Inflammatory bowel disease

Inflammatory bowel disease

IBD(Inflammatory bowel disease) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract.

It is a spectrum of chronic idiopathic inflammatory conditions.

Classification of Inflammatory bowel disease

1)Ulcerative colitis

Ulcerative colitis is a disease that causes mucosal inflammation & sores (ulcers) in the lining of the large intestine (colon).

2)Chron’s disease

Chron’s disease is a chronic, relapsing, and remitting inflammatory disease of the GIT, affecting any site from mouth to anus.

Epidemiology

In the united states, it is currently estimated that about 1-1.3 million people suffer from IBD.

Ulcerative colitis is slightly more common in makes while Chron’s disease is more frequent in women.

Diet, oral contraceptives, peripheral & childhood infections, or atypical mycobacterial infections have been suggested, but not proven, to play a role in developing IBD.

Etiology of Inflammatory bowel disease

1)Infectious agents

Viruses (Measles)

Bacteria (Mycobacteria)

2)Genetics

3)Environmental factors

Diet

Smoking

4)Psychological factors

Stress

Emotional or physical trauma

Inflammatory bowel disease Pathophysiology 

1)Altered mucosal immune response.

Dietary &bacterial antigens penetrate into the intestinal wall & activate the immune system.

This causes increased production of pro-inflammatory mediators which will lead to inflammation of the mucosal layer.

A variety of epithelial defects have been described in Crohn’s disease & ulcerative colitis.

Defects in epithelial cells will lead to an influx of bacterial components such as dendritic cells and macrophages which activate CD+4 cells.

Activates CD4+ cells activate other inflammatory cells like B-cells & variable T-cells or recruit more inflammatory cells by stimulation of homing receptor on leucocytes & vascular epithelium.

Inflammation in IBD is maintained by an influx of leukocytes from the vascular system into sites of active disease. this influx is promoted by the expression of adhesion molecules (such as α-4-integrins) on the surface of endothelial cells in the microvasculature in the area of inflammation.

 

Clinical manifestations

  • Diarrhea
  • Abdominal pain, cramping & bloating due to bowel obstruction
  • Haematochezia:- Blood in stool
  • Low fever
  • Decreased appetite
  • Weight loss & anorexia
  • Fatigue & arthritis
  • Diagnosis
  • Physical examination
  • Endoscopy
  • Biopsy
  • Radiology
  • Blood test
  • Goals of treatment

1)Maintain/improve quality of life

2)Terminate the acute attack & induce clinical remission

3)Prevent symptoms during chronic symptomatic periods.

4)Reduce/prevent complication

5)Use the most cost-effective drug treatment.

6)Avoid the surgery if possible

7)Replacement of vitamin A,D, K if necessary

Non- pharmacological treatment

1.To avoid smoking cessation

2.To reduce alcohol consumption

3.To avoid the use of NSAID’S

4.To avoid spicy & oily foods

5.To take fiber-rich diet

6.To incorporate more omega-3- fatty acids into the diet.

Inflammatory bowel disease Treatment

1.In mild cases

i)Antibiotics

ii)Aminosalicylates

2.In moderate cases

i)Corticosteroids

ii)Immunomodulators

3.In severe cases

i. Surgery→ It includes

a. Proctocolectomy

b. Restorative proctocolectomy

c. Strictureplasty

d. Resection

e. Colectomy

Pharmacological treatment

The major types of drug therapy used in IBD are

  • Amino salicylates
  • Corticosteroids
  • Immunosuppressive agent
  • TNP (Tumour Necrosis Factor) inhibitors
  • Antimicrobials

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