Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease

It is the chronic relapsing inflammatory bowel disease.

1. Altered immunity

2. Altered response to gut microbiota

3. Genetic predisposition

What causes inflammatory bowel disease?

Caucasians & Jews

Inflammatory Bowel Disease (IBS) is common to what race?

Smoking

What environmental factor contributes to the cause of Inflammatory Bowel Disease?

Crohn’s Disease & Ulcerative Colitis

What are the two types of Inflammatory Bowel Disease?

Regional Enteritis

Crohn’s Disease is also known as

Location: Mouth to Anus (common: ileum/cecum)

Pattern: Patchy, Skip, Regional

Depth: Transmural Lesion (affects all the layers of the bowel wall from mucosa to serosa)

What is the characteristics in terms of the location, pattern, and depth of Crohn’s Disease?

1. RLQ pain with Diarrhea

• triggered by food

• not relieved by defecation

2. Steatorrhea

• fatty stools d/t impaired fat absorption in the small intestine

3. Weight Loss

• d/t diarrhea & loss of appetite

What are the signs and symptoms Crohn’s Disease?

1. Stricture/Stenosis

• narrowing of ileum, causes small bowel osbrtuction

2. Malabsorption

• decrease Vitamin B12, may lead to pernicious anemia

3. Fistula Formation

• due to ulceration of all the layers od the abdominal wall

4. Fluid and Electrolyte Imbalance

5. Colon Cancer

What complications may arise from Crohn’s Disease?

Location: Colon/Rectum

Pattern: Continuous (distal to proximal colon)

Depth: Mucosa/Submucosa (Superficial Lesion)

What is the characteristics in terms of the location, pattern, and depth of Ulcerative Colitis?

1. LLQ pain with bloody diarrhea

• rectal bleeding (hematochezia)

2. Bowel movement of 10-20 stools/day or >6 stools per day

3. Rectal Stenesmus

• painful bowel urgency

4. Weight Loss

What are the symptoms of ulcerative colitis?

1. Anemia

2. Fluid and Electrolyte Imbalance

3. Toxic Megacolon

4. Colorectal Cancer

What complications may arise from Ulcerative Colitis?

Cobblestone appearance

What are the typical colonoscopic findings in Crohn’s disease?

Pseudopolyps

What are the typical colonoscopic findings in Ulcerative Colitis?

UGIS (barium swallow)

Findings: String Sign

What barium study is used when diagnosing Crohn’s Disease? What are the findings?

LGIS (barium enema)

Findings: Lead Pipe Sign

What barium study is used in diagnosing Ulcerative Colitis? What are the findings?

Increase WBC

Increase CRP & ESR

What are the usual lab findings in patients with Inflammatory Bowel Disease?

Drug Therapy

1. Corticosteroids

• for moderate-severe inflammation

• not a maintenance, only for acute attacks

2. Aminosalicylate

• for mild-moderate inflammation

• can be used for maintenance

• responds more to Ulcerative Colitis

• e.g. Mesalamine, Sulfasalazine

3. Immunomodulators

• steroids-sparring

• e.g. Azathioprene, Methotrexate

How is the drug therapy for Inflammatory Bowel Disease?

If patient can tolerate (mild inflammation)

• small frequent feedings and increase fluid

• low residual, low fiber diet

• high calories, high protein

• give iron & vitamin supplementation

If patient cannot tolerate oral feeding

• enteral feeding (NGT) for gavage

If patient cannot tolerate NGT

• TPN

For severe inflammation

• NPO

What is the diet recommended for Inflammatory Bowel Disease?

Crohn’s Disease CANNOT be cured

1. Bowel Resection

• To prevent fistula formation

2. Stricturoplasty

• To prevent small bowel obstruction

What surgery is recommended for Crohn’s Disease?

1. Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis

2. Total Proctocolectomy with Ileostomy

What surgery is recommended for Ulcerative Colitis?