3. Inflammatory bowel disease
It includes a group of chronic disorders that
cause inflammation or ulceration in large and
9. Genetic factors
• Ulcerative colitis is more common in
• Crohn’s disease is more common in
DR5 DQ1 alleles
• 3-20 times higher incidence in first degree
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.
(Infection, NSAID, other)
failure of repair or
• Ulcerative colitis
Usually involves rectum & extends proximally to
involve all or part of colon.
Spread is in continuity.
May be limited colitis( proctitis &
in total colitis there is back wash ileitis (lumpy-
15. Macroscopic features
• Crohn’s disease
Can affect any part of GIT
Segmental with skip lesions
Creeping fat- adhesions & fistula
18. Microscopic features
• Aphthous ulcerations
• Focal crypt abscesses
• Submucosal or subserosal lymphoid
• Transmural with fissure formation
29. IBD Is Not the Same as IBS
• IBD is sometimes confused with irritable bowel syndrome
• 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
• Signs of inflammation in the intestine as well as symptoms
outside of the abdomen are not seen in IBS.
• Varies by agent: may be released in the distal/terminal
ileum, or colon1
Distribution of 5-ASA Preparations
• Reach the upper rectum2,5
(15-20 cm beyond the anal verge)
• 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
May reduce risk of colorectal cancer
• Adverse effects
Nausea, headache, epigastric pain, diarrhoea,
Caution in renal impairment, pregnancy, breast feeding
• Anti inflammatory agents for moderate to
• Inhibition of inflammatory pathways
• Budesonide- 9mg/dl used for 2-3 months &
• No role in maintainence therapy
• No role in active/quienscent UC
• Metronidazole is effective in active
inflammatory,fistulous & perianal CD.
• Dose-15-20mg/kg/day in 3 divided doses.
61. Commonly observed ADR with agents
used to treat IBD
– Hyperglycemia, hypertension, osteoporosis, fluid
retention and electrolyte, disturbances, myopathies,
psychosis, and reduced resistance to infection,
– Specific regimens for withdrawal of glucocorticoid
therapy have been suggested
62. Commonly observed ADR with agents
used to treat IBD
– Bone marrow suppression, and have been
associated with lymphomas (in renal transplant
patients) and pancreatitis.
– Infusion reactions, serum sickness, sepsis, and
reactivation of latent tuberculosis.
63. Commonly observed ADR with agents
used to treat IBD
– GI disturbances- nausea, vomiting, diarrhea, or
– Patients receiving sulfasalazine should receive oral
folic acid supplementation since sulfasalazine inhibits
folic acid absorption