal inflammation Common Uncommon PATHOLOGIC FEATURES OF CD AND UC
  • 12. UC CD Collar button ulcers Nodularity Granularity RADIOLOGIC FEATURES OF CD AND UC
  • 13. PATHOPHYSIOLOGY • Bacterial antigens are taken up by specialized M cells, pass between leaky epithelial cells or enter the lamina propria through ulcerated mucosa • After processing they are presented on type 1 T-helper cells by antigen presenting cells (APC) in the lamina propria. • T-cell activation and differentiation results in Th1 T cell mediated cytokine response • With the secretion of cytokines including gamma interferon (IFN )ƴ
  • 14. PATHOPHYSIOLOGY • Further amplification of T cells perpetuates the inflammatory process with activation of non immune cells and release of the important cytokines. • Eg: IL-12, IL-23, IL-1, IL-6 and tumor necrosis factor (TNF) • These pathways occur in all normal individual exposed to inflammatory insults and this is self limiting in healthy subjects • In genetically predisposed persons, dysregulation of innate immunity may trigger inflammatory bowel disease.
  • 15. MANAGEMENT OF IBD Non-pharmacological • Initial tretment is nonoperative Stop Smoking (for crohn’s disease) • Nutrition
  • 16. PHARMACOLOGICAL • Aminosalicilates (5-ASA): sulfasalazine, mesalazine, olsalazine • Corticosteroids : Budesonide, presnisolone, methylprednisolone • Immunosuppressants: azathioprine , 6-mercaptopurine • Antibiotics : metronidazole, ciprofloxacin • Anti diarrhoals : loperamide, Diphenoxylate & atropine
  • 17. PHARMACOLOGICAL • Antispasmodic agent: Dicyclomine • Immunoglobulin - İnfliximab • Miscellaneous( Total or supplementary parenteral nutrition, fish oils, sodium cromoglycate, lidocaine, nicotine trans dermally) • Surgical management