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Inflammatory bowel disease (Crohn disease and ulcerative colitis): Difference between revisions
Inflammatory bowel disease (Crohn disease and ulcerative colitis) (view source)
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'''Inflammatory bowel disease''' (IBD) is an umbrella term for two idiopathic conditions; '''Crohn disease''' (CD) and '''ulcerative colitis''' (UC). Both are chronic diseases of the gastrointestinal tract that involve some inappropriate immune activation of the mucosa. Luckily for medical students the two diseases have different features that can be used to differentiate them | '''Inflammatory bowel disease''' (IBD) is an umbrella term for two idiopathic conditions; '''Crohn disease''' (CD) and '''ulcerative colitis''' (UC). Both are chronic diseases of the gastrointestinal tract that involve some inappropriate immune activation of the mucosa. Luckily for medical students the two diseases have different features that can be used to differentiate them. | ||
IBD is a chronic disease, but it isn’t always active. There are usually periods of active disease with weeks or months of asymptomatic periods between them. The asymptomatic periods are called ''remission'' while the symptomatic periods are called ''flares''. Several factors may provoke a flare-up, like stress, specific types of food, or cigarette smoking. However, most flares occur without an apparent trigger. | IBD is a chronic disease, but it isn’t always active. There are usually periods of active disease with weeks or months of asymptomatic periods between them. The asymptomatic periods are called ''remission'' while the symptomatic periods are called ''flares''. Several factors may provoke a flare-up, like stress, specific types of food, or cigarette smoking. However, most flares occur without an apparent trigger. | ||
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* Family history | * Family history | ||
* Genetic predisposition (NOD2 mutation, HLA-B27 | * Genetic predisposition ([[NOD2]] mutation, [[HLA-B27]]) | ||
* Diet poor in fibre and rich in total fat and animal fat | * Diet poor in fibre and rich in total fat and animal fat | ||
* White or Jewish ethnicity | * White or Jewish ethnicity | ||
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Due to transmural oedema, inflammation, submucosal fibrosis, and hypertrophy of the muscularis propria may strictures (stenosis, narrowing) develop. These strictures can narrow the lumen, causing bowel obstruction. | Due to transmural oedema, inflammation, submucosal fibrosis, and hypertrophy of the muscularis propria may strictures (stenosis, narrowing) develop. These strictures can narrow the lumen, causing bowel obstruction. | ||
Noncaseating granulomas are found in 35% of CD patients. Because the terminal ileum is commonly affected, the absorption of B12 and intrinsic factor can be deficient. Iron deficiency, protein deficiency and generalized nutrient malabsorption may occur. Malabsorption of fatty acids can lead to excess absorption of oxalate, which will be filtered out by the kidney. This increases the risk for calcium oxalate kidney stones. | Noncaseating granulomas are found in 35% of CD patients. Because the terminal ileum is commonly affected, the absorption of [[B12]] and [[intrinsic factor]] can be deficient. Iron deficiency, protein deficiency and generalized nutrient malabsorption may occur. Malabsorption of fatty acids can lead to excess absorption of oxalate, which will be filtered out by the kidney. This increases the risk for calcium oxalate [[Kidney stone|kidney stones]]. | ||
== Clinical features == | == Clinical features == | ||
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== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
Colonoscopy with biopsy is essential. The diagnosis of UC is made in the patient with chronic diarrhoea, colitis on biopsy, and when other causes of diarrhoea have been ruled out. Stool should be tested for bacterial causes of diarrhoea. | [[Colonoscopy]] with biopsy is essential. The diagnosis of UC is made in the patient with chronic diarrhoea, colitis on biopsy, and when other causes of diarrhoea have been ruled out. Stool should be tested for bacterial causes of diarrhoea. | ||
== Treatment == | == Treatment == | ||
Early treatment is necessary to achieve remission and to maintain it, and to prevent complications. Unfortunately, many patients with UC require surgery due to complications in their lifetime. | Early treatment is necessary to achieve remission and to maintain it, and to prevent complications. Unfortunately, many patients with UC require surgery due to complications in their lifetime. | ||
Many drugs are used in the treatment of UC, including 5-ASA, | Many drugs are used in the treatment of UC, including [[5-ASA]], [[corticosteroids]], immunosuppressants ([[azathioprine]], [[6-MP]]), and biological therapies, like [[anti-TNF]]. Choice of treatment depends on the severity. 5-ASA is very effective for UC. Steroids are often used for induction of remission, rather than for maintenance. | ||
UC carries an elevated risk for <abbr>[[Colorectal cancer|CRC]]</abbr>. Patients should undergo regular (every 1 – 3 years) colonoscopy to assess for dysplasia and malignancy. | UC carries an elevated risk for <abbr>[[Colorectal cancer|CRC]]</abbr>. Patients should undergo regular (every 1 – 3 years) colonoscopy to assess for dysplasia and malignancy. | ||
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Total colectomy with end ileostomy is a possible alternative. | Total colectomy with end ileostomy is a possible alternative. | ||
<noinclude>[[Category:Gastroenterology]] | <noinclude>[[Category:Gastroenterology]] | ||
[[Category:Gastrointestinal surgery]]</noinclude> | [[Category:Gastrointestinal surgery]] | ||
</noinclude> | |||