Gastrointestinal System >
Inflammatory Bowel Disease (IBD)

“A group of inflammatory disorders of the colon and small intestine, principally Ulcerative Colitis (UC) and Crohn’s Disease (CD)”

Risk Factors
  • Infective agents (e.g Mycobacteria, rotavirus, measles virus, chlamydia)
  • IBD in 1st-degree relative
  • Good hygiene
  • Smoking (­ risk of CD; ¯ risk in UC)
  • Immunosuppression
Aetiology

Not entirely understood but relies on the interaction between environmental triggers (nutrition and hygiene), genetic susceptibility, immune response and gut microflora

Pathophysiology

Altered gut microflora/overzealous immune response/genetic defect →­ bacterial colonisation → bacteria adhere to and compromise mucosal barrier → mucosal invasion → inflammation of GI mucosa

Crohn’s DiseaseUlcerative Colitis
DistributionWhole GI TractColon only
ContinuitySkip lesionsContinous (procitis spreads backwards)
InflammationTransmuralSuperficial
PathologyCobblestoningGoblet cell loss, crypt abcesses
GranulomasYesNo
SmokingWorsens diseaseProtective
Clinical Presentation
  • Crohn’s Disease – Diarrhoea (80%), abdo pain, weight loss. 2o symptoms: malaise, fever, lethargy, N/V
  • Ulcerative Colitis – Diarrhoea with blood/mucous, mouth ulceration, relapsing/remitting condition
Investigations
  • FBC – anaemia common, ­ ESR, CRP, WCC (UC: pANCA +, CD: usually pANCA -ve)
  • Stool culture – faecal calprotectin, rule out infective colitis
  • Colonoscopy – superficial lesion, deep ulceration, “skip lesions”
  • Abdo XR in acute exacerbations; Abdo USS determine extent of pathology
Management
  • Crohn’s Disease:
    • Medical:
      • Aminosalicylates (e.g mesalazine)
      • Abx in adults with infective component (e.g metronidazole)
      • Corticosteroids (e.g prednisolone)
      • Immunomodulators (e.g azathioprine, methotrexate, 6-MP) or Biologics (Anti-TNFα: infliximab, adlimumab, certolizumab)
      • Oxygen controlled via Venturi mask
      • Ventilation
    • Surgical:
      • in ~80% CD patients
      • Minimal bowel resections only. Recurrence risk of 15%/year.
  • Ulerative Colitis:
    • Medical:
      • 1st Line – Aminosalicylates for disease remission (+rectal steroids if rectal involvement)
      • UC attack/total colitis – IV hydrocortisone (+ azathioprine in recurrent disease).
    • Surgery/Rescue therapy – IV hydrocortisone + a) IV cyclosporine or b) Anti-TNFα then switch to oral prednisolone + aminosalicylate for remission
Complications
  • UC Attacks
  • GI Obstruction
  • Toxic Megacolon
  • Adhesions
  • Bowel Perforation
  • Non-GI complications (rheumatoid diseases, skin change, HPB complications common: sclerosing cholangitis, cholelithiasis, Fatty Liver disease)

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