Inflammatory bowel disease (IBD) is an immune-mediated chronic intestinal condition with two major subtypes, ulcerative colitis and Crohn's disease. IBD results from a disruption of homeostasis between the gut microbiota, intestinal epithelial cells, and immune system due to environmental and genetic factors in susceptible individuals. Common symptoms include diarrhea, abdominal pain, and weight loss. Diagnosis involves endoscopy, imaging, and lab tests. Treatment depends on disease severity and includes medications like 5-ASAs, steroids, immunomodulators, biologics, and sometimes surgery.

1. Inflammatory Bowel
Disease (IBD)
Andualem F. (MD)
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2. Outline
• Introduction
• Etiologies and risk factors
• Clinical manifestation of chron’s
disease and ulcerative colitis
• Diagnosis
• Treatment of IBD
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3. Introduction
• Inflammatory bowel disease (IBD) is
an immune-mediated chronic
intestinal condition. Ulcerative colitis
and Chron’s disease are the two major
subtypes.
• Under physiologic conditions,
homeostasis normally exists between
the commensal microbiota, intestinal
epithelial cells and immune cells.
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4. Cont’d…
• These host compartments function together as an
integrated “supraorganism”. This relation can be
affected by specific environmental (e.g. smoking,
antibiotics, enteropathogens), and genetic factors
that in a susceptible host, cumulatively and
interactively disrupt homeostasis, which in so doing
culminates in a chronic state of dysregulated
inflammation; that is IBD.
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5. Cont’d…
• IBD is considered as an inappropriate immune
response to the endogenous commensal
microbiota within the intestines, with or without
some component of autoimmunity.
• Some common genetic disorders associated with
IBD include Turner’s syndrome, wiskott-Aldrich
syndrome (WAS) and Glycogen storage diseases.
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6. Epidemiology and risk factors
• Peak incidence of IBD is in the second to fourth
deacdes. The second peak is between the seventh to
ninth decade (Bimodal).
• Greatest disease incidence among whites and Jewish
people.
• Concomitant Oral contraceptive pill use and smoking
increase risk of CDs in females.
• Positive family history
• Antibiotic use in early life increases risk of IBD.
• Breast feeding, early appendectomy and smoking are
protective from UC.
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7. Ulcerative colitis
• Ulcerative colitis is characterized by recurring
episodes of inflammation limited to the mucosal
layer of the colon.
• It commonly involves the rectum and may extend in
a proximal and continuous fashion to involve other
parts of the colon
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8. Cont’d…
• Different terms have been used to describe the
degree of involvement.
Proctitis
Proctosigmoiditis
Left sided or Distal ulcerative colitis
Extensive colitis
Pancolitis
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9. Clinical manifestations
History
• Patients usually present diarrhea (may be bloody).
• Bowel movements are frequent and small in volume
• Colicky abdominal pain, urgency, tenesmus, and
incontinence.
• Distal disease may manifest with constipation with
frequent discharge of blood and mucus.
• Onset of symptoms is usually gradual and progressive
over weeks.
• Systemic symptoms including fever, fatigue, and weight
loss
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10. Cont’d…
Physical examination - is often normal.
• -abdominal tenderness to palpation,
• -fever, hypotension, tachycardia
• -pallor
• -Rectal examination –blood
• -muscle wasting & loss of subcutaneous fat
• -peripheral edema due to weight loss and
malnutrition.
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11. Cont’d…
Disease severity
• The severity of disease in patients with ulcerative
colitis is important in guiding clinical management
and can predict long-term outcomes.
• Montreal classification of severity of ulcerative
colitis stratifies ulcerative colitis severity into mild,
moderate, and severe based on the frequency and
severity of Diarrhea, and the presence of systemic
symptoms/signs and laboratory abnormalities.
