INFLAMMATORY BOWEL DISEASE Dr Omar Mansour Consultant Colorectal

INFLAMMATORY BOWEL DISEASE Dr Omar Mansour Consultant Colorectal & Laparoscopic General Surgeon Assistant Professor of General Surgery Al-Balqa Applied University FRCSI FEBC MSc MRCSI

What IS IBD? � � Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine. Crohn's disease and ulcerative colitis are the principal types of inflammatory bowel disease. Crohn's disease affects the small intestine and large intestine, as well as the mouth, esophagus, stomach and the anus, whereas ulcerative colitis primarily affects the colon and the rectum

Demographics � � � Differential diagnosis Gastroenteritis, irritable bowel syndrome, celiac disease Frequency 11. 2 millions worldwide (2015)[1] Deaths 47, 400 worldwide (2015)[2]

Risk Factors � � � Diet Microbial Genetics �

Classification � � � � The chief types of inflammatory bowel disease are Crohn's disease and ulcerative colitis (UC). Inflammatory bowel diseases fall into the class of autoimmune diseases, in which the body's own immune system attacks elements of the digestive system. [33] Accounting for fewer cases are other forms of IBD, which are not always classified as typical IBD: Microscopic colitis subdivided into collagenous colitis and lymphocytic colitis Diversion colitis Behçet's disease Indeterminate colitis

How to Diagnose IBD

How to Diagnose IBD Histroy Exam Labs Radiology Endoscopy

Colonoscopy Video

What is this?

Erythema Nodosum

Pyoderma gangrenosum � � � is a condition that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs. When they occur, they can lead to chronic wounds. Ulcers usually initially look like small bug bites or papules, and they progress to larger ulcers. Though the wounds rarely lead to death, they can cause pain and scarring.

Treatment of IBD

Crohn’s � The disease was identified in 1930. It affects approximately 1 person in 100, 000 in the population. Though it can affect people of any age, it mostly affects people in their 40 s and 50 s. [1]

� � Aminosalicylates represent first-line therapy for mild-to-moderate CD. These 5 -aminosalicylic acid (5 -ASA) compounds act on epithelial cells, moderating the release of lipid mediators, cytokines, and reactive oxygen species. 19 Examples include sulfasalazine, mesalamine, olsalazine, and balsalazide. Studies of sulfasalazine 3 g to 5 g/day demonstrated an elevated rate of remission (40%-50%) at 16 weeks. 2

� � 1 Sulfasalazine contains a sulfa moiety that is responsible for most allergic reactions (e. g. , Stevens-Johnson syndrome). Adverse effects include anorexia, headache, nausea, GI distress, and oligospermia. Other possible reactions include pancreatitis, agranulocytosis, and alveolitis. 8 Mesalamine, a newer 5 -ASA compound, does not contain a sulfa moiety and causes fewer allergic reactions

Biological Treatment � � Infliximab: Infliximab, a chimeric mouse/human m. Ab, was FDA-approved in 2003 for reducing signs and symptoms and maintaining remission in moderateto-severe CD. It also is useful in the treatment of fistulizing CD. Infliximab neutralizes the biological activity of TNFalpha by binding to the cytokine and preventing it from binding to its receptors. Infliximab is immunogenic and may be associated with infusion reactions and decreased efficacy