1. Inflammatory bowel disease
Crohn's disease
Ulcerative colitis
Dr. S. Parasuraman
Faculty of Pharmacy,
AIMST University, Malaysia

2. Inflammatory bowel disease (IBD)
• IDB is a group of inflammatory conditions of the colon and small
intestine.
• The major types of IBD
– Crohn's disease
– Ulcerative colitis
• Ulcerative colitis (involves ascending colon) causes long-lasting
inflammation in digestive tract. Symptoms usually develop over
time, rather than suddenly. Ulcerative colitis usually affects only the
innermost lining of large intestine (colon) and rectum.
• Crohn's disease (involves sigmoid and descending colon) causes
inflammation anywhere along the lining of digestive tract, and often
spreads deep into affected tissues. This can lead to abdominal pain,
severe diarrhea and even malnutrition.

3. Symptoms of IBD
• The severity of symptoms is very form time to time and form
person to person, which includes
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Pain in the abdomen
Weight loss
Diarrhoea (sometimes with blood and mucus)
Tiredness
Constipation
Malnutrition
Nausea
Vomiting
Delayed or impaired growth in children.

4. Causes of Crohn’s disease and colitis
• The causes of these diseases are unknown.
• It is believed that, the cause might be a defect in the body’s
immune system.
Diagnosis of Crohn’s disease and colitis
•
Blood tests
– blood cell counts and erythrocytes sedimentation rates[ESR]
–
red blood cell counts (anemia), low blood proteins, and low body minerals, reflecting loss of these minerals
due to chronic diarrhea
•
Faecal (bowel motion) examination
•
X-rays
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Barium X-ray studies can be used to define the distribution, nature, and severity of the disease
Colonoscopy and gastroscopy

5. Symptoms of Crohn’s disease and colitis
• The severity of symptoms is very form time to time and form
person to person, which includes
–
–
–
–
–
–
–
–
–
Pain in the abdomen
Weight loss
Diarrhoea (sometimes with blood and mucus)
Tiredness
Constipation
Malnutrition
Nausea
Vomiting
Delayed or impaired growth in children.

6. Characteristics in Crohn’s Disease and
Ulcerative Colitis
Crohn’s disease
Ulcerative colitis
Age of onset
10 – 40 yr
10 – 30 yr
Location
Large intestine (distal
ileum and colon)
Large or small intestine
Involves ascending colon
Involves sigmoid and
descending colon
Inflammation
Skip lesions
Uniform and continuous
Layers involved
Mainly submucosal
Mainly mucosal
Bloody stool
Rare
Common
Diarrhea
Common
Common
Malabsorption
Rate
Common
Abdominal pain
Mild to severe
Mild to severe

7. Crohn’s disease- Pathology
• Crohn’s disease affects the terminal ileum and ascending colon (70% of
cases).
• The inflammation is transmural (affects the whole thickness of the bowel
wall) and involves the mesentery and lymph nodes and causing adhesions
between loop of bowel.
• The affected bowel is hard, rubbery and narrowed with a small lumen (the
‘string sing’) and become fibrosed.

8. Crohn’s disease-Etiology
• Etiology is unknown. Possible role of pre-inflammatory cytokines in the
pathogenesis may cause Crohn’s disease.
• Possible association found with Mycobacterium paratuberculosis, measles
and mumps infections.
• Associated environmental factors: Infection, smocking, consumption of
refined sugar, high fiber
• Most common in distal ileum and colon.
Crohn’s disease- Epidemiology
• Inflammatory bowel disease affects all race and both sexes.
• The incidence is generally higher in developed countries, especially in
Northern Europe.
• Lack of dietary fiber, environmental and genetic factor are infusing the
disease progression.

9. Manifestations of Crohn’s disease
• Diarrhea (blood is usually not evident in the stool but may be
occult, i.e., detected by clinical assay)
• Intestinal pain similar to indigestion
• Fever
• Weight loss from intestinal malabsorption
• Nausea, anorexia, vomiting
• Complications: intestinal obstruction, formation of fistulas
• Toxic megacolon
– Life-threatening distention of the colon.
– May lead to perforation of the colon, septicemia and peritonitis.
– Mortality associated with a perforated colon is on the order of 40% or
more.

10. Treatment of Crohn’s disease
• Nutritional supplementation (poor nutrition that can result
from anorexia and intestinal malabsorption)
• Total parenteral nutrition may be indicated in severe cases
• Anti-inflammatory drugs: sulfasalazine, Mesalamine,
corticosteroids
• Antibodies that block cytokine: metronidazole, ciprofloxacin

11. Ulcerative colitis - Pathology
• Rectum is involved in over 90% of cases of ulcerative colitis and
inflammation may spread to involved the sigmoid and descending colon.
• In severe cases (chronic and non-episodic), whole of the colon (pancolitis)
affected. Severe causes may be life-threatening.
• It may be affect terminal part of ileum.
• Unlike Crohn’s disease the pattern of inflammation is continuous
throughout the affected area.
• Ulcerative colitis may cause 10-20 watery, bloody motions with mucus
throughout a 24 h period.

12. Manifestations of ulcerative colitis
• Chronic, bloody diarrhea
• Fever, pain
• Weight loss
• Possible anemia from blood loss
• Possible complications: toxic megacolon, perforation of the
intestine, significant blood loss; an increased incidence of
colon cancer

13. Diagnosis of ulcerative colitis
• Requires a careful history and examination
• Investigations include a full blood count, ESR, electrolytes,
barium meal and follow-through, double-contrast barium
enema, sigmoidoscopy and/or colonoscopy and biopsy, and
stool cultures.

14. Treatment of ulcerative colitis
• Anti-inflammatory drugs (salicylates)
• Sulfasalazine — A combination sulfa and aminosalicylate drug.
• Nicotine appears to exert a protective effect in ulcerative
colitis but not Crohn’s disease.
• Severe malnutrition may require nutritional supplementation.
• Surgical resection of diseased bowel may be required.

15. Management of ulcerative colitis
• Rapid symptom relief and prompt control of acute attacks
• Correction of metabolic disturbances
• Prevention of serious complications
• Long-term immunosuppressive and/or anti-inflammatory,
• Prophylactic or maintenance therapy (for some patients)
• Anticipation of the need for surgery and, if possible, avoidance
of emergency procedures.

16. Thank you