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12. Cont’d…
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mild moderate sever
Endoscopic
appearance
Erythema,
decreased vascular
pattern, fine
granularity
Marked erythema,
coarse granularity,
absent vascular
markings, contact
bleeding, no
ulcerations
Spontaneous
bleeding,
ulcerations
Tachycardia none <90 >90
Anemia mild > 75% < 75%
ESR <30 --- >30
Blood in stool small moderate sever
Bowel
movements
<4 per day 4–6 per day >6 per day
fever none <37.5 >37.5

13. Acute complications
• bleeding
• Fulminant colitis
• Toxic mega colon: colonic diameter ≥6 cm or cecal
diameter >9 cm with systemic toxicity
• Perforation - commonly consequence of toxic mega
colon or first attack of UC
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14. Chronic complications
• Colorectal cancer
• Stictures (benign or malignant)
• Anal fissures
• Perianal abscesses,
• Hemorrhoids
• Obstruction????? But not as cmn as crhons disease
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15. Cont’d…
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16. Investigations
Imaging modalities
• Flexible sigmoidoscopy or colonoscopy
• Plain abdominal x-ray
• Barium enema
• Trans abdominal bowel sonography (TABS)
• Abdominal CT scan
Laboratory
• CBC, ESR, fecal lactoferrin and calprotectin
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17. Crohn’s disease
• CD is a disorder of uncertain etiology that is
characterized by transmural inflammation of the
gastrointestinal tract with skip lesions
• The transmural inflammatory nature of Crohn's disease
often leads to fibrosis and to obstructive clinical
presentations that are not typically seen in ulcerative
colitis
• CD may involve the entire gastrointestinal tract from
mouth to the perianal area, sparing the rectum, In
contrast to UC.
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18. Clinical manifestation
More variable than those of ulcerative colitis.
Abdominal pain
colonic obstruction
Diarrhea
Bleeding
Fatigue
Prolonged diarrhea with or without gross
bleeding
Abdominal pain, weight loss, and fever are the
hallmarks of CD .
N.B, Patients may Present with complication
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19. Extra-intestinal manifestations
• Arthritis – the most common extra intestinal manifestation.
• Eye involvement – uveitis, iritis, and episcleritis
• Skin disorders – erythema nodosum and pyo derma
gangrenosum
• Primary sclerosing cholangitis
• Secondary amyloidosis is very rare but may lead to renal failure
and other organ system involvement
• Venous and arterial thrombo embolism resulting from hyper
coagulability
• Renal stones
• Bone loss and osteoporos
• Vitamin B12 deficiency
• Pulmonary involvement:- bronchiectasis, chronic bronchitis, ILD
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20. Complications
Perforation: Penetrating trans-mural disease may lead to
abscess or fistula formation.
 Stricures: fibro-stenotic strictures of the ileum secondary
to acute inflammation and edema, compression due to the
mass effect of an abscess or formation of adhesions.
 Peri-rectal disease: ano-rectal fistulas and abscesses.
 Nutritional deficiencies
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21. Cont’d…
Cancer
• Small bowel adenocarcinoma risk increases in
patients with Crohn,s disease.
• Typically, these cancers arise in segments of long-
term active disease & segments of bypassed bowel.
• Annual surveillance with colonoscopy is
recommended in patients with Crohn,s colitis.
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22. Laboratory findings
CBC:
leukocytosis , thrombocytosis, Anemia.
Marked leukocytosis suggests complication with
abscess.
ESR and CRP are usually elevated.
Hypoalbuminemia, anemia and leukocytosis are
suggestive of sever disease.
Iron studies may reveal iron deficiency anemia
Imaging:Endoscopy, Barium enema, CT scan and
MRI
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23. Cont’d…
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25. Differential Diagnosis
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26. Management
• Sulfasalazine and other 5-ASA agents are the main
stay of therapy for the IBDs.
• Other treatment options include Glucocorticoids,
Antibiotics, Azathioprine and 6-mercaptopurine,
Methotrexate, Cyclosporine, Tacrolimus and other
biologic agents like Anti-TNF therapies.
• Surgical Therapy
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