ibd

1. DR K.S. LIKHAR

3. Inflammatory bowel disease
It includes a group of chronic disorders that cause
inflammation or ulceration in large and small
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
(Infection, NSAID, other)
Complete Healing
Chronic Inflammation
Genetically
Susceptible
Host
Acute Inflammation
↓ Immunoregulation,
failure of repair or
bacterial clearance
Tolerance
Acute Injury
Environmental
trigger

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

37. Microscopy-