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Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease encompasses ulcerative colitis and Crohn's disease, affecting approximately 1.4 million people in the U.S. These chronic conditions involve immune-mediated inflammation of the gastrointestinal tract, with distinct characteristics and treatment options. While there is no cure, effective treatments allow many patients to achieve remission and maintain a normal life.
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Inflammatory Bowel Disease (IBD)
- 1. Inflammatory Bowel Disease UlcerativeColitis and Crohn’s Disease Roger Klein, MD, FACP
- 2. Definition • Chronic immunemediated inflammation of the gastrointestinal tract • Two distinct diseases • Overlapping clinical characteristics • Affects 1.4 million people in the United States
- 3. Ulcerative Colitis • Inflammationof inner lining of Colon • Does not involve small intestine • Begins in rectum and extends upward • Continuous disease
- 4.
- 5. Crohn’s Disease • Fullthickness 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. The GI Tract Universityof Rochester
- 7. Terminal Ieum University ofRochester
- 8. Layers of GITract Essentials of Human Physiology by Ginsburg and Costoff
- 9.
- 10. Crohn’s Fistulae Johns HopkinsMedical Center
- 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. Risk Factors • Genetics 10-25% have a relative with IBD • Smoking and CD • NSAID and aspirin • Possible western diet • Unknown environmental trigger
- 13. Genetic Risk • Geneticscontribute 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. UC Presentation • Gradualonset over weeks • Diarrhea often bloody • Abdominal cramping • Tenesmus • Extra intestinal manifestations Arthritis Skin/Eyes Liver
- 15. CD Presentation • Oftenpresents with chronic symptoms • Abdominal cramping • Intermittent diarrhea • Obstruction • Abscess/fistulae • Weight loss/anemia/fatigue/fevers
- 16. Evaluation • History andphysical • Stool studies to exclude infection • Colonoscopy to ileum with biopsies • Labs Anemia Markers of inflammation pANCA, ASCA • Enterography/capsule endoscopy
- 17. Treatment • One sizedoes not fit all • Mesalamine • Antibiotics • Steroids • Immunomodulators • Biologic/ Anti-TNF • Surgery
- 18. Mesalamine • First linetherapy acts topically • Oral “Packaged” to release in different areas • Rectal Suppository Enema • Safe even in pregnancy • Not effective in small bowel Crohn’s
- 19. Antibiotics • Ciprofloxacin andMetronidazole • Effective in Crohn’s • No role in UC • Issues with tolerance • May lead to resistant bacteria
- 20. Steroids • Can begiven oral, rectal, or IV • Very effective short term • Not a maintenance drug • Need a plan when starting • Many serious side effects Diabetes Osteoporosis
- 21. Immunomodulators • Azathioprine and6-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. Biologics • Act byinterfering 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. Biologics-Risks • Infectious complications TB/Fungal infections Hepatitis • Cancer Risk Lymphoma
- 24. Surgery-UC • Refractory disease •Cancer • Surgery is curative • Remove entire colon • IPAA or Ileostomy
- 25. Surgery-CD • 50% ofpatients 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. Long Term Issues •Cancer skin, cervical, lymphoma • Osteoporosis • Colon cancer
- 27. Colon Cancer andIBD • 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. 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
Editor's Notes
- #4 Involves mucosa, does not extend to deeper layers of colon
- #7 University of Rochester Medical Center
- #9 Essentials of Human Physiology by Ginsburg, JM and Costoff, A
- #10 Healthfavo.com
- #11 Johns Hopkins Medical Center
- #13 Western diet-processed food, fried food , sugar
- #15 Skin-Erythema nodosum, pyoderma Arthritis- large joint and ankylosing spondylitis Liver- sclerosing cholangitis
- #17 Colonoscopy-continuous disease from rectum Inflammatory markers sed rate and CRP, stool calprotectin Anti-sacchromyces cervissiae, Anti-OmpC
- #18 Treatment needs to be individualized based on extent of disease, severity and initial response
- #20 Intolerance-metallic taste, parasthesias
- #22 Intolerance due to nausea, pancreatitis, hepatitis Risk of lymphoma, skin cancer, cervical cancer due to HPV
- #23 Adalibumab(Humira), Infliximab(Remicade)
- #25 Ileal pouch anal anastamosis
- #28 No increased risk for proctitis Chromoendoscopy