Inflammatory

Bowel
Disease

By
Tutorial 8

LEARNING OBJECTIVE
DEFINISI,

PATOGENESIS,
MANIFESTASI KLINIS:
ULCERATIVE COLITIS
CROHNS DIEASES

PENATALAKSANAAN

IDIOPATIK
M.O. PATOGEN
LINGKUNGAN
GENETIK

DIARE DAN
PENDARAHAN

PENURUNAN
IMUNITAS

ROS/ STRESS
OKSIDASI
NYERI PERUT

ELEKTROLIT
TIDAK SEIMBANG

OSTEOPOROSIS

INFLAMASI
ULSERATIF RM

NYERI TMJ

RESORBSI
TULANG
PENATALAKSANAAN KG

TYPES
Crohns disease

Ulcerative colitis

Extends into the deeper layers

of the intestinal wall, and may

affect the mouth, esophagus,
stomach, and small intestine.
Transmural inflammation
and skip lesions.
In 50% cases -ileocolic,30%
ileal and 20% -colic region.

Regional enteritis

causes ulceration and inflammation of

the inner lining of the colon and rectum.

It is usually in the form of characteristic
ulcers or open sores.

Etiopathogenesis
Exact cause is unknown.
Genetic factors
Immunological factors
Microbial factors
Psychosocial factors
Dietary factor

Ulcerative colitis

Introduction
Ulcerative colitis (UC) is a chronic disease of unknown etiology
characterized by inflammation of the mucosa and submucosa of
the large intestine.
The inflammation usually involves the rectum down to the anal
margin and extends proximally in the colon for a variable
distance.
There is no difference between men and women.
The worldwide incidence is 0.5~24 new cases per 100 000
individuals, and prevalence is 100~200 cases per 100 000.

UC: is a form of (IBD). It is a form of colitis, of that includes

characteristic ulcers, or open sores, in the colon.
The main symptom of active disease is usually diarrhea mixed
with blood, of gradual onset.
UC is, however, a systemic disease that affects many parts of
the body outside the intestine. Because of the name, IBD is
often confused with irritable bowel syndrome ("IBS"), a
troublesome, but much less serious condition.

Clinical manifestations
The five most common symptoms of UC are rectal bleeding,
diarrhea, abdominal pain, weight loss, and fever.
The clinical presentation of UC depends on the extent of the
disease process. Patients usually present with diarrhea mixed
with blood and mucus, of gradual onset.
They also may have signs of weight loss, and blood on rectal
examination.
The disease is usually accompanied with different degrees of
abdominal pain, from mild discomfort to severely painful cramps.

Extent of involvement
UC is normally continuous from the rectum up the colon. The
disease is classified by the extent of involvement, depending
on how far up the colon the disease extends:
Distal colitis, potentially treatable with enemas:
Proctitis:
Involvement limited to the rectum.
Proctosigmoiditis:
Involvement of the rectosigmoid colon, the portion of the colon
adjacent to the rectum.
Left-sided colitis:
Involvement of the descending colon, which runs along the
patient's left side, up to the splenic flexure and the beginning of
the transverse colon.

Pancolitis: Involvement of the entire colon, extending from the

rectum to the cecum, beyond which the small intestine begins.

Extraintestinal features
As UC is a systemic disease, patients may present with
symptoms and complications outside the colon. These include
the following:
aphthous ulcers of the mouth .
Ophthalmic .
Iritis or uveit.
Episcleritis.

Patients with ulcerative colitis can occasionally have

aphthous ulcers involving the tongue, lips, palate and
pharynx

CROHNs DISEASE

What is Crohns?
inflammatory disease of the intestines

that may affect any part of

thegastrointestinal
tractfrommouthtoanus

Symptoms
abdominal pain
diarrhea(which may be bloody)
vomiting
weight loss
skin rashes
arthritis
inflammation of the eye

Comparisons of various factors in Crohn's disease and ulcerative

colitis
Crohn's Disease

Ulcerative Colitis

Involves terminal ileum

Commonly

Seldom

Involves colon?
Involves rectum?

Usually
Seldom

Always
Usually

Peri-anal involvement

Commonl

Seldom

Bile duct involvement?

Not associated

Higher rate of Primary

sclerosing cholangitis

Distribution of Disease

Patchy areas of
inflammation

Continuous area of
inflammation

Endoscopy

Linear and serpiginous

(snake-like) ulcers

Continuous ulcer

Depth of inflammation

May be transmural, deep

into tissues

Shallow, mucosal

Comparisons of various factors in Crohn's disease and UC (Cont.)

Fistulae, abnormal
passageways between
organs

Commonly

Seldom

Biopsy

Can have granulomata

Crypt abscesses and

cryptitis

Surgical cure ?

Often returns following

removal of affected
part

Smoking

Usually cured by
removal of colon, can
be followed by
po uchitis
Higher risk for smokers Lower risk for smokers

Autoimmune disease

Generally regarded as
an autoimmune
disease

No consensus

Cancer risk?

Lower than ulcerative

colitis

Higher than Crohn's

Treatment

Diet change

Lifestyle changes

Surgery
Drugs

Lifestyle changes

Taking rest

Doing exercise

No smoking

Stress reduction

Drugs

5-ASA agents
Glucocorticoids
Antibiotics
Immunosuppresants
Biological therapy

5-ASA Agents
Sulfasalazine (5aminosalicylic acid and
sulfapyridine as carrier
substance)
Mesalazine (5-ASA), e.g.
Asacol, Pentasa
Balsalazide (prodrug of 5ASA)
Olsalazine (5-ASA dimer
cleaves
in colon)

Use
In mild to moderate UC & crohns colitis
Maintaining remission
May reduce risk of colorectal cancer
Adverse effects
Nausea, headache, epigastric pain, diarrhoea,
hypersensitivity, pancreatitis
Caution in renal impairment, pregnancy, breast
feeding

Glucocorticoids

Anti inflammatory agents for moderate to

severe relapses.
Inhibition of inflammatory pathways
Budesonide- 9mg/dl used for 2-3 months
& then tapered.
Prednisone-40-60mg/day
No role in maintainence therapy

Antibiotics

No role in active/quienscent UC
Metronidazole is effective in active
inflammatory,fistulous & perianal CD.
Dose-15-20mg/kg/day in 3 divided doses.
Ciprofloxacin
Rifaximin

Immunosuppresants

Thiopurines
Azathioprine
6-mercaptopurin
Methotrexate
Cyclosporine

Cyclosporine

Preventing clonal expansion of T cell

subsets
Use
Steroid sparing
Active and chronic disease
Side effects
Tremor, paraesthesiae, malaise,
headache, gingival hyperplasia, hirsutism
Major: renal impairment, infections,
neurotoxicity

Other medications

Anti- diarrheals - Loperamide (Imodium)

Laxatives - senna, bisacodyl
Pain relievers. acetaminophen (Tylenol).
Iron supplements
Nutrition