Inflammatory Bowel Disease (IBD)

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Join us for a lecture on inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Roger S. Klein, MD, FACP, will highlight the latest in diagnostic technologies and treatment approaches for IBD. He also will discuss the importance of comprehensive care to help prevent IBD-associated health problems.

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  • Involves mucosa, does not extend to deeper layers of colon
  • University of Rochester Medical Center
  • Essentials of Human Physiology by Ginsburg, JM and Costoff, A
  • Healthfavo.com
  • Johns Hopkins Medical Center
  • Western diet-processed food, fried food , sugar
  • Skin-Erythema nodosum, pyoderma Arthritis- large joint and ankylosing spondylitis Liver- sclerosing cholangitis
  • Colonoscopy-continuous disease from rectum
    Inflammatory markers sed rate and CRP, stool calprotectin
    Anti-sacchromyces cervissiae, Anti-OmpC
  • Treatment needs to be individualized based on extent of disease, severity and initial response
  • Intolerance-metallic taste, parasthesias
  • Intolerance due to nausea, pancreatitis, hepatitis
    Risk of lymphoma, skin cancer, cervical cancer due to HPV
  • Adalibumab(Humira), Infliximab(Remicade)
  • Ileal pouch anal anastamosis
  • No increased risk for proctitis
    Chromoendoscopy
  • Inflammatory Bowel Disease (IBD)

    1. 1. Inflammatory Bowel Disease Ulcerative Colitis and Crohn’s Disease Roger Klein, MD, FACP
    2. 2. Definition • Chronic immune mediated inflammation of the gastrointestinal tract • Two distinct diseases • Overlapping clinical characteristics • Affects 1.4 million people in the United States
    3. 3. Ulcerative Colitis • Inflammation of inner lining of Colon • Does not involve small intestine • Begins in rectum and extends upward • Continuous disease
    4. 4. Colitis
    5. 5. Crohn’s Disease • Full thickness inflammation of bowel wall • Involves anywhere from mouth to anus • Most commonly involves Ileum and colon • Skip areas of involvement • Complicated by strictures and fistulae
    6. 6. The GI Tract University of Rochester
    7. 7. Terminal Ieum University of Rochester
    8. 8. Layers of GI Tract Essentials of Human Physiology by Ginsburg and Costoff
    9. 9. Crohn’s Healthfavo.com
    10. 10. Crohn’s Fistulae Johns Hopkins Medical Center
    11. 11. Epidemiology • UC 238/100,000 • CD 201/100,000 • Lower incidence in Asia and Middle East • Mostly presents age 15-40 • Second peak age 60-80 • No difference between sexes • More common in people of Jewish descent
    12. 12. Risk Factors • Genetics  10-25% have a relative with IBD • Smoking and CD • NSAID and aspirin • Possible western diet • Unknown environmental trigger
    13. 13. Genetic Risk • Genetics contribute to susceptibility • First degree relatives are at 3-20 X risk • Children of 2 parents with IBD 33% risk • Up to 160 genes involved
    14. 14. UC Presentation • Gradual onset over weeks • Diarrhea often bloody • Abdominal cramping • Tenesmus • Extra intestinal manifestations  Arthritis  Skin/Eyes  Liver
    15. 15. CD Presentation • Often presents with chronic symptoms • Abdominal cramping • Intermittent diarrhea • Obstruction • Abscess/fistulae • Weight loss/anemia/fatigue/fevers
    16. 16. Evaluation • History and physical • Stool studies to exclude infection • Colonoscopy to ileum with biopsies • Labs  Anemia  Markers of inflammation  pANCA, ASCA • Enterography/capsule endoscopy
    17. 17. Treatment • One size does not fit all • Mesalamine • Antibiotics • Steroids • Immunomodulators • Biologic/ Anti-TNF • Surgery
    18. 18. Mesalamine • First line therapy acts topically • Oral “Packaged” to release in different areas • Rectal  Suppository  Enema • Safe even in pregnancy • Not effective in small bowel Crohn’s
    19. 19. Antibiotics • Ciprofloxacin and Metronidazole • Effective in Crohn’s • No role in UC • Issues with tolerance • May lead to resistant bacteria
    20. 20. Steroids • Can be given oral, rectal, or IV • Very effective short term • Not a maintenance drug • Need a plan when starting • Many serious side effects  Diabetes  Osteoporosis
    21. 21. Immunomodulators • Azathioprine and 6-MP • Target immune response • Effective in both Crohn’s and UC • Can take up to 3 months to work • Need labs monitored regularly • Not always tolerated • May increase risk of certain cancers
    22. 22. Biologics • Act by interfering with TNF • Given by IV or injection • Very effective • Work quickly • Used for moderate/severe UC • May alter natural history if used early in CD
    23. 23. Biologics-Risks • Infectious complications  TB/Fungal infections  Hepatitis • Cancer Risk  Lymphoma
    24. 24. Surgery-UC • Refractory disease • Cancer • Surgery is curative • Remove entire colon • IPAA or Ileostomy
    25. 25. Surgery-CD • 50% of patients will have at least one • Abcess/fistulae • Stricture/obstruction • Refractory disease • Not curative so limit resection • Often recurs at anastamosis • Need post-op plan
    26. 26. Long Term Issues • Cancer  skin, cervical, lymphoma • Osteoporosis • Colon cancer
    27. 27. Colon Cancer and IBD • Equal risk for UC and CD with colitis • Depends on extent of colitis and duration • Risk increases after 8-10 years • Need to screen for flat lesions • 2.5% risk after 20 years • 7.6% risk after 30 years
    28. 28. Take Home Message • UC and CD are chronic inflammatory diseases • No cure but treatments are effective • Remission is attainable • Newer drugs are on the way • No increased mortality • Majority of patient lead normal lives

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