INFLAMMATORY BOWEL SYNDROME

DEFINITION,ETIOLOGY,EPIDEMIOLOGY, PATHOPHYSIOLOGY, NON-PHARMACOLOGICAL & PHARMACOLOGICAL TREATMENT.

1. INFLAMMATORY BOWEL SYNDROME

2. For many years, little was known about Crohn's disease and ulcerative colitis . Ulcerative colitis was first described in 1875 by two English physicians, Wilks and Moxon , who distinguished it from  diarrheal diseases  caused by infectious agents . SAMUEL WILKS WALTER MOXON

3. Definition: Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that involve chronic inflammation of your digestive tract. Etiology: Causes:

4. Factors responsible for IBD: GENES: Anti-microbial peptide, Autophagy Handling of bacteria Cytokines ENVIRONMENT: Microorganisms, Diet, Infections, NSAID’S, Smoking, Antibiotics, Stress. Age, Race, Familyhistory , Smoking. Signs & Symptoms: Diarrhoea , Rectal Bleeding, Abdominal pain, Fever, Weight loss, Vomiting, Cramps, Muscle spasms. Rectal Bleeding

5. Epedimiology : The incidence of new cases of ulcerative colitis in Europe and USA is 2–8 per 100,000 per year with a prevalence of 40–80 per 100,000 per year. The incidence has remained fairly static over the last 40 years. In the UK, Crohn's disease occurs with a similar frequency to ulcerative colitis with around 4 per 100,000 per year and a prevalence of 50 per 100,000. The rates in central and southern Europe are lower. Pathophysiology IBD may result from a primary failure of regulatory lymphocytes and cytokines , such as interleukin-10 and transforming growth factor-β , to control inflammation and effector pathways. In Crohn's disease, it is also thought that T-cells are resistant to apoptosis after inactivation . Non-pathogenic bowel flora appears to be an essential factor .

6. Based on the location of disease of IBD it’s of 2 types : Ulcerative colitis Crohn’s disease Ulcerative colitis: Inflammation of Colon & Sigmoid colon. 40-50% Proctitis , 30-40% Left-sided colitis, 20% Extensive colitis. SMOKING is Protective. ONSET-15-40yrs. COMPLICATIONS—Severe Bleeding, Colon Cancer, Rupture of bowel, Toxic Megacolon . GENDER—Both Male & Female. PATHOLOGY—Continuous inflammation lesion, Distal to Proximal colon. HISTOLOGY—Superficial Inflammation . CROHN’S DISEASE: Ileo-caecal inflammation(40%) Skip lesions in Small Intestine(30-40%) Crohn’s colitis (20%) Perianal colitis (>10%) SMOKING –AGGRESSIVE. ONSET-15-40yrs. COMPLICATIONS—Very severe Stenosis , Abscess formation, Fistula, Colon Cancer, Perforation. GENDER—MALE<FEMALE. PATHOLOGY— Discotinuous patchy, Gut inflammation with skip lesions. HISTOLOGY— Transmural inflammation.

7. SYSTEMIC COMPLICATIONS: Mouth Ulcer, Large joint arthritis, Conjuctivitis Iritis Pyoderma gangrenosum Liver Abscess Mesentric /Portal vein thrombosis, Venous thrombosis Erythema nodosum

8. Investigations: 1)Full Blood Count: Anaemia , Malabsorpton (VitB12,IRON); 2)Blood Chemistry: Decreased Albumin(due to inflammation & enteropathy ) 3)ESR/CRP : Inflammatory markers 4)MCS: Rule out Bacterial/parasitic ivolvement .

9. 5)Endoscopy—Colonoscopy: U.C( Erythematous appearance, Continuous lesion, Pesudopolyps , Petechae , Exudates, oedema ). Crohn’s disease(Cobble stone appearance, Skip lesions, Pesudopolyps , Granulomas ) 6)Biopsy: For Ulcerative Colitis(Crypt abscess, Crypt Atrophy, Mucin depletion, Inflammation sign) 7)Radiology for Crohn’s disease(Essential for the staging of Crohn’s disease,Traditional Barium is used, MRI is common here )

10. DIAGNOSIS: Ulcerative Colitis: Presence of Chronic diarrhoea > 4weeks & evidence of Active inflammation on Endoscopy & chronic changes on Biopsy. DIAGNOSIS: Crohn’s Disease: Endoscopic findings & imaging studies with compatible clinical history.

11. NON-PHARMACOLOGICAL TREATMENT

12. PHARMACOLOGICAL TREATMENT The major types of drug therapy used in IBD include Aminosalicylates , Corticosteroids, Immunosuppressive agents ( Azathioprine , Mercaptopurine , Cyclosporine, and Methotrexate ), Antimicrobials Metronidazole and Ciprofloxacin), and agents to inhibit TNF-α (Anti–TNF-α antibodies).

13. ULCERARTIVE COLITIS & CROHN’S DISEASE

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