WK7 - IBD

What percentage of the UK population is living with Crohn's disease or ulcerative colitis?

0.81% (approximately 1 in 123 people). In people over 70, it is 1 in 67.

What is the prevalence of Crohn's disease in the UK?

10.6 per 100,000 people.

What is the median age at diagnosis for Crohn's disease?

Approximately 30 years.

What is the prevalence of ulcerative colitis in the Western world?

Approximately 1 per 1000 people.

What are the peak ages for diagnosis of ulcerative colitis?

20-40 years, with a second peak at age 60.

Which gender is more affected by ulcerative colitis?

Slightly more males than females.

What are the 4 components that must work together to maintain gut health?

Microbes, epithelium, immune cells, and renewal/regeneration (stem cells).

What is the function of the mucus layer in the gut?

Keeps bacteria away from the epithelium.

Lgr5+ stem cells.

What cells renew the intestinal epithelium?

What happens when the balance between microbes, epithelium, immune cells, and renewal is disrupted?

Inflammation occurs (can become chronic in IBD).

What percentage of patients with upper GI symptoms see a GP versus self-treat?

90% self-treat, 9% see a GP, 1% see a consultant.

What is the problem with self-treatment of GI symptoms?

It can mask potentially serious conditions like cancer.

How many deaths from stomach cancer occur in the UK each year?

Approximately 4,400 deaths per year.

What is the 5-year survival rate for stomach cancer?

19% (1-year survival is 42%).

What percentage of stomach cancer cases are diagnosed at a late stage?

70%.

What percentage of stomach cancer cases are preventable?

54%.

What is the most common infectious cause of stomach cancer?

H. pylori infection – responsible for 32% of stomach cancer cases.

Name 3 risk factors for stomach cancer.

H. pylori infection, smoking, alcohol, high salt intake, diet low in fresh food (any 3)

What is the prevalence of GORD?

10-20% of adults.

What is the prevalence of peptic ulcer disease (PUD)?

10-25% of adults.

What is the prevalence of gastritis?

Approximately 30%.

What is the prevalence of functional dyspepsia?

Approximately 30%.

What is the prevalence of oesophageal and gastric cancer?

Approximately 2%.

What is functional dyspepsia?

Indigestion symptoms with no identifiable organic cause (no ulcer, no inflammation, no cancer).

What are the extra-intestinal manifestations of IBD?

Arthritis, mouth ulcers, red eye (uveitis), skin problems (erythema nodosum), bone disease, liver disease.

What is the cancer risk in Crohn's disease after 30 years?

18%.

What is the cancer risk in ulcerative colitis?

3-5% of patients.

What is pouchitis?

Inflammation of an ileal pouch after surgery – a complication unique to UC.

What is toxic megacolon?

A severe complication of UC where the colon dilates and can perforate – life-threatening.

What is the difference in smoking risk between Crohn's and UC?

Smoking INCREASES risk of Crohn's (worse course). Smoking DECREASES (protects against) UC.

What is the genetic risk factor NOD2 associated with?

Crohn's disease – it recognises bacterial MDP.

What is the genetic risk factor ATG16L1 associated with?

Crohn's disease – involved in autophagy.

What test is used to diagnose H. pylori?

Carbon-13 urea breath test (gold standard) or stool antigen test.

What is the difference in inflammation depth between Crohn's and UC?

Crohn's = TRANSMURAL (all layers). UC = MUCOSAL (and submucosa).

What is the difference in distribution between Crohn's and UC?

Crohn's = any part of GI tract (patchy/skip lesions). UC = colon and rectum only (continuous from rectum).

What histological finding is almost diagnostic of Crohn's disease?

Non-caseating granulomas.

What endoscopic finding is characteristic of Crohn's disease?

Cobblestoning (deep ulcers with swelling of surrounding tissue).

What endoscopic finding is characteristic of ulcerative colitis?

Pseudopolyps, loss of vascular pattern, crypt abscesses.

What is the pain pattern of gastric ulcer?

Pain immediately with or after food.

What is the pain pattern of duodenal ulcer?

Pain between meals or at night; relieved by eating.

What is the difference between dysphagia and odynophagia?

Dysphagia = difficulty swallowing. Odynophagia = pain on swallowing.

What is the most serious complication of long-standing GORD?

Barrett's oesophagus (pre-cancerous condition).

What is Barrett's oesophagus?

Pre-cancerous change where normal squamous lining of oesophagus changes to columnar (stomach-like) epithelium due to chronic acid exposure.

Complete the sentence: "Antibiotics cause ___% of drug-induced oesophagitis."

50

Complete the sentence: "A hiatus hernia is present in ___% to ___% of the population."

30 / 50

Complete the sentence: "H. pylori is responsible for ___% of stomach cancer cases."

32

Complete the sentence: "___% of patients with upper GI symptoms self-treat."

90