INFLAMMATORY BOWEL DISEASE (IBD) “Upper & Lower GI Diseases” Lecture of Gastroentero-Hepatology System, FKUH Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo Hospital Teaching Internal Medicine, Faculty of Medicine, Hasanuddin University Level of competent : 3A
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INFLAMMATORY BOWEL DISEASE(IBD)
“Upper & Lower GI Diseases” Lecture of Gastroentero-Hepatology System, FKUH
Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo Hospital TeachingInternal Medicine, Faculty of Medicine, Hasanuddin University
Level of competent : 3A
Introduction DEFINITION a chronic
inflammation of the intestine that is marked by remission & relapses and distills clinically into ulcerative colitis (UC) and Crohn’s disease (CD).
CD, initially described in 1932 by Drs Burrill Crohn, Gordon Oppenheimer, and Leon Ginzburg, is an idiopathic transmural chronic inflammatory disorder affecting any part of the gastrointestinal tract.
UC, have been described by Drs Wilks and Moxon in 1875; is a diffuse mucosal inflammation limited to the colon.
EpidemiologyCrohn’s disease (CD) : Incidence rates were
generally lower and were broadly similar for men and women, with rates for both sexes declining with increasing age
Ulcerative colitis (UC) : Incidence rates for men
remaining fairly constant with increasing age, whereas for women decreased.
Typicallypresent at a relative young age, often in adolescence
The median age of diagnosis CD and UC is the third and fourth decade of life, respectively
Female predominance in CD and male predominance in UC
Pathogenesis Three major contributory
factors: genetic susceptibility, environmental triggers, and immune activation
Dysregulated mucosal immune respone to antigenic components of the normal commensal microbiota that reside within the intestine in a genetically susceptible host
Dependent on several distinct factors : disease location (eg, ileocecal vs colonic or proctitis vs pancolitis), severity (mild, moderate, or severe), and complications.
Should be individualized based on the patient’s prior symptomatic response and tolerance to specific medical therapies.
Therapy is sequential to treat acute disease and then to maintain remission.
TREATMENT Diet and nutrition Drugs :
5-Aminosalicylates : sulfasalazine 1-4g/day twice daily, mesalamine 2-4g/day 3-4times daily, olsalazine 1-3g/day twice daily Steroids oral-iv in CD : budesonide 9mg/d, prednisone/ methylprednisolone 40-60mg/d Antibiotics : ciprofloxacin 500mg twice daily, metronidazole 1-1.5g/d (in CD with perianal disease)Immunomodulators : azatioprine2-2.5mg/kg/d or mercaptopurine 1-1.5mg/kg/d, methotrexate 15-25mg im once daily (inchronic active & steroid dependent)Anti-Tumor Necrosis Factor (TNF) : Infliximab 5mg/kg at week 0,2,6
Surgery : due to complication
Prognosis
75% have to surgery 25% can managed
using medical therapy (UC)
Risk for CRC 8-10 years later
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