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Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

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Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease. 浙江大学医学院附属邵逸夫医院 曹 倩. 学习目标. 掌握 IBD 的发病机制 掌握 IBD 临床表现和治疗 掌握溃疡性结肠炎和克罗恩 病的鉴别. 炎症性肠病 Inflammatory Bowel Disease (IBD). chronic, relapsing, immunologically-mediated inflammatory condition of the GI tract - PowerPoint PPT Presentation

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Page 1: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Inflammatory Bowel Disease:Ulcerative Colitis & Crohn’s

Disease

浙江大学医学院附属邵逸夫医院曹 倩

Page 2: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

学习目标

•掌握 IBD 的发病机制

• 掌握 IBD 临床表现和治疗

• 掌握溃疡性结肠炎和克罗恩 病的鉴别

Page 3: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

炎症性肠病Inflammatory Bowel Disease

(IBD)• chronic, relapsing, immunologically-mediated

inflammatory condition of the GI tract• Presentation varies widely• Characterized by exacerbations & remissions• Affects males and females equally

Page 4: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Ulcerative Colitis Crohn’s Disease

Limited to colon+rectumContinuous

mucosal

“Mouth to anus”TransmuralSkip lesionsgranulomasIndeterminate Colitis

5-10%

Spectrum of Disease

IBD1 IBD2 IBD3 IBD4

SevereDisease

MildDisease

Page 5: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Inflammatory Bowel Disease (IBD)

Page 6: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease
Page 7: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Etiologic Theories in Inflammatory Bowel Disease

Mucosal Immune Mucosal Immune SystemSystem

(Immuno-regulatory (Immuno-regulatory Defect)Defect)

Environmental Environmental TriggersTriggers

(Lumenal Bacteria, (Lumenal Bacteria, Infection)Infection)

Genetic Genetic PredispositionPredisposition IBD

Page 8: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease
Page 9: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease
Page 10: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

炎症性肠病是怎么发生的?

Page 11: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Key Differences Between UC and Crohn’s

UC

ColorectalMucosal

continuous

Crohn’s

Mouth to anusTransmuralSkip areas

granulomas

Page 12: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease
Page 13: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

UC Extraintestinal Manifestations

Page 14: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Clinical Presentation: CD

• Patchy, transmural inflammation• Affects any part of the GI tract• Can have skip lesions• Stricturing

– Obstructions

• Fistulizing– Entero-enteric, entero-vesical, anal

• Hemorrhage is less common than UC

Page 15: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease
Page 16: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

CD DiagnosisColonoscopy

• Serpiginous ulcers

• “Cobblestoning”

• Skip areas

Biopsy

• Transmural inflammatory infiltrate

• Noncaseating granulomas

Page 17: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Medical Treatment of IBD

5-ASA medications-blocks production of PG and LT, inhibits bacterial

peptide-induced neutrophil chemotaxis, scavengesreactive oxygen metabolites, inhibits NF-kB

6-MP / azathioprine-suppresses T cell function

Steroids

Infliximab- binds soluble TNF, may lead to monocyte apoptosis

Cyclosporine- Inhibits lymphocyte activation

Page 18: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Treating severe CD (and UC)

• Infliximab (Remicade)– Chimeric anti-TNF monoclonal Ab– Strong anti-inflammatory effect– Effective in both active and fistulizing CD– Needs repeated infusions

Remission: 39-45% at 30 weeks*Fistula closure: initial response 69%

complete response at 12 mths: 36%**

*ACCENT-1, **ACCENT-2

Page 19: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Ileal pouch – anal anastomosis(IPAA)

Page 20: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Surgery for CDGeneral Guidelines

Indications:

• Failure of medical therapy

• Complications

• Suspicious for CA

• Surgery is not curative

• Repeated operations may be necessary

• Principle: Bowel conservation

Page 21: Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Summary

• IBD is a chronic inflammatory condition

of the GI tract with unclear etiology and

no known cure

• A spectrum of disease

• Requires multidisciplinary approach