Inflammatory Bowel Diseases(IBD) Ulcerative colitis and Crohn's disease - || MedicScientist :: Total Health Portal || Quality Generic Medicines ||

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Inflammatory Bowel Diseases

Inflammatory Bowel Disease (I BD) is an idiopathic and chronic intestinal inflammation.

It is of 2 major types :
- Ulcerative colitis UC)
- Crohn’s diseas (C.D)
The factors associated with increased incidence of IBD are smoking, oral contraceptive, family history, genetic predisposition, hypogammaglobulinaemia, emotional stress.
The term for a number of chronic, relapsing inflammatory diseases of the gastrointestinal tract of unknown etiology.
The two most common types are ulcerative colitis and Crohn’s disease.
UC affects the colon, whereas CD can involve any component of the gastrointestinal tract from the oral cavity to the anus.
Age of onset is 15-30 years and 60-80 years.
It is equally common in males and females.

There is pain in right lower quadrant of abdomen, diarrhea, palpable mass sometimes, fever, anorexia, fear of eating.
Afl inflammatory mass is palpable in right lower quadrant sometimes.
There is bowel obstruction due to progressive narrowing and stricture.
There may be pain after meals. ~Fistulas are common due to perforation.

The diagnosis of IBD involves five steps.
The first two are typically performed by the general pediatrician, and the last three are performed by the pediatric gastroenterologist.
Clinical suspicion of the illness based upon history,
examination and screening laboratory data Exclusion of other illnesses that have a similar presentation
Establishment of the diagnosis of IBD, with differentiation between CD and UC
Localization of the region of the disease Identification of extraintestinal manifestations

Involves the rectum and extends upwards.
The mucosa is ede’r1atous, haemorrhagic and ulcerated.
Pseudopolyps may be present.
The colon becomes narrowed and shortened.
There may be perforations. There may be crypt abscesses.
There may be pseudopolyps or carcinoma in colon. Stricture and obstruction may occur, seen on endoscopy.

In X-ray with barium there is string sisn of narrowed lumen of intestine.

Gross blood in stools
The onset of symptoms may be insidious, with non-bloody diarrhea and sometimes poor weight gain.
Mucus in stools
ANCA (Antineutrophil cytoplasmic antibody) positive Rectum is usually involved
Patients with UC have colitis affecting the rectum and extending proximally to a variable degree
The lesions are continuous Strictures are rarely found.

Systemic symptoms are common
Any part of GI tract, usually terminal ileum and/or colon; transmural inflammation, bowel wall thickening, linear ulcerations,
Blood and mucus usually not present in stools Abdominal pain is common
Abdominal mass usually palpable
There is significant perianal and perineal disease Fistulas are common
Strictures are frequent
Intestinal obstruction is common Colonic obstruction is common Responds to antibiotics
May recur after surgery
AS CA (Anti Saccharomyces cerevisiae antibody) Rectum is spared
Fever, abdominal pain, diarrhea (often without blood), fatigue, weight loss, growth retardation in children;
There is cobblestoning in endoscopy (cobblestones are large cricket ball size stones used for paving paths)
There may be granuloma on biopsy
Small bowel may be involved
There is segmental colitis.

Treatment for inflammatory bowel disease is Sulphasalazine (4-8 g/day) and other 5-ASA agents dose 2-4 gjday).
5 ASA agents are Sulfasalazine, Olsalazine, Asacol, Pentasa.
For distal disease 5-ASA oral and enema is given. IV glucocorticoids, glucocorticoid enemas.
IV CSA (cyclosporin), Azathioprine, 6 Mercaptopurine.

Anti TNF antibody
Newer immunosuppressive agents like tacrolimus Surgical therapy for haemorrhage, obstruction, fistula, stricture.