Download Inflammatory Bowel Disease

Inflammatory bowel disease (IBD)
Niazy B Hussam Aldin
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Overview
Types
Causes
Risk Factors
Symptoms
Complications
Diagnosis
Treatment
Overview
Inflammatory bowel disease (IBD) represents a
group of intestinal disorders that cause prolonged
inflammation of the digestive tract. IBD can be
very painful and disruptive, and in some cases,
may even be life-threatening.
What Are the Main Types
of Inflammatory Bowel
Disease?
What Pathophysiology
Inflammatory Bowel Disease?
The major theories of the cause of IBD involve a combination,of infectious,genetic,
and immunologic causes. The inflammatory response with IBD may indicate
abnormal regulation of the normal immune response or an autoimmune reaction
to self-antigens. Microflora of the GI tract may provide a trigger to activate
inflammation. Crohn’s disease may involve a T lymphocyte disorder that arises in
genetically susceptible individuals as a result of breakdown in the regulatory
constraints on mucosal immune responses to enteric bacteria
Smoking appears to be protective for ulcerative colitis but
associated with
increased frequency of Crohn’s disease
Multiple potential active mediators in smoke may be
responsible for these clinical effects, including nicotine and
carbon monoxide, but the precise mechanism remains
unknown. Nicotine's application as a therapeutic treatment in
What Are the Risk Factors for Developing
Inflammatory Bowel Disease?
The Crohn’s & Colitis Foundation of
America (CCFA) estimates that 1.6
million people in the United States
have IBD. The biggest risk factors
for developing Crohn’s disease and
ulcerative colitis include:
Ethnicity
in all populations but Caucasians and Ashkenazi higher
risk.
Age
in most cases before 35 years.
Family History
Geographical Region
People who live in urban areas and industrialized countries have
a higher risk of getting IBD. This can be partially explained by
lifestyle choices and diet. IBD is also more common among
people living in northern climates, where it’s often cold.
Gender
In general, IBD affects both genders equally. Ulcerative
colitis is more common among men, while Crohn’s
disease is more common among women.
What Are the Symptoms of Inflammatory Bowel Disease?
•weight loss and anemia, which can cause delayed
growth or development in children
People with Crohn’s disease may get canker
sores in their mouths. Sometimes ulcers and
fissures also appear around the genital area or
anus.
What Are the Possible Complications of
Inflammatory Bowel Disease?
Possible complications of IBD include:
•malnutrition with resulting weight loss
•colon cancer
•fistulas (ulcers that go through the bowel wall, creating a
hole between different parts of the digestive tract)
•intestinal rupture (or perforation)
•bowel obstruction
In rare cases, a severe bout of IBD can make you go into
shock. This can be life-threatening. Shock is usually
caused by blood loss during a long, sudden episode of
bloody diarrhea.
How Is Inflammatory Bowel Disease Diagnosed?
Stool Sample and Blood Test
Barium Enema
A barium enema is an X-ray exam of the colon
and small intestine. In the past, this type of test
was often used, but now other tests have largely
replaced it.
Flexible Sigmoidoscopy and Colonoscopy
Capsule Endoscopy
This test inspects the small intestine, which is
much harder to examine than the large intestine.
For the test, you swallow a small capsule
containing a camera. As it moves through your
small intestine, it takes pictures. Once you’ve
passed the camera in your stool, the pictures can
be seen on a computer.
This test is only used when other tests have failed
to find the cause of Crohn’s disease symptoms.
Plain Film or X-Ray
A plain abdominal X-ray is used in emergency
situations where intestine rupture is suspected.
Computer Tomography (CT) and Magnetic
Resonance Imaging (MRI)
How Is Inflammatory Bowel
Disease Treated?
Medical therapy for IBD has three main goals:
Inducing remission (periods of time that are symptom-free)
Maintaining remission (preventing flare-ups of disease)
Improving the patient's quality of life.
To achieve these goals, therapy must suppress the chronic intestinal
inflammation that causes the symptoms of IBD. When the inflammation is
under control, the intestines can absorb essential nutrients. This, in turn,
enables patients to avoid surgery and long-term complications.
