WHAT IS IBD?

2006 2012

David Rampton
 OVERVIEW

 Definition
 Incidence
 Pathology
 Presentation
 Complications
 Investigations
 Prognosis
 DEFINITION

Chronic inflammatory diseases of gastrointestinal tract

CROHN’S DISEASE
ULCERATIVE COLITIS
(Anywhere from mouth
(Colon and rectum only)
to anus)
extra-intestinal
manifestations
GRANULOMATOUS ILEITIS

Who is this?

Burrill Crohn 1884-1983

COMBINED INCIDENCE OF IBD

• Incidence 25/100,000/yr

• Prevalence 400/100,000

• UK has about 240000 patients with IBD

INCIDENCE OF IBD
 2 age peaks
 minor sex
differences

Bernstein Am J GE 2006
 EPIDEMIOLOGY
 first degree relatives 10%
 Ashkenazi Jews
 North & West > South & East
 Related to
» Non-smoking - UC
» Smoking – Crohn’s
MACROSCOPIC DISTRIBUTION
 MACROSCOPIC APPEARANCES

terminal ileal Crohn’s

ulcerative colitis
What are these diagnoses?
 HISTOLOGY

What are
these
diagnoses?
normal

ulcerative colitis Crohn’s

 PRESENTATION

 diarrhoea, often bloody  relapses & remissions

 abdominal pain
 weight loss
 malaise  onset any age
 life-long
 COMPLICATIONS

 INTESTINAL  ELSEWHERE
» Bleeding from » Gall stones
ulceration » Kidney stones
» Strictures – oxalate
» Fistula – urate
» Abscesses » Thrombosis
» Perforation
» Cancer
FISTULAE IN
CROHN’S

Healing with
infliximab

Rutgeerts NEJM 2004

COLORECTAL CANCER

Other risk factors

• extent of disease
• sclerosing cholangitis
• FH colorectal cancer
• poorly controlled disease

Eaden Gut 2001

EXTRA-INTESTINAL
MANIFESTATIONS

 Skin
 Eyes
 Joints
 Liver
 SKIN

pyoderma gangrenosum

What are these diagnoses?

erythema nodosum
IRITIS

What is this diagnosis?

 ANKYLOSING
SPONDYLITIS
What is this diagnosis?
SCLEROSING CHOLANGITIS
What is this diagnosis?

normal sclerosing cholangitis

 INVESTIGATION - BLOOD TESTS

 Diagnosis and severity

» Hb, platelet count, CRP, ESR, albumin
» pANCA* (UC), ASCA* (Crohn’s)
 Complications
» B12, folate (Crohn’s)
» LFTs

*Perinuclear anti-neutrophil cytoplasm antibody

Anti-saccharomyces cerevisiae antibody
 EXCLUDE INFECTION

 Infection complicates/initiates 10% UC

relapses
 Hot fresh stool
» Microscopy for amoebae in travellers
» Clostridium difficile toxin
 INVESTIGATION - IMAGING

 sigmoidoscopy
 ileocolonoscopy
 histology
 AXR
 contrast radiology
» barium follow-through
» ultrasound, CT, MRI
» WBC SCAN
• wireless capsule endoscopy
 ENDOSCOPIC APPEARANCES

ulcerative colitis
normal
ENDOSCOPIC APPEARANCES

Stricture in Crohn’s
 AXR IN ACUTE UC
What does this
AXR show?

 Transverse colon
dilation, mucosal
islands and
thumb-printing
TERMINAL ILEAL CROHN’S ON
BARIUM FOLLOW-THROUGH

What are the abnormalities?

 SCANNING IN
CROHN’S

CT

ultrasound
thickened bowel wall

• main role is in
identifying abscesses
ASSESSING DISEASE EXTENT IN UC WITH
RADIOLABELLED WHITE CELL SCAN

What is this test and what does it show?

• 99-Tc HMPAO scan

• UC extending to mid-
transverse colon
WIRELESS CAPSULE
ENDOSCOPY

 avoid in stricturing
disease
 false positives?
 role unclear
 PROGNOSIS
 Life-long relapses and remissions
 Bowel resections
» UC 20%
» Crohn’s 70%
 Mortality
» slightly increased in Crohn’s
– sepsis
– pulmonary embolus, COPD
» Slightly reduced in UC
– less cardiovascular disease
Jess Gut 2006