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Inflamatory Bowel Disease
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Inflammatory Bowel Disease
Fernando Vega, M.D.
The Spectrum of IBD
Epidemiology
• CD and UC together 1:400
• UC Prevalence 1:500 • UC Incidence 6-12K/annum• CD Prevalence 1:1000• CD Incidence 3-6K/annum
• Fistula• 30% Granulomata• Surgery not curative• Smokers worse off
• No fistula• No granulomata• Cured by colectomy• Smokers ?better off
Inflamatory Bowel Disease
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Blood tests
• Anaemia• Iron , B12 or folate deficiency• ESR/CRP• ESR/CRP
Endoscopy
UC or CD?
Differential Diagnosis: Endoscopic Appearance
UC CDInvolvement of rectum Rectum often sparedDiffuse erythema Asymmetric inflammationContinuous inflammation Discontinuous inflammationMucosal granularity Aphthous ulcerationMucosal friability Linear/serpiginous ulcersUlceration in inflamed mucosa Discrete ulcersPseudopolyps Cobblestoning
Fistulae
Salena BJ, Hunt RH. In: Inflamatory Bowel Disease. From Bench to Bedside. 1994:352-365.
UC: Location and Extent
Percentages based on extent of disease at diagnosis.
Inflamatory Bowel Disease
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Differential Diagnosis: Colonoscopic Biopsy
UC CDAll samples inflamed Normal samples
Distal biopsy specimens most severe No pattern of inflammation
Mucosal disease Transmural disease
Geller SA. In: Inflammatory Bowel Disease. From Bench to Bedside. 1994:336-351.
Goblet cells reduced Goblet cells may be normal
Crypt abscess Mononuclear infiltrate
Capillary and venule engorgement Lymphangiectasia
No granulation tissue/fibrosis Granulation tissue/fibrosis
No granulomata Granulomata
CD or UC?
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• Pancolitis –colonoscope at 8 years post diagnosisEvery 3 years in 2nd decadeEvery 3 years in 2nd decade Every 2 years in 3rd decade and then annually.
Left sided colitis –Colonoscope at 15 years post diagnosis
Inflamatory Bowel Disease
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Differential Diagnosis of UC• Infection• Ischemia• Diversion,
pseudomembranous, or radiation colitisradiation colitis
DrugTreatment of UC• Aminosalicylates (PO/PR)• Mesalazine, also known as 5-aminosalicylic acid, 5-ASA, Asacol, Pentasa and Mesalamine. • Sulphasalazine• Balsalazide, also known as Colazal. • Olsalazine, also known as Dipentum.
• Immunosuppressive drugs • 6-mercaptopurine, also known as 6-MP• Azathioprine, also known as Imuran (US) which metabolises to 6-MP. • Cyclosporin• Infliximab
Drug treatment of CD• Aminosalicylates • Mesalazine, also known as 5-aminosalicylic acid, 5-ASA, Asacol, Pentasa and
Mesalamine. • Sulphasalazine
• Antibiotics• Antibiotics• Metronidazole
• Corticosteroids • prednisolone• hydrocortisone
• Immunosuppressive drugs • 6-mercaptopurine, also known as 6-MP• Azathioprine, also known as Imuran (US) which metabolises to 6-MP. • Methotrexate• Infliximab