1) Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis, which are chronic inflammatory disorders of the gastrointestinal tract of unknown cause. 2) Crohn's disease can affect any part of the GI tract and causes granulomatous inflammation, while ulcerative colitis causes non-granulomatous inflammation of the rectum and colon. 3) Symptoms of IBD include diarrhea, abdominal pain, rectal bleeding, weight loss, and malnutrition. Diagnostic tests include endoscopy, colonoscopy, imaging, and lab tests. 4) Treatment involves medications to reduce inflammation like aminosal

1. Dr. Virendra Kumar Gupta
MD Pediatrics
Fellowship In pediatric Gastroentero-Hepatology & Liver
Transplantation
Assistant Professor
Department Of pediatrics
NIMS Medical College & Hospital , Jaipur

2.  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.  Both are chronic inflammatory disorders of the GI tract
that currently have no real cure.
 disorders of unknown cause involving genetic and
immunological influence on the gastrointestinal tract's
ability to distinguish foreign from self-antigens.

4.  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.

6.  Immunology
 Initiating pathogen
 Environmental Factors
 Genetic factors

7. 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

9. Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource Center,Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource Center,
www.hopkins-gi.org,copyright 2006, Johns Hopkins University, all rights reserved.www.hopkins-gi.org,copyright 2006, Johns Hopkins University, all rights reserved.
ExtraintestinalmanifestationsofIBD

10.  Colitic arthritis
 Sacroiliitis
 Ankylosing spondylitis
 Hepatobiliary
complications
 Osteopenia, osteoarthritis
 Avascular necrosis
 Renal stones
 UTI due to fistulae
 Pyoderma gangrenosum
 Erythema nodosum
 Sweet syndrome
 Uveitis
 Episcleritis
 DVT/PE, intracranial,
intraocular
thromboembolic events
 Extraintestinal manifestations of IBD

11.  Endoscopy
 Colonoscopy
 Histopathology
 Radiology
 Hematological tests and microbiological stool
test for infection

12. UC CD
ESR elevation
Hypoalbuminemia
Anaemia
Electrolyte imbalance
Leucocytosis
ESR ↑
Hypoalbuminemia
Anaemia

13. 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%

14. Feature UC
Transmural inflammation Uncommon
Granulomas No
Fissures Rare
Fibrosis No
Submucosal inflammation Uncommon
CD
Yes
50-75%
Common
Common
Common

15. CD UC
Nodularity
Granularity
Collar button ulcers

16.  Chronic infectious colitis
 Ischemic colitis
 Diverticulitis
 Irritable Bowel Syndrome
 Small Bowel Bacterial Overgrowth
 Crohn’s Disease
 Ulcerative Colitis
 Colon Cancer

17. Non-pharmacological
 Nutrition
 Initial tretment is nonoperative Stop Smoking
(for crohn’s disease)

18.  Aminosalicilates (5-ASA):
sulfasalazine, mesalazine, olsalazine
 Corticosteroids :
Budesonide, presnisolone, methylprednisolone
 Immunosuppressants:
azathioprine , 6-mercaptopurine
 Antibiotics :
metronidazole, ciprofloxacin
 Anti diarrhoals :
loperamide, Diphenoxylate & atropine

19.  Antispasmodic agent : Dicyclomine
 Immunoglobulin : İnfliximab
 Miscellaneous :
Total or supplementary parenteral
nutrition, fish oils, sodium cromoglycate, lidocaine,
nicotine trans dermally
 Surgical management

20.  Indications:
◦ Failure of medical therapy
◦ Recurrent obstruction
◦ Perforation
◦ Fistula
◦ Abcess
◦ Hemorrhage
◦ Growth retardation (children)
◦ carcinoma

21. Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource Center,Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource Center,
www.hopkins-gi.org,copyright 2006, Johns Hopkins University, all rights reserved.www.hopkins-gi.org,copyright 2006, Johns Hopkins University, all rights reserved.

22.  Commonly see recurrence near the ileocolonic
anastomosis from previous surgery.
 Endoscopic recurrence is found as high as 73%
only 1 year later.
 Prevention of recurrences using
◦ Mesalamine/5-ASA, 6-MP, probiotics (lactobacillus),
metronidazole

23.  ABSOLUTE
INDICATIONS:
◦ Hemorrhage
◦ Perforation
◦ Cancer or dysplasia
◦ Unresponsive acute sx
 RELATIVE
INDICATIONS:
◦ Chronic intractability
◦ Steroid dependency
◦ Growth retardation
◦ Systemic complications
associated with UC
Ulcerative Colitis SurgeryUlcerative Colitis Surgery
IndicationsIndications

24.  Describe the disease process of Crohn’s versus
Ulcerative Colitis
 Identify the clinical presentation of a patient with
Crohn’s Disease and Ulcerative Colitis
 Discuss the various diagnostic workups and how they
may differentiate Crohn’s from other GI ailments
 Select appropriate treatments for a patient with
Crohn’s Disease and Ulcerative Colitis

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