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Internal Medicine

Inflammatory bowel disease (IBD)

Inflammatory bowel disease (IBD) is a term for two conditions (Crohn’s disease and ulcerative colitis) that are characterized by chronic inflammation of the gastrointestinal (GI) tract.


Pathophysiology

Mucosal barrier in Crohn’s disease, and in ulcerative colitis
Mucosal barrier in Crohn’s disease, and in ulcerative colitis. | Stange E. (ed.): Entzündliche Darmerkrankungen, Stuttgart: Schattauer 2015; 26, 27, with the kind permisison of Schattauer Verlag.
Differential diagnosis of UC & Crohn's disease
Differential diagnosis of UC & Crohn’s disease | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072

Presentation

Crohn’s disease (CD):

Transmural inflammatory disease of the mucosa with episodic progression.
IBD: Crohns disease
The Calgary Guide | http://calgaryguide.ucalgary.ca/

Ulcerative colitis (UC):

Nontransmural inflammatory disease with episodic progression that is restricted to the colon.
IBD: Ulcerative colitis
The Calgary Guide | http://calgaryguide.ucalgary.ca/

Extraintestinal manifestations:

Common extra-intestinal manifestations & associated autoimmune disesases
Common extra-intestinal manifestations & associated autoimmune disesases | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072

Diagnosis

Basic diagnostic evaluation for patients with suspected ulcerative colitis or Crohn's disease
Basic diagnostic evaluation for patients with suspected ulcerative colitis or Crohn’s disease | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072

Full ileocolonoscopy with biopsies

M/C, GOLD STANDARD
Typical endoscopic and tomographic findings in chronic inflammatory bowel disease
Typical endoscopic and tomographic findings in chronic inflammatory bowel disease: (a) Mild ulcerative colitis: edema and erythema, with broken light reflexes from the granulated colonic mucosa. (b) Terminal ileitis in Crohn’s disease: partly aphthous (8 o’clock), partly confluent ulcerations (2 and 4 o’clock) of the small bowel mucosa. (c) Contrast-enhanced computerized tomography (CT): massively dilated cecum with coprostasis and thickening of the wall of the ascending and transverse colon with loss of haustration in an acute, severe relapse of longstanding ulcerative colitis (kindly provided by PD Dr. C. Schraml, Department of Diagnostic and Interventional Radiology [Director, Prof. Dr. K. Nikolaou], Universitätsklinikum Tübingen). (d) Contrast-enhanced magnetic resonance enteroclysis: Crohn’s disease, mixed inflammatory and fibrotic-stenotic changes in the terminal ileum (acknowledgement as above). | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072

Management

Treatment pyramid for ulcerative colitis (UC) and Crohn disease (CD)
Treatment pyramid for ulcerative colitis (UC) and Crohn disease (CD) in children. TPN=total parenteral nutrition, TNF-α=tumor necrosis factor-alpha, 6-MP=6-mercaptopurine, 5-ASA=5-aminosalicylates, IV=intravenous | Glick, S. R. and Carvalho, R. S. (2010) ‘Inflammatory Bowel Disease’, Pediatrics in Review, 32(1), p. 14 LP-25. Available at: http://pedsinreview.aappublications.org/content/32/1/14.abstract.

Medical management:

Surgical management:

  • Ileal Pouch Anal Anastomosis (IPAA) or J-pouch
    • Mainly curative for Ulcerative Colitis
  • Bowel resection

Summary

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