- Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis, both characterized by chronic inflammation of the gastrointestinal tract. The causes are not fully understood but involve immune dysfunction and genetic factors. - Crohn's disease can affect any part of the GI tract and cause transmural inflammation and complications like strictures and fistulas. Ulcerative colitis primarily involves only the inner mucosal layer of the colon and rectum. - Treatment depends on disease severity and includes medications to induce and maintain remission as well as surgery for complications. The goals are to control symptoms, improve quality of life, and prevent disease progression.

1. Inflammatory Bowel Disease Dr. Mohammad Shaikhani CABM,FRCP. 2/2010

16. UC

17. Distinguishing characteristics of CD and UC UC CD Feature Only colon (rarely “ backwash ileitis ” SB or colon Location Continuous, begins distally Skip lesions Anatomic distribution Involved in >90% Rectal spare Rectal involvement Universal Only 25% Gross bleeding Rare 75% Peri-anal disease No Yes Fistulization No 50-75% Granulomas

18. Endoscopic features of CD and UC UC CD Feature Continuous Discontinuous Mucosal involvement Rare Common Aphthous ulcers Abnormal Relatively normal Surrounding mucosa Rare Common Longitudinal ulcer No In severe cases Cobble stoning Common Uncommon Mucosal friability distorted Normal Vascular pattern

19. Pathologic features of CD and UC UC CD Feature Uncommon Yes Transmural inflammation No 50-75% Granulomas Rare Common Fissures No Common Fibrosis Uncommon Common Submucosal inflammation

20. Radiologic features of CD and UC UC CD Feature Collar button ulcers Nodularity granularity cobble stoning string sign of SB

21. Comparison of Features in Ulcerative Colitis and Crohn's Disease Crohn's Disease Ulcerative Colitis Feature Transmural Mucosal Depth of inflammation Skip areas Contiguous Pattern of disease Mouth to anus Colorectum Location Less common Usual Rectal involvement Common Backwash ileitis (15%–20% of patients ) Ileal disease Common Rare Fistulas Common Rare Perianal disease 10%–30% of patients Unlikely Granulomas Less common Usual Overt bleeding More common Unlikely Malnutrition Colorectal cancer, small bowel cancer (depending on disease location ) Colorectal cancer, cholangiocarcinoma (if primary sclerosing cholangitis is present ) Cancer risk Harmful Protective Tobacco use

22. UC

23. CD

46. Complications of IBD

47. Standard Diagnostic Evaluation for Suspected IBD: Colonoscopy with intubation of the terminal ileum& biopsies of the involved mucosa Stool analysis for ova / parasites & Clostridium difficile toxin plus stool culture Barium radiographs of small bowel, CT enterography&/or capsule endoscopy if Crohn's disease is suspected Plain abd radiographs if bowel obstruction, toxic megacolon, or perforation is suspected Abdominopelvic CT scan if abscess or fistula is suspected

72. Infliximab - mucosal healing Baseline Week 10 Week 54 Rutgeerts et al. DDW 2002: [abstract] W1367.