Inflammatory Bowel Disease1
Inflammatory Bowel Disease1
Inflammatory Bowel Disease1
3A
INFLAMMATORY BOWEL
DISEASE
(IBD)
Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo
Hospital Teaching
Internal Medicine, Faculty of Medicine, Hasanuddin
University
Introduction
DEFINITION a chronic
inflammation of the
intestine that is marked by
remission & relapses and
distills clinically into
ulcerative colitis (UC) and
Crohns disease (CD).
Epidemiology
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
Pathogenesis
Modifying enviromental
factors (e.g tobacco, OCPs,
appendectomy)
Mucos
al
immu
ne
respo
ns
Regulatio
n of
immune
response
?
Commen
sal
Microbial
Antigen
Regulatio
n of
barrier &
bacteria?
Genetics
(e.g.
chromosomes
5 and 16)
T
Regulator
y
response
Th1,Th2 or
Th17
mediated
inflammat
ory
response
Tissue
injury
Clinical
symptom
s
General symptoms
Chronic diarrhea
Abdominal pain &
cramping
Blood in stool
Reduced appetite
Weight loss
Fever
Distiguishing Features of UC
& CD
ULCERATIVE COLITIS
CROHNS DISEASE
Bloody stool
No abdominal mass
DIAGNOSIS
Anamnesis :
Physical examination :
Often thin & undernourished,
anemia, tachycardia, low grade
fever, mild-moderate
abdominal tenderness (UC), a
tender mass in RLQ
Toxic megacolon or abscess :
Abdominal distention, rebound
tenderness, absence of bowel
sound & high fever
Extraintestinal manifestation
may be evident : hepatobiliary,
dermatologic, oral, occular,
musculoskeletal, hematologic
Diagnostic studies
Stool examination
Plain abdomen, CT
abdomen, CT
enterography-colonography
COMPLICATIONS
Perforation, abscess,
fistula, obstruction
Anemia, osteoporosis
Life-threatening
hemorrhage (rare)
Toxic megacolon
Colorectal cancer
DIFFERENTIAL DIAGNOSIS
Bacterial colitis
(campylobacter, shigella,
salmonella, E.coli)
Clostridium difficileassociated colitis
Parasitic colitis
(amebiasis)
Ischemic colitis
Radiation colitis
Sexual transmitted
colitis (CMV, herpes)
Crohns disease lookalikes (lymphoma,
yersinia, tuberculosis)
GI malignancy
Irritable Bowel
Syndrome (IBS)
Therapy is sequential to
treat acute disease and
then
to
maintain
remission.
TREATMENT
Prognosis
References
Avunduk C. Inflammatory Bowel Disease. In Manual of Gastroenterology diagnosis & therapy. 4 th Edition.
Lippincott Williams & Willkins. 2009;pp244-263.
Blumberg RS. Inflammatory Bowel Disease : Imunologic considerations. In Current diagnosis & treatment
Gastroenterology, Hepatology & Endoscopy. Ed by Greenberger NJ, Blumberg RS, Burakoff R. Lange McGraw-Hill
companies, 2009,pp11-21.
Burakoff R, Hande S. Inflammatory Bowel Disease : Medical considerations. In Current diagnosis & treatment
Gastroenterology, Hepatology & Endoscopy. Ed by Greenberger NJ, Blumberg RS, Burakoff R. Lange McGraw-Hill
companies. 2009;pp22-33.
Inflammatory Bowel Disease. MIMS Gastroenterology Indonesia. 2 nd Edition. CMP Medica. 2009/2010.
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Pathology . Ed by Klaus Schiller F.R. Cockel R,. Hunt RH. Blackwell Science Ltd, 2002; pp 270-289.
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Adenomatous Polyposis, Clinical Management and Patients Quality of Life. Ed by Delaini GG. Springer-Verlag
Italy. 2006
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