Inflammatory bowel disease (IBD) includes chronic disorders like ulcerative colitis and Crohn's disease that cause inflammation in the intestines. Genetic factors contribute to IBD risk, and symptoms include abdominal pain, diarrhea, and bloody stools. Treatment involves lifestyle changes, medications like 5-aminosalicylates and immunosuppressants to reduce inflammation, and sometimes surgery for severe cases.

3. Inflammatory bowel disease
It includes a group of chronic disorders that
cause inflammation or ulceration in large and
small intestines.
intestines.

9. Genetic factors
• Ulcerative colitis is more common in
DR2-related genes
• Crohn’s disease is more common in
DR5 DQ1 alleles
• 3-20 times higher incidence in first degree
relatives

10. Other forms of IBD
• Collagenous colitis
• Lymphocytic colitis
• Ischemic colitis
• Behcet’s syndrome
• Infective colitis
• Intermediate colitis

11. Pathogenesis of IBD
American Gastroenterological Association Institute, Bethesda, MD.
Sartor RB. Nat Clin Pract Gastroenterol Hepatol. 2006;3:390-407.
Normal
Gut
Tolerance-
controlled
inflammation
Environmental
trigger
(Infection, NSAID, other)
Acute Injury
Complete Healing
Chronic Inflammation
Genetically
Susceptible
Host
Acute Inflammation
↓ Immunoregulation,
failure of repair or
bacterial clearance
Tolerance

12. Pathology
Macrocopic features
• Ulcerative colitis
Usually involves rectum & extends proximally to
involve all or part of colon.
Spread is in continuity.
May be limited colitis( proctitis &
proctosigmoiditis)
in total colitis there is back wash ileitis (lumpy-
bumpy appearance)

14. Microscopic features
 Crypts atrophy & irregularity
 Superficial erosion
 Diffuse mixed inflammation
 Basal lymphoplasmacytosis

15. Macroscopic features
• Crohn’s disease
Can affect any part of GIT
Transmural
Segmental with skip lesions
Cobblestone appearance
Creeping fat- adhesions & fistula

18. Microscopic features
• Aphthous ulcerations
• Focal crypt abscesses
• Granuloma-pathognomic
• Submucosal or subserosal lymphoid
aggregates
• Transmural with fissure formation

29. IBD Is Not the Same as IBS
• IBD is sometimes confused with irritable bowel syndrome
(IBS).
• The striking difference between the two diseases is that
there is no identifiable inflammation in IBS.
• Some symptoms may be similar - abdominal pain, diarrhea,
• but the other symptoms and signs of IBD are not seen -
bloody stools, fever, and weight loss.
• The cause of IBS is believed to be dysfunction of the
intestinal muscles, nerves, and secretions and not
inflammation.
• Signs of inflammation in the intestine as well as symptoms
outside of the abdomen are not seen in IBS.

30. D/D of IBD?

31. Diagnosis
• Laboratory tests
• Endoscopy
• Radiography
• Biopsy
• CT enterography

32. Laboratory tests
• CRP-elevated
• ESR-elevated
• Anemia
• Leukocytosis
• hypoalbuminemia

33. Barium enema
String
sign

34. Colonoscopy

35. CT enterography
• Mural hyperenhancement
• Stratification
• Engorged vasa recta
• Perienteric inflammatory
changes

38. Treatment

39. Treatment

40. Lifestyle changes

44. 5-ASA Agents
•Sulfasalazine (5-aminosalicylic
acid and sulfapyridine as carrier
substance)
•Mesalazine (5-ASA), e.g. Asacol,
Pentasa
•Balsalazide (prodrug of 5-ASA)
• Olsalazine (5-ASA dimer cleaves
in colon)

45. Oral
• Varies by agent: may be released in the distal/terminal
ileum, or colon1
Distribution of 5-ASA Preparations
Suppositories
• Reach the upper rectum2,5
(15-20 cm beyond the anal verge)
Liquid Enemas
• May reach the splenic flexure2-4
• Do not frequently concentrate in the rectum3
Topical Action of 5-ASA: Extent of Disease
Impacts Formulation Choice
1. Sandborn WJ, et al. Aliment Pharmacol Ther. 2003;17:29-42; 2. Regueiro M, et al. Inflamm Bowel Dis. 2006;12:972–978; 3. Van Bodegraven AA,
et al. Aliment Pharmacol Ther. 1996; 10:327-332; 4. Chapman NJ, et al. Mayo Clin Proc. 1992;62:245-248; 5. Williams CN, et al. Dig Dis Sci. 1987;32:71S-75S.

46. • Use
 In mild to moderate UC & crohn’s colitis
 Maintaining remission
 May reduce risk of colorectal cancer
• Adverse effects
 Nausea, headache, epigastric pain, diarrhoea,
hypersensitivity, pancreatitis
 Caution in renal impairment, pregnancy, breast feeding

47. Glucocorticoids
• Anti inflammatory agents for moderate to
severe relapses.
• Inhibition of inflammatory pathways
• Budesonide- 9mg/dl used for 2-3 months &
then tapered.
• Prednisone-40-60mg/day
• No role in maintainence therapy

48. Antibiotics
• No role in active/quienscent UC
• Metronidazole is effective in active
inflammatory,fistulous & perianal CD.
• Dose-15-20mg/kg/day in 3 divided doses.
• Ciprofloxacin
• Rifaximin

49. Immunosuppresants
• Thiopurines
Azathioprine
6-mercaptopurin
• Methotrexate
• Cyclosporine

50. Cyclosporine
• Preventing clonal expansion of T cell subsets
• Use
Steroid sparing
Active and chronic disease
• Side effects
Tremor, paraesthesiae, malaise, headache, gingival
hyperplasia, hirsutism Major: renal impairment,
infections, neurotoxicity

59. Other medications
Anti- diarrheals - Loperamide (Imodium)
Laxatives - senna, bisacodyl
Pain relievers. acetaminophen (Tylenol).
Iron supplements
 Nutrition

60. Surgery
Ulcerative colitis
Indications:
• Fulminating disease
• Chronic disease with anemia, frequent stools,
urgency & tenesmus
• Steriod dependant disease
• Risk of neoplastic change
• Extraintestinal manifestations
• Severe hemorrhage or stenosis

61. Commonly observed ADR with agents
used to treat IBD
Glucocorticoids
– Hyperglycemia, hypertension, osteoporosis, fluid
retention and electrolyte, disturbances, myopathies,
psychosis, and reduced resistance to infection,
adrenocortical suppression
– Specific regimens for withdrawal of glucocorticoid
therapy have been suggested

62. Commonly observed ADR with agents
used to treat IBD
Immunosuppressants
– Bone marrow suppression, and have been
associated with lymphomas (in renal transplant
patients) and pancreatitis.
Infliximab
– Infusion reactions, serum sickness, sepsis, and
reactivation of latent tuberculosis.

63. Commonly observed ADR with agents
used to treat IBD
Sulfasalazine
– GI disturbances- nausea, vomiting, diarrhea, or
anorexia
– Patients receiving sulfasalazine should receive oral
folic acid supplementation since sulfasalazine inhibits
folic acid absorption

64. References
• http://demystifyingmedicine.od.nih.gov/DM1
2/2012-03-27/2012-03-27-Yao.htm
• http://www.slideshare.net/ParichiBuch/inflam
matory-bowel-disease-10728466
• http://www.medicinenet.com/inflammatory_
bowel_disease_ibd_pictures_slideshow/articl
e.htm