Inflammatory bowel disease

1. Inflammatory bowel disease Michal Holecki, MD, PhD Department of Pathophysiology

2. Inflammatory bowel disease refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis and Crohn's disease. Although the diseases have some features in common, there are some important differences.

3. Inflammatory bowel disease Medical research hasn't determined yet what causes inflammatory bowel disease. But researchers believe that a number of factors may be involved, such as environment diet possibly genetics

4. Inflammatory bowel disease Current evidence suggests that there's likely a genetic defect that affects how our immune system works and how the inflammation is turned on and off in those people with inflammatory bowel disease, in response to an offending agent, like: bacteria a virus or a protein in food

5. Epidemiology of IBD

6. Ulcerative colitis � microscopic features Process is limited to the mucosa and submucosa with deeper layer unaffected Two major histologic features: - the crypt architecture of the colon is distorted - some patients have basal plasma cells and multiple basal lymphoid aggregates

7. Ulcerative colitis is an inflammatory disease of the large intestine, also called the colon. In ulcerative colitis, the inner lining - or mucosa - of the intestine becomes inflamed and develops ulcers is often the most severe in the rectal area, which can cause frequent diarrhea.

8. Ulcerative colitis � macroscopic features 40-50% of patients have disease limited to the rectum and rectosigmoid 30-40% of patients have disease extending beyond the sigmoid 20% of patients have a total colitis Proximal spread occurs in continuity without areas of uninvolved mucosa

9. Ulcerative colitis � macroscopic features Mucosa is : - erythematous, has a granular surface that looks like a sand paper In more severe diseases: - hemorrhagic, edematous and ulcerated In fulminant disease a toxic colitis or a toxic megacolon may develop ( wall become very thin and mucosa is severly ulcerated)

10. Ulcerative colitis � clinical presentation The major symptoms of UC are: - diarrhea - rectal bleeding - tenesmus - passage of mucus - crampy abdominal pain

11. Ulcerative colitis � clinical presentation Patients with proctitis usually pass fresh blood or blood-stained mucus either mixed with stool or streaked onto the surface of normal or hard stool When the disease extends beyond the rectum, blood is usually mixed with stool or grossly bloody diarrhea may be noted When the disease is severe, patients pass a liquid stool containing blood, pus, fecal matter Other symptoms in moderate to severe disease include: anorexia, nausea, vomitting, fever, weight loss

12. Radiologic change of UC Fine mucosal granularity Mucosa become thickenned and superficial ulcers are seen (collar-button ulcers) Loss of haustration

13. Ulcerative colitis - complication Hemorrhage Perforation Stricture Toxic megacolon (transverse colon with a diameter of more than 5,0 cm to 6,0 cm with loss of haustration)

14. UC � disease presentation

15. UC � disease presentation