Introduction to Inflammatory Bowel Diseases Flashcards
1
Q
IBD
A
o IBD is chronic or recurring inflammation of the GI tract due to dysregulated immune response
o IBD IS NOT THE SAME AS IBS!!
2
Q
prevalence of IBD
A
- Approximately 1.85M patients with IBD in US
- Slightly more UC > CD
3
Q
incidence of IBD
A
- Slight M > F in UC
- Slight F > M in CD
- Majority diagnosed young (15-35yo)
- Bimodal distribution with small bump in new diagnoses 60-70s yo (M>F in late UC dx, F>M in late CD dx)
4
Q
Ulcerative colitis
A
- Term first used in 1875 by Samuel Wilks and Walter Moxon to differentiate case of inflamed colon from infectious diarrhea
- Involves ONLY the colon
- Always involves the rectum, can involve the colon more proximally in a continuous fashion
5
Q
UC pathology
A
-Limited to mucosa and submucosa
6
Q
UC clinical manifestations
A
- Bloody diarrhea (Mucus, Frequency, Urgency, Tenesmus, Nocturnal bowel movements)
- Abdominal pain
- Constitutional symptoms (Fatigue, Anorexia, Weight loss)
7
Q
Chron’s disease
A
- Named after Dr. Burrill B. Crohn who published a landmark paper in 1932 describing the features of what is known today as Crohn’s disease
- Can affect ANY portion of the digestive tract from mouth to anus (Small bowel disease only: 30%, Ileocolonic disease: 40%, Colonic disease only: 30%, Upper GI tract: 0.5-4%, Perianal disease: 33% (5% anus only))
8
Q
chrons pathology
A
- Involves entire thickness (“transmural inflammation”)
- Will involve cobblestoning
9
Q
consequences of transmural inflammation
A
- Abscess
- Fistula – connecting from one space to another
- Stricture
- The inflammation breaks down the wall and the fecal matter goes to a different lumen
10
Q
Clinical symptoms of CD
A
- Highly variable depending on location of inflammatory process
- Colonic: can be similar to ulcerative colitis (Diarrhea, Blood in stool, Abdominal pain, Weight loss, weakness and anorexia)
- Small bowel (Diarrhea, usually non-bloody, Abdominal pain, Fever/weight loss/anorexia, Malabsorption/malnutrition, Stricturing – nausea, vomiting, bloating, food aversion, Perforating - FUO, Sepsis)
11
Q
risk factors for inflammatory bowel disease
A
- Heritability (One parent with UC = 2% chance of offspring with IBD, One parent with Crohn’s disease = 5%, Both parents with IBD = 36%, Monozygotic twin studies show 18% and 58% concordance in UC and CD, respectively)
- Race/Ethnicity (Ashkenazi Jewish and Caucasians vs Navajo Indians)
- Industrialization, urban areas, northern climates (Leading markets US (prevalence: 319/100,000) and Europe (322/100,000) vs China 1-2/100,000)
12
Q
geographic distribution of inflammatory bowel disease
A
- Rates highest in northern locales
- More common in Caucasians than in blacks
- Less common in Asians and Hispanics
13
Q
risk factors for inflammatory bowel disease
A
- Smoking (Increases risk of CD, Is PROTECTIVE in UC)
- NSAIDs
- ? Other medications (Accutane, OCPs)
- ? Appendicitis – children who had appendectomy may have reduced risk of UC but higher increased risk of CD
- ? Diet (high in animal protein)
14
Q
fecal microbiota are abnormal in IBD
A
- UC and CD fecal microbiota are distinct from each other as well as from infectious colitis and normal patients
- Depleted microbiome diversity has been demonstrated in both CD and UC
- Colonic microbiome contribute to multiple functions critical to health (Metabolism of insoluble carbohydrates, Vitamin / micronutrient production, Immune development and homeostasis, Ancillary mucosa protection)
15
Q
challenges to treating IBD
A
- Often fluctuating disease severity and disease “flares”
- Treatments don’t work for everyone
- Treatments that do initially work may stop working
- Drugs are expensive
- Drugs have side effects and safety concerns
- Patients may want to stop treatment
- No one-size-fits-all
