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Inflammatory bowel disease

Background Knowledge 🧠

Overview

  • Chronic inflammation of the gastrointestinal tract.
  • Main types: Crohn’s disease (CD) and Ulcerative colitis (UC).

Pathophysiology

  • Crohn’s disease: TransmuralΒ inflammation, can affect any part of the GI tract from mouth to anus.
  • Ulcerative colitis: Confined to the mucosa,Β typically affects the rectum and may extend proximally in a continuous manner.

Aetiology

  • Exact cause is unknown but believed to be a combination of genetic, immune, and environmental factors.
  • Smoking increases risk of CD but decreases risk of UC.

Clinical Features πŸŒ‘️

Symptoms

  • 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 πŸ§ͺ

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 πŸ₯Ό

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 increases after 10 years.
  • Both types: Osteoporosis, anaemia, growth retardation in children.

Key Points

  • IBD is often classified as either Crohn’s disease (CD) and Ulcerative colitis (UC).
  • Early diagnosis and management is crucial to prevent recurrent flares and complications such as colorectal cancer in UC.
  • CD can affect any part of the GI tract, whereas UC is confined to the mucosa.
  • Presentation of CD is dependent on location (diarrhoea, abdominal pain, weight loss); UC often presents with bloody diarrhoea with mucus.
  • Colonoscopy with biopsy is the diagnostic procedure of choice.
  • Management is dependent on the type and severity of disease (mesalazine, immunosuppressants, biologic agents and possibly surgery), with corticosteroids used for acute flares.

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