Inflammatory bowel disease.pptx ditected notes of bowel disorders

Bowel diseases

1. Inflammatory bowel disease By Basil George Id 35498

2. Inflammatory bowel disease It is a chronic relapsing inflammatory disease of the ileum, colon, or both, that may be associated with systemic manifestations. It is idiopathic, but appears to have an important immune component triggered by a variety of factors. Characterized by diarrhoea , bleeding, abdominal discomfort, anemia and weight loss.

3. Types of inflammatory bowel disease Ulcerative colitis Crohn’s disease

4. Ulcerative colitis Involves only the colon starting from the anal canal. It may remain restricted to the rectum or extend proximally in a contagious manner to variable extent upto caecum. The lesions are mucosal and may diffuse or confluenconfluent .

5. Crohn’s disease Lesions are patchy and transmural ; may involve any part of the gastrointestinal tract from mouth to the anus. Majority of patients have ileocaecal disease upto ascending colon, but in some it may be restricted to the small intestine, while in others to the colon. Because the lesions are transmural , complications like perforation, abscess, fistula, strictures, etc. occur.

6. Drugs used in inflammatory bowel disease Aminosalicylates Glucocorticoids Immunomodulators Biological response modulators Antibiotics Others : Sulphasalazine , Mesalamine , Olsalazine , Balsalazide : Prednisolone, Methylprednisolone, Hydrocortisone, Budesonide : Azathioprine, 6-mercaptopurine, Methotrexate, Cyclosporine : Infliximab : Metronidazole, Ciprofloxacin, Clarithromycin : Probiotics

7. Aminosalicylates SULPHASALAZINE It is a prodrug. Composed of sulphapyridine and 5-aminosalicylic acid. On oral administration, Sulphasalazine reaches the colon, where it is broken down by colonic bacteria to 5-aminosalicylic acid and sulphapyridine .

8. MECHANISM OF ACTION AMINOSALICYLATES

9. ADVERSE EFFECTS OF AMINOSALICYLATES Nausea, vomiting, headache Allergic side effects : skin rashes, fever, hepatitis, pancreatitis, puemonitis , etc. To avoid these side effects of sulphapyridine , several 5-aminosalicylic acid compounds have been developed which can be directly targeted to the colon.

10. OTHER AMINOSALICYLATES MESALAMINE ( MESALAZINE) 5-aminosalicylic acid Well absorbed in upper gastrogastrointestinal tract. It can be administered as suppository or enema. OLSALAZINE Composed of 2 molecules of 5- aminosalicylic acid with an azo linkage. Poorly absorbed after oral administration.

11. Mesalamine , Olsalazine and Balsalazide have a lower incidence of side effects than sulphasalazine . They may cause headache and skin rashes. Diarrhoea is common with olsalazine . 5-aminosalicylic acid agents are mainly effective for mild to moderate ulcerative colitis and Crohn’s disease.

12. GLUCOCORTICOIDS Used for the short term treatment of moderate to severe inflammatory bowel disease. Used in patients who do not respond to 5- aminosalicylic acid compounds. In responsive patients symptomatic relief usually starts within 3 - 7 days and remission is induced in 2 – 3 weeks. Glucocorticoids are discontinued after remission is induced. Prolonged use leads to suppression of hypothalamic-pituitary-adrenal axis suppression. Other side effects: Osteoporosis, peptic ulcer, infections and hyperglycemia.

13. Antibiotics Used as adjuncts in patients with active Crohn’s disease. Commonly used antibiotics are metronidazole, clarithromycin, ciprofloxacin.

14. Immunosuppressants Used in severe disease. Used in patients with steroid dependant /steroid unresponsive inflammatory bowel disease. Commonly used immunosuppressants are Methotrexate, 6-mercaptopurine,Azathioprine.

15. Biological response modulators Used in severe cases of Crohn’s disease and refractory ulcerative colitis. Main disadvantage is increased susceptibility to infections. Commonly used drugs are infliximab, adalimumab , certolizumab .

16. Probiotics Used to restore intestinal flora Useful as adjunct therapy in patients with severe inflammatory bowel disease. Examples : lactobacillus, bacteroides etc.