definition,types of ibd,etiology,epidemology,lab investigations,anatomy and physiology,clinical manifestations,treatment,life style modifications

1. By
CH.SAMPATH KUMAR
13H61T0004
PHARM D 4th YEAR
Inflammatory
Bowel Disease
By
CH.SAMPATH KUMAR
13H61T0004
PHARM D 4th YEAR

2. DEFINITION
 It is an idiopathic inflammatory intestinal
disease resulting from an inappropriate
immune activation to host intestinal
microflora.
 Types of IBD are
 Ulcerative colitis(UC)
 Crohn’s disease(CD)

3. Ulcerative colitis(UC):
 only affects the colon (large intestine)
Crohn’s disease(CD) : also known as
regional enteritis
 can affect all of the digestive system, from the
mouth to the anus.

4. ANATOMY AND PHYSIOLOGY

5. Epidemiology
 The incidence of UC is 3 times higher than that of CD.
But recent data suggest that the incidence of CD is
increasing.
 The highest rates of IBD are seen in developed countries,
and the lowest in the developing regions;

6. Incidence and prevalence of ulcerative colitis
in India
 Prevalence rate- 44.3/ 100,000 Persons
 Incidence rate- 6.02 cases/ 100,000 Persons
CD:
 Hindus have a much lower incidence of CD than
Europeans
 the minimum incidence of CD is 0.14/1lakh persons-
years,

7. Causes
 The exact cause of IBD is unknown,
However, most investigators believe that
IBD results from a combination of :
 Genetic factors.
 Mucosal immune responses.
 Environmental factors
 Bacteria( epithelial defect )
7

8. Clinical presentation of IBD
A- symptoms:
- diarrhea
- rectal bleeding
- tenesmus
- passage of mucus
- abdominal pain
- other symptoms: anorexia,
nausea, vomiting, fever,
and weight loss

9. B- Signs
 Loss of weight
 General ill health
 ulceration of mouth, glossitis, angular
stomatitis
 Abdominal tenderness
 fissures, fistulae

10. Clinical findings That Differ between CD and UC
CD UC
Defecation Often porridge like
,sometimes steatorrhea
Often mucus-like and with
blood
Tenesmus Less common More common
Fever Common Indicates severe disease
Fistulae Common ununcommon
Weight loss Often rare
Malignant potential With colonic involvement Yes
after surgery Recurrence is common No recurrence

12. Investigation
Endoscopy
Radiology
Laboratory tests

13. Endoscopy
Sigmoidoscopy
Used to confirm diagnosis of
ulcerative colitis

14. Endoscopic Features of IBD
Ulcerative colitis
 Edema
 Erythema/Loss of vascularity
 Erosions
 Mucopurulent exudate
 Spontaneous bleeding
 Ulceration
14

15. Endoscopic Features of IBD
Crohn’s Disease
 Patchy edema, erythema
(Discontinuous)
 ulcerations
 Cobblestoning
15

16. Radiology
Double contrast barium enema

17. Laboratory tests
Microbiological examination of
stool
Haematological & biochemical
values
High WBC countsIron deficiency anemia
Low ESR Low serum albumin
May provide evidence of
infection as a cause of colonic
inflammation

20. TREATMENT
Treatment for IBD may include:
DIETARY CHANGES LIFESTYLE CHANGES
DRUG THERAPY SURGERY

21. Dietary Changes
 Eating :
 Low-fat foods.
 Smaller, more
frequent meals.
 Avoiding :
 foods high in
undigestible fiber.
 Refined sugars .

22. LIFESTYLE CHANGES
.
Taking rest No smoking
Stress reductionDoing exercise

25. Drug Therapies
1- 5-Aminosalicylates (5-ASA)
2- Glucocorticoids (steroids)
3- Antibiotics
4- Immunosuppressants
Thiopurines
Azathioprine
6-mercaptopurin
Methotrexate
Cyclosporine(2-4mg/kg)
5- Biological Therapy
Infliximab (5mg/kg)

26. Amino
salicylates
Eg
Sulfasalazine
Dose
Maintain remission : 2-4 g / day
Acute attacks : 4-8 g / day
The most effective in
maintaining remission in
ulcerative colitis
( Anti-inflammatory )

27. Corticosteroids
Eg
Predinoslone
Steroid of choice as
it can be used
orally , rectally &
parentrally in
emergency
Dose :
20–60 mg orally or IV
Used up to 2 weeks

28. Used in patients unresponsive
to steroid & amino salicylates
Immuno
suppressants
Eg
Azathioprine
Dose:
1.5–2.5 mg/kg per day orally
Inhibit purine biosynthesis &
reduce IBD-associated GI
inflammation

29. Used in patients unresponsive
to steroid & amino salicylates
Immuno
suppressants
Eg
6-
Mercaptopurine
Dose:
1.5–2.5 mg/kg per day orally
Active form of
Azathioprine

30. Used in patients unresponsive
to steroid & amino salicylates
Immuno
suppressants
Eg
Methotrexate
Dose:
15–25 mg weekly
(IM/SC/orally)

31. Used in patients unresponsive
to steroid & amino salicylates
Immuno
suppressants
Eg
Cyclosporine
Dose:
4 mg/kg per day
Effective in patients refractory
to cenventional drug therapy

32. Immuno
suppressants
Eg
INFLIXIMAB
Adverse
effects
Intravenous administration
Fever
Chest
Pain
Hypo-
tension
Dyspnea
Associated
with
reactivation
of serious
infections
Exa-
cerbation
of heart
failure
infusion-related reactions
Effective in patients whose
conventional therapy failed
Dis advantages
Significant drug cost Potential for adverse effects

33. Other agents
Eg
Antibiotics
Dose:
Adults < 12 yrs : 250 - 500mg / 12 hrs for 7-14 days.
Eg. Ciprofloxacin
For active chrons disease
accompained by fever

34. Other agents
Eg
Anti Diarrheal
Relief diarrhea symptoms
associated eith IBD
Diphenoxylate LoperamideCodiene