Inflammatory bowel disease
Dr Wrishi Raphael
Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohns disease.
Both usually involve severe diarrhea, pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications. Why it happens is still poorly understood, however several authorities agree that there is a sustained response of the immune system, perhaps to enteric flora in a genetically predisposed
individual. The current hypothesis is that there is a lack of appropriate down-regulation of immune responsiveness.
Genetics:
There is increased risk of both ulcerative colitis and Crohns disease in relatives of patients with either
disease, especially siblings, especially early onset disease.
The familial risk is greater if proband (a person serving as the starting point for the genetic study of a family) has Crohns rather than ulcerative colitis.
Certain genetic mutations like CARD15/NOD2 are associated with Crohns disease
Chrons disease is a chronic inflammatory disease of the intestines, especially the colon and ileum, associated with ulcers and fistulae.
Clinical features
The natural history of the disease is unpredictable and it most often presents as recurrent episodes of abdominal cramps, diarrhoea and weight loss. The most common location is ileum and ascending colon.
Ileitis may present with post-prandial pain, vomiting, mass in right lower abdomen and mimics acute appendicitis. Fistulae, fissures, abscesses are common and extra-intestinal manifestations are more common with colonic involvement. Linear ulcers lead to mucosal islands and cobblestone appearance
With an increased risk of perforation into contiguous viscera (leads to fistulae and abscesses).
Investigations
Colonoscopy with biopsy is the first choice of investigation (less often gastroscopy).CT enterography to visualize small bowel. CRP is elevated in most new cases and is useful to monitor treatment response
bacterial cultures.
Management
Smoking cessation
diet
Fluids only during acute exacerbation
Those with extensive small bowel involvement or extensive resection require electrolyte,
mineral and vitamin supplements
The following drugs are effective in symptom management; loperamide, diphenoxylate, codeine
as they all work by decreasing small bowel motility.
Caution if colitis is severe (risk of precipitating toxic megacolon).
Ulcerative colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum.
Clinical features
Chronic disease is most frequently characterized by diarrhea and rectal bleeding but can also have a
bdominal cramps/pain, especially with defecation.
Severity of colonic inflammation correlates with symptoms (stool
volume, amount of blood in stool). Tenesmus, urgency, incontinence may also be present.
Systemic symptoms like fever, anorexia, weight loss, fatigue in severe cases with extra-intestinal manifestations are present with characteristic exacerbations and remissions; 5% of cases are fulminant.
Investigations
Sigmoidoscopy with mucosal biopsy (to exclude self-limited colitis) without bowel prep is often sufficient for diagnosis
Colonoscopy is helpful to determine extent of disease; contraindicated in severe exacerbation
CT colonography (formerly barium enema) if colonoscopy cannot be done; contraindicated in severe disease
Stool culture, microscopy, C. difficile toxin assay is necessary to exclude infection however there is no single confirmatory test.
Management
Mainstays of treatment is corticosteroids, with azathioprine used in steroid-dependent or resistant cases. Changes in diet are of little value in decreasing inflammation but may not alleviate symptoms.n (Reprint)
