This document discusses inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. It notes that the cause is unknown but involves an immune-mediated chronic inappropriate inflammatory response. Treatment involves nutritional therapy like supplements and diet modifications as well as drug treatments. Drug treatments discussed include steroids like prednisone to induce remission, aminosalicylates like sulfasalazine and mesalazine to maintain remission, and immunomodulators like azathioprine for moderate to severe cases.

1.  Developed nation
 10-40 yrs
 Fast food, animal fat, refined
carbohydrate
 Smoking
 NSAIDs
 Stress
 Microflora
……???

2. 1. 16TH
chromosome……
CARD15/NOD2
2. IL-23 R gene
……..+Mutations

4. Inflammatory bowel disease
How to treat….

5. Crohn’s disease
Ulcerative colitis

9. Pathogenesis
 Actual cause unknown
 Immune mediated
Chronic inappropriate
inflammatory response
with relapse and
remissions

10. Treatment …

11. 1. Nutritional therapy
2. Drug treatment

12. Nutritional treatment
 Fe and Ca supplements
 Vitamins
 Minerals
 Low fibre diet
 Low lactose diet
 Total parenteral nutrition regimen
(severe cases)

13. Mode of treatment
 Active cases (for inducing
remission) – steroids
 Maintenance of remission phase-
aminosalicylates, azathioprine

14. Drug treatment
1. Steroids
2. Aminosalicylates
3. Purine analogues

15. Steroids
 Prednisolone 40mg/day
 Highly effective in controlling
symptoms/inducing remission
in both ulcerative colitis and
crohn’s disease
 DOC in moderately severe
exacerbations

16.  Hydrocortisone enema/foam---
topical treatment of proctitis and
distal ulcerative colitis
 Steroids are discontinued after
remission is induced
 Mesalazine is started during steroid
therapy is continued to prevent
relapses

17. Aminosalicylates
1. Sulfasalazine
2. Mesalazine
3. Olsalazine
4. Balsalazine

18. Sulfasalazine
 5-ASA + Sulfapyridine
 Low solubility
 Poorly absorbed from
ileum
 Sulfapyridine-only helps
to carry 5ASA to colon
without being absorbed
proximally

19. MOA
 Inhibits COX,LOX.
 ….Cytokines,PAF,TNF-alpha,nuclear
transcription factor(NFKB)
 Reduce migration of inflammatory
cells
 Reduce mucosal secretions

20. Effects
 Reduce no. of stools,abdominla
cramps,and fever

21. Use
 Mild to moderate exacerbations
 3-4g/day……..induce remission for
few weeks
 Relapse common after stoppage
 Maintenance therapy-1.5-2g/day…
postpones relapse as long as taken
 Main use –maintaining
remission

22. ADR
 Due to sulfapyridine absorbed
1. Rashes
2. Fever
3. Joint pain
4. Hemolysis
5. Blood dyscrasias
6. NV,headache,malaise also
7. Oligospermia
8. Male infertility

23. Mesalazine/mesalamine
 5-ASA
 Not effective orally-
 Delayed release preparations by
coating with acrylic polymer
 Effectively deliver to distal small
bowel and colon

24.  Daily dose-2.4g for ulcerative colitis
 Primary use —maintenance of
remission
 Mild to moderate exacerbations

25. ADR
 Nephrotoxic
 Contraindicated in renal and hepatic
impairment
 DI- coated mesalazine may
enhance the gastric toxicity of
steroids and hypoglycemicaction of
sulphonylureas

26.  5-ASA enemas
 1-2g once /twice daily…..distal
ulcerative colitis, including
refractory cases

27. Olsalazine
 2 molecules of 5-ASA linked by an
azo bond
 Most reliable preparation of
delivery of 5-ASA to the colon
 But it aggravates diarrhoea

28. Azathioprine
 Delayed response occurs after
weeks or months
 Lower toxicity
 Moderate to severe crohn’s disease
and ulcerative colitis
 Useful in steroid resistant cases
 Good remission maintenance
property

29.  Azathioprine---6mercapto purne in
liver
 Inhibit purine nucleotide----inhibit
lymphocyte function esp. Tcells

30. Thank u……….
Gopisankar.M.G.
2008 MBBS