Inflammatory Bowel Diseases(IBD) Ulcerative colitis and Crohn’s disease

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.

Inflammatory Bowel Diseases(IBD)

Inflammatory Bowel Diseases(IBD) Ulcerative colitis and Crohn’s diseas


Clinical features of Crohn’s disease

  • 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.

DIAGNOSTIC APPROACH —

  • 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

Pathology in Ulcerative colitis

  • 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.

Summary of findings in Ulcerative colitis

  • 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.

Summary of findings in Crohns disease

  • 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 of Ulcerative 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.

Treatment of Crohn’s disease

  • 5 -ASA oral or enema Metronidazole
  • Ciprofloxacin
  • Oral or IV glucocorticoids Azathioprine
  • Infliximab
  • Total parenteral nutrition (TPN).

Newer therapies

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