1. IBD
Inflammatory Bowel Disease(IBD) is
currently presumed to result from the
aggregate effect of inherited variants of
genes conferring risk of disease and
environmental factors affecting the
immune system, which combined lead to
an aberrant inflammatory response.

4. THE INFLAMMATORY CASCADE IN IBD
 Inflammatory response is perpetuated by T-cell activation
Inflammatory cytokines, such as L-1, IL-6, and TNF, have diverse
effects on tissues.
 They promote fibrogenesis, collagen production, activation of
tissue metalloproteinases, and the production of other
inflammatory mediators; they also activate the coagulation
cascade in local blood vessels.

5. REPLICATED GENETIC LOCI IN IBD
IBD Locus a
Chromosome Gene b
Phenotype
IBD1
16q
CARD15
CD
IBD2
12p
---
DC,UC
IBD3
6p
MHC?
CD
IBD4
14q
---
CD
IBD5
5q
OCTN?
CD
IBD6
19p
---
CD,UC

6. Defective immune regulation in IBD
CROHN’S DISEASE
ULCERATIVE COLITIS
It is associated with HLA,DR1/DQw5 and NOD2 genes Associate with HLA-DR2 polymorphism
and an abnormal T-cell response particularly,CD4+T
in IL-10 gene and an abnormal T-cell
cell (TH1 cells).
response particularly of CD4+ T cells
( TH2cells).
It is chronic granulomatous disease which can be
affect any part of the gut

7. DIFFERENT CLINICAL, ENDOSCOPIC, AND
RADIOGRAPHIC FEATURES
Clinical
Ulcerative Colitis
Crohn’s Disease
Gross blood in stool
Yes
Occasionally
Mucus
Yes
Occasionally
Systemic symptoms
Occasionally
Frequently
Pain
Occasionally
Frequently
Abdominal mass
Rarely
Yes
Significant perineal disease
No
Frequently
Fistulas
No
Yes
Small-intestinal obstruction
No
Frequently
Colonic obstruction
Rarely
Frequently
Response to antibiotics
No
Yes
Recurrence after surgery
No
Yes
ANCA-positive
Frequently
Rarely
ASCA-positive
Rarely
Frequently

8. Radiographic
Ulcerative Colitis
Crohn’s Disease
Small bowel significantly
abnormal
No
Yes
Abnormal terminal ileum
Occasionally
Yes
Segmental colitis
No
Yes
Asymmetric colitis
No
Yes
Stricture
Occasionally
Frequently
Endoscopic
Ulcerative Colitis
Crohn’s Disease
Rectal sparing
Rarely
Frequently
Continuous disease
Yes
Occasionally
“Cobblestoning”
No
Yes
Granuloma on biopsy
No
Occasionally

9. Colonoscopy is the procedure of choice
Sigmoidoscopy examines the colon up to the splenic flexure
and is currently used to exclude distal colonic inflammation or
obstruction in young patients not at significant risk for colon
cancer. For elusive capsule endoscopy, or the novel technique
of double-balloon enteroscopy.

14. MORPHOLOGY
CD
• The earliest lesion in crohn’s is the
aphthous ulcer. Many such ulcers may
fuse together to form serpentine ulcer
arranged longitudinally.
• Grossly, involved bowel segment
typically has a rigid, strictured or
thickened wall with creeping fat.
• Full thickness of the intestine is
affected in the disease i.e there is
transmural inflammation. This causes
weakness in the wall there by leading
to fissure and fistula formation in
Crohn’s disease. Fibrosis is also
commoner in this type IBD. Perianal
fistula is the most common fistula
seen .
UC

•
•
The disease involves the entire colon
(pancolitis )starting from the rectum
(retrograde involvement). There is
presence of regenrating mucosa which
projects in the lumen and is called
“pseudopolyps”.
In extreme cases, there is involvement
of the nerve plexus in the muscularis
layer resulting in decrese in the motility
of the colon and increase in its size over
a period of time giving rise to “toxic
megacolon”
The characteristic feature of the disease
is mucosal damage continuously from
the rectum and extended proximally.
This may also lead to “backwash ileitis”.
This type of IBD is more commonly
associated with progression of the
development of cancer.

15. • There is patchy involvement of the
intestine which is known as presence
of “skip lesion”. The intervening area
between two affected portions is
absolutely normal. So, the mucosa
appears to be irregular which is
unknown as “cobblestone mucosa.”
• There is a presence of non-caseating
granulomas.
• Clinical features are intermittent
attacks of abdominal pain, blood in
stools, fever steatorrhoea and
megaloblastic anemia (the last two
features result because there is
impairment in the absorption of bile
acids and vitamin B12 respectively
from the ileum).
Screeing test is presence of ASCA . AB
formation is common against cell wall
of yeast , sacchromyces cerevisae in
patients with crohn’s disease.
• There is absence of granulomas.
Clinical features are : intermittent
attacks of abdominal pain, bloody
mucoid stools and fever.
There is presence of p-ANCA.

18. Medical management of IBD.

19. Medical management of IBD.

20. Indication for surgery
Ulcerative Colitis
•
•
•
•
•
•
•
•
•
Intractable disease
Fulminant disease
Toxic megacolon
Colonic perforation
Massive colonic hemorrhage
Extracolonic disease Abscess
Colonic obstruction
Colon cancer prophylaxis
Colon dysplasia or cancer
Crohn’s Disease
• Small Intestine
• Stricture and obstruction
unresponsive to medical therapy.
• Massive hemorrhage
• Refractory fistula
• Colon and Rectum
• Intractable disease
• Fulminant disease
• Perianal disease unresponsive to
• medical therapy
• Refractory fistula
• Colonic obstruction
• Cancer prophylaxis
• Colon dysplasia or cancer

21. Novel agents currently under investigation for treating
inflammatory bowel disease

22. Kings college of London (NHS)

23. Kings college of London (NHS

24. Kings college of London (NHS

25. Waiting for your answer !
Blossom Sabi :)