Join us for a lecture on inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Roger S. Klein, MD, FACP, will highlight the latest in diagnostic technologies and treatment approaches for IBD. He also will discuss the importance of comprehensive care to help prevent IBD-associated health problems.
2. Definition
• Chronic immune mediated inflammation
of the gastrointestinal tract
• Two distinct diseases
• Overlapping clinical characteristics
• Affects 1.4 million people in the United
States
3. Ulcerative Colitis
• Inflammation of inner lining of Colon
• Does not involve small intestine
• Begins in rectum and extends upward
• Continuous disease
5. Crohn’s Disease
• Full thickness inflammation of bowel
wall
• Involves anywhere from mouth to anus
• Most commonly involves Ileum and
colon
• Skip areas of involvement
• Complicated by strictures and fistulae
11. Epidemiology
• UC 238/100,000
• CD 201/100,000
• Lower incidence in Asia and Middle East
• Mostly presents age 15-40
• Second peak age 60-80
• No difference between sexes
• More common in people of Jewish descent
12. Risk Factors
• Genetics
10-25% have a relative with IBD
• Smoking and CD
• NSAID and aspirin
• Possible western diet
• Unknown environmental trigger
13. Genetic Risk
• Genetics contribute to susceptibility
• First degree relatives are at 3-20 X risk
• Children of 2 parents with IBD 33% risk
• Up to 160 genes involved
14. UC Presentation
• Gradual onset over weeks
• Diarrhea often bloody
• Abdominal cramping
• Tenesmus
• Extra intestinal manifestations
Arthritis
Skin/Eyes
Liver
15. CD Presentation
• Often presents with chronic symptoms
• Abdominal cramping
• Intermittent diarrhea
• Obstruction
• Abscess/fistulae
• Weight loss/anemia/fatigue/fevers
16. Evaluation
• History and physical
• Stool studies to exclude infection
• Colonoscopy to ileum with biopsies
• Labs
Anemia
Markers of inflammation
pANCA, ASCA
• Enterography/capsule endoscopy
17. Treatment
• One size does not fit all
• Mesalamine
• Antibiotics
• Steroids
• Immunomodulators
• Biologic/ Anti-TNF
• Surgery
18. Mesalamine
• First line therapy acts topically
• Oral “Packaged” to release in different
areas
• Rectal
Suppository
Enema
• Safe even in pregnancy
• Not effective in small bowel Crohn’s
19. Antibiotics
• Ciprofloxacin and Metronidazole
• Effective in Crohn’s
• No role in UC
• Issues with tolerance
• May lead to resistant bacteria
20. Steroids
• Can be given oral, rectal, or IV
• Very effective short term
• Not a maintenance drug
• Need a plan when starting
• Many serious side effects
Diabetes
Osteoporosis
21. Immunomodulators
• Azathioprine and 6-MP
• Target immune response
• Effective in both Crohn’s and UC
• Can take up to 3 months to work
• Need labs monitored regularly
• Not always tolerated
• May increase risk of certain cancers
22. Biologics
• Act by interfering with TNF
• Given by IV or injection
• Very effective
• Work quickly
• Used for moderate/severe UC
• May alter natural history if used early in
CD
25. Surgery-CD
• 50% of patients will have at least one
• Abcess/fistulae
• Stricture/obstruction
• Refractory disease
• Not curative so limit resection
• Often recurs at anastamosis
• Need post-op plan
26. Long Term Issues
• Cancer
skin, cervical, lymphoma
• Osteoporosis
• Colon cancer
27. Colon Cancer and IBD
• Equal risk for UC and CD with colitis
• Depends on extent of colitis and
duration
• Risk increases after 8-10 years
• Need to screen for flat lesions
• 2.5% risk after 20 years
• 7.6% risk after 30 years
28. Take Home Message
• UC and CD are chronic inflammatory
diseases
• No cure but treatments are effective
• Remission is attainable
• Newer drugs are on the way
• No increased mortality
• Majority of patient lead normal lives
Notes de l'éditeur
Involves mucosa, does not extend to deeper layers of colon
University of Rochester Medical Center
Essentials of Human Physiology by Ginsburg, JM and Costoff, A
Healthfavo.com
Johns Hopkins Medical Center
Western diet-processed food, fried food , sugar
Skin-Erythema nodosum, pyoderma Arthritis- large joint and ankylosing spondylitis Liver- sclerosing cholangitis
Colonoscopy-continuous disease from rectum
Inflammatory markers sed rate and CRP, stool calprotectin
Anti-sacchromyces cervissiae, Anti-OmpC
Treatment needs to be individualized based on extent of disease, severity and initial response
Intolerance-metallic taste, parasthesias
Intolerance due to nausea, pancreatitis, hepatitis
Risk of lymphoma, skin cancer, cervical cancer due to HPV