INFLAMMATORY BOWEL
DISEASES
CONTENT
• An introduction to IBD
• Etiology
• Physiology of IBD
• Clinical presentation
• Complications
• Diagnosis
• Management- Treatment algorithm, Non pharmacological, pharmacological
management
DEFINITION
• Inflammatory bowel disease (IBD) is a group of disorders that cause chronic
inflammation (pain and swelling) in the intestines.
ETIOLOGY
• Infectious agents
Viruses (e.g., measles)
L-Forms of bacteria
Mycobacteria
Chlamydia
• Genetics
Metabolic defects
Connective tissue disorders
ETIOLOGY
• Environmental Factors
Diet
Smoking (Crohn’s disease)
• Immune defects
Altered host susceptibility
Immune-mediated mucosal damage
• Psychologic factors
Stress
Emotional or physical trauma
Occupation
TYPES OF IBD
Feature Ulcerative Colitis Crohn’s disease
Involvement of GIT Large Bowel Any part of GIT
Rectal Involvement Frequent Rare
Inflammation Superficial Transmural
Skip areas Absent Present
Ulcers If present- superficial Deep
Fissures & Fistulae Less common Very common
Histology Infiltration is mainly neutrophilic Presence of granulomas
Smoking Protective Predict a worse course
Clinical Presentation of Ulcerative Colitis
Abdominal cramping
• Frequent bowel movements, often with blood in the stool
• Weight loss , Fever and tachycardia in severe disease
• Blurred vision, eye pain, and photophobia with ocular involvement
• Arthritis
• Raised, red, tender nodules that vary in size from 1 cm to several centimeters
• Physical examination
• Hemorrhoids, anal fissures, or perirectal abscesses may be present
• Iritis, uveitis, episcleritis, and conjunctivitis with ocular involvement
• Dermatologic findings with erythema nodosum, pyoderma gangrenosum, or aphthous ulceration
• Laboratory tests
Decreased hematocrit/hemoglobin
Increased erythrocyte sedimentation rate
Leukocytosis and hypoalbuminemia with severe disease
• Complex disease classifications are generally not used in clinical practice
for ulcerative colitis. The mild, moderate, and severe disease activity are
generally used, and these are determined largely by clinical signs and
symptoms.
• Mild—Fewer than four stools daily, with or without blood, with no
systemic disturbance and a normal erythrocyte sedimentation rate (ESR).
• Moderate—More than four stools per day but with minimal systemic
disturbance.
• Severe—More than six stools per day with blood, with evidence of
systemic disturbance as shown by fever, tachycardia, anemia, or ESR of
>30
Clinical Presentation of Crohn’s Disease
• Malaise and fever
• Abdominal pain
• Frequent bowel movements
• Hematochezia
• Fistula
• Weight loss, Arthritis
Physical examination
• Abdominal tenderness
• Perianal fissure or fistula
• Laboratory tests
• Increased white blood cell count and erythrocyte sedimentation rate
DIAGNOSIS
Crohn’s disease ulcerative colitis
• For Crohn’s disease, there are two types • By contrast, ulcerative colitis involves
of endoscopy, as follows: the endoscope insertion through the
anus only. The two types are:
• Colonoscopy: The flexible tube, known
as an endoscope, is inserted through the • Sigmoidoscopy: This allows the
anus to allow for an examination of the doctor to examine the rectum and
colon. lower colon for the extent and degree
• Upper endoscopy: The flexible tube is of inflammation in those areas.
inserted through the mouth, down the • Total colonoscopy: This occurs when
esophagus, into the stomach, and into the the doctor examines the entire colon.
first part of the small intestine.
TREATMENT PYRAMID
NON PHARMACOLOGICAL TREATMENT
• Proper nutritional support is necessary.
• Eliminate the food that exacerbate the symptoms.
Eg, milk
• Parenteral nutrition is beneficial in severe case
• Patient need to be adequately addressed with enteral supplements.
GOAL OF THERAPY
• Resolution of acute inflammatory process
• To reduce complications
• Maintenance of remission
• Surgical palliation and cure
• SURGERY- ileostomy and proctocolectomy
• OTHERS
Laxative
Pain relievers
Iron supplements
Antidiarrhoeals
ULCERATIVE COLITIS
CROHN’S DISEASE
AGENTS FOR THE TREATMENT OF IBD
DRUG MONITORING PARAMETERS
THANK YOU
