INFLAMMATORY BOWEL DISEASE

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INFLAMMATORY BOWEL DISEASE

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INFLAMMATORY BOWEL DISEASE

  1. 1. Inflammatory Bowel Disease
  2. 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. 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. 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. 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. 6. ETIOLOGY • Immunology • Initiating pathogen • Environmental Factors • Genetic factors
  7. 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. 8. INVESTIGATIONS • Endoscopy • Colonoscopy • Histopathology • Radiology • Hematological tests and microbiological stool test for infection
  9. 9. UC CD ESR elevation Hypoalbuminemia Anaemia Electrolyte imbalance Leucocytosis ESR ↑ Hypoalbuminemia Anaemia LABORATORY INVESTIGATION
  10. 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. 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. 12. UC CD Collar button ulcers Nodularity Granularity RADIOLOGIC FEATURES OF CD AND UC
  13. 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. 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. 15. MANAGEMENT OF IBD Non-pharmacological • Initial tretment is nonoperative Stop Smoking (for crohn’s disease) • Nutrition
  16. 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. 17. PHARMACOLOGICAL • Antispasmodic agent: Dicyclomine • Immunoglobulin - İnfliximab • Miscellaneous( Total or supplementary parenteral nutrition, fish oils, sodium cromoglycate, lidocaine, nicotine trans dermally) • Surgical management

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