Investigators suggest links between diet,
the immune system and bacteria in the
digestive tract.
Anti-inflammatory drugs first step in the
treatment of inflammatory bowel disease.
They include:
•Aminosalicylates. Sulfasalazine can be
effective in reducing symptoms of ulcerative
colitis and for some people with Crohn's
disease confined to the colon.
Corticosteroids. These drugs, which include prednisone and
hydrocortisone, are generally reserved for moderate to severe
ulcerative colitis or Crohn's disease that doesn't respond to
other treatments.
Immune system suppressors
For some people, a combination of these drugs works better than
one drug alone. Immunosuppressant drugs include:
Azathioprine and mercaptopurine . These are the most widely used
immunosuppressants for treatment of IBS
•Cyclosporine . This drug is normally reserved for people who
haven't responded well to other medications. Its use is generally
confined to ulcerative colitis.
•Infliximab . These drugs, called tumor necrosis factor (TNF)alpha inhibitors, or "biologics," work by neutralizing a protein
produced by your immune system. Infliximab is given by
intravenous injection and the others by subcutaneous injection.
They may be combined with other immunosuppressant
medications such as azathioprine or mercaptopurine.
Antibiotics
People with ulcerative colitis who run fevers will likely be given antibiotics to help
prevent or control infection. Antibiotics can reduce the amount of drainage and
sometimes heal fistulas and abscesses in people with Crohn's disease.
Researchers also believe antibiotics help reduce harmful intestinal bacteria and
suppress the intestine's immune system
Metronidazole (Flagyl). At one time, metronidazole was the most commonly used
antibiotic for Crohn's disease
Ciprofloxacin (Cipro). improves symptoms in some people with Crohn's disease, is
now generally preferred to metronidazole. A rare side effect is tendon rupture
Other medications
Anti-diarrheal medications. A fiber supplement — such as psyllium powder or methylcellulose
For more severe diarrhea, loperamide may be effective.
•Pain relievers. For mild pain,acetaminophen However, ibuprofen ,naproxen sodium
and diclofenac sodium (Voltaren) .
Iron supplements.
Vitamin B-12 shots. Crohn's disease can cause vitamin B-12 deficiency.
Calcium and vitamin D supplements
Nutrition. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition)
or nutrients injected into a vein (parenteral nutrition) to treat your Crohn's disease. This can
improve your overall nutrition and allow the bowel to rest
Surgery
•Surgery for ulcerative colitis. Surgery can often eliminate
ulcerative colitis, but that usually means removing your entire
colon and rectum (proctocolectomy). In most cases, this involves
a procedure called ileoanal anastomosis that eliminates the need
to wear a bag to collect stool. Your surgeon constructs a pouch
from the end of your small intestine. The pouch is then attached
directly to your anus, allowing you to expel waste relatively
normally.
In some cases, a pouch is not possible. Instead, surgeons create
a permanent opening in your abdomen (ileal stoma) through
which stool is passed for collection in an attached bag.
•Surgery for Crohn's disease. Up to one-half of people with Crohn's disease
will require at least one surgery. However, surgery does not cure Crohn's
disease.
During surgery, the doctor removes a damaged portion of your digestive tract
and then reconnects the healthy sections. Surgery may also be used to close
fistulas and drain abscesses. A common procedure for Crohn's disease is
strictureplasty, which widens a segment of the intestine that has become too
narrow.
If you have had surgery on your colon or where your small intestine and colon
meet, your doctor may recommend a repeat colonoscopy in six to 12 months
to look for signs of disease and help with correct treatment.
PREGNANCY
• Drug therapy for IBD is not a contraindication for pregnancy, and most
pregnancies are well managed in patients with these diseases. The indications
for medical and surgical treatment are similar to those in the
Nonpregnant patient. If a patient has an initial bout of IBD during
pregnancy, a standard approach to treatment with sulfasalazine or steroids
should be initiated.
• Folic acid supplementation, 1 mg twice daily, should be given.
• Metronidazole or methotrexate should not be used during pregnancy.
Azathioprine and mercaptopurine may be associated with fetal deformities.
Reference
Pubmed •
www.health line.com •
Roger and walker 5th edition •