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) 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 Crohn‘s 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.