IBD

Question 1

What is IBD? Epidemiology?

Answer 1

It is a group of different condition involving a part or the whole bowel tract in an inflammatory process. Etiology is unknown but the processes involved can be : infective, ulcerative colitis, Crohn’s disease, radiation enteritis, microscopic colitis.

Possible bimodal distribution. Etiopathogenesis involves immunological factors, microbial factors, psychosocial factors and genetic factors.

Question 2

Ulcerative colitis?

Answer 2

Targets the colon and rectum in different locations like sigmoid rectum, splenic flexure (most common) and entire colon and rectum (panulcerative colitis 25% of cases).

Macroscopically it can vary from mild, moderate or severe to long standing and fulminant.
Microscopically landmarks include crypts, atrophy and irregularities, superficial erosion, inflammation.

Clinical manifestation include diarrhea, rectal bleeding, passage of mucus and abdominal cramps.

Question 3

Chrons disease?

Answer 3

Most commonly affects the ileocecal region (40%).
CD is a transmural process and it is segmental.

Microscopic features include apthous ulcers, crypt abscesses, granulomas, transmural fissure formation.

Clinical manifestations include colitis and perianal disease, bloody diarrhea, lethargy, weight loss.

Question 4

UC vs CD? Extraintestinal manifestations?

Answer 4

Fever, abdominal tenderness, abdominal mass, weight loss is common only in CD.
Tenesmus and rectal bleeding are more common in UC.

They both can present with extraintestinal symptoms like erythema nodosum, ankylosing spondylitis, uveitis, gallstones and nephrolithiasis.

Question 5

IBD diagnosis?

Answer 5

Lab test —> often not useful.

Endoscopy —> useful for initial diagnosis, assessment of severity. Can classify diseases based on mayo endoscopic subscore. UC presents continuous disease while CD shows rectal sparing, occasional continuous disease, cobblestoning and granulomas.

Radiography —> CT enterography, MRI, small bowel US.

Biopsy —> still very difficult to reach diagnosis. During colonoscopy 33 biopsies are taken to analyze each part of the bowel.

Question 6

Therapy for IBD?

Answer 6

Medical therapy is based on anti inflammatory drugs like local and systemic steroids and immunosuppressants like aziathoprine, anti TNF.

Surgery in UC : indicated in cases that do not resolve with medical therapy or in cases with carcinoma or high grade dysplasia.
Surgical options include total colectomy, total proctocolectomy with ileostomy, restorative proctocolectomy with ileal pouch (50% of patients develop significant complications including pouchitis).

Surgery in CD : surgery is not curative in CD, both medical and surgical therapy are palliative. Medications and therapy depends on the type of CD according to the Vienna classification (inflammatory, structurizing, fistulizing).