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Inflammatory bowel disease

Overview
  • Chronic inflammation of the gastrointestinal tract.
  • Main types: Crohn’s disease (CD) and Ulcerative colitis (UC).
Aetiology
  • Exact cause unknown but believed to be a combination of genetic, immune, and environmental factors.
  • Smoking increases risk of CD but decreases risk of UC.
Pathophysiology
  • Crohn’s disease: Transmural inflammation, can affect any part of the GI tract from mouth to anus.
  • Ulcerative colitis: Confined to the mucosa, typically affects the rectum and may extend proximally in a continuous manner.
Clinical Features
  • Crohn’s disease: Diarrhoea, abdominal pain, weight loss, mouth ulcers, and complications such as fistulas and abscesses.
  • Ulcerative colitis: Bloody diarrhoea with mucus, rectal urgency, and tenesmus. May also have systemic symptoms like fever and weight loss.
  • Extra-intestinal manifestations: Arthritis, uveitis, erythema nodosum, primary sclerosing cholangitis.
Investigations
  • Colonoscopy with biopsy: Diagnostic procedure of choice.
  • Barium studies: Especially for CD, to visualise small bowel.
  • Stool cultures: To rule out infectious causes.
  • CRP and ESR: Raised in active disease.
  • Full blood count: Anaemia, raised white cell count.
  • Antibodies: p-ANCA (more common in UC), ASCA (more common in CD).
Management
  • 5-aminosalicylic acid compounds (Mesalazine): Anti-inflammatory agents.
  • Corticosteroids: For acute flares.
  • Immunosuppressants: Azathioprine, mercaptopurine.
  • Biologic agents: Infliximab, adalimumab for refractory cases.
  • Surgery: May be needed for complications or refractory disease.
Complications
  • Crohn’s disease: Strictures, fistulas, abscesses, malnutrition.
  • Ulcerative colitis: Toxic megacolon, colon cancer risk increased after 10 years.
  • Both types: Osteoporosis, anaemia, growth retardation in children.

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