Colonic Diseases

1. Colonic Diseases Ismael A. Lapus Jr. M.D. Internal Medicine-Gastroenterology September 11, 2008

2. Colonic Diseases Careful history and physical examination Diagnostic modalities • Stool exam with occult blood • Barium enema • CT scan • Virtual colonoscopy • Video colonoscopy

3. Colonic Diseases Irritable Bowel Syndrome Diverticular Diseases Polyps

4. Normal Colon

5. Irritable Bowel Syndrome • Common gastrointestinal disorder characterized by recurrent abdominal pain or discomfort and a disturbance in bowel habit (constipation or diarrhea) IN THE ABSENCE OF ORGANIC PATHOLOGY • No specific test • No unique physiologic factors as a cause of IBS • Often necessitates several diagnostic test (upper and lower endoscopy, ultrasound/CT-scan of the abdomen) • Chronic functional disorder • 70% affected are women

6. Irritable Bowel Syndrome Rome II diagnostic criteria for IBS At least 12 weeks , which need NOT be consecutive , in the preceding 12 months of abdominal discomfort or pain that has two out of the following three features • Relieved with defecation; and/or • Onset associated with change in frequency of stool; and/or • Onset associated with a change in form (appearance) of stool

7. Irritable Bowel Syndrome Other signs/symptoms: Passage of mucus Bloating or feeing of abdominal distention Gynecologic symptoms (dyspareunia) Slightly tender abdomen

8. Irritable Bowel Syndrome No effect on life longevity No end organ damage result

9. Irritable Bowel Syndrome Health Care Burden • IBS accounts to 12% of patients seen in primary setting • Largest diagnostic group seen by gastroenterologist • Considerable cost to society (direct medical expenses and indirect cost such as absenteeism)

10. Irritable Bowel Syndrome Management Reassurance Dietary fiber Antispasmodics Anti-diarrhea agents Prokinetics Psychotropic medication

11. Diverticulosis A small bulging sac which protrudes from weak spots of the colon wall

13. Diverticulosis Signs and Symptoms • Cramping • Bloating • Flatulence • Irregular defecation

14. Diverticulosis Management • High fiber diet • Left alone unless associated with complication

15. Diverticulosis Health Burden • Prevalence is age dependent • < 5% by age 40 • > 30% by age 60 • > 65% by age 85 • 70% - asymptomatic • 15-25% - diverticulitis • 5-15% - bleeding

16. Diverticulitis • Inflammation of diverticula • Nothing per mouth and antibiotics • 70-100% successful • Surgical management • failure of above conservative treatment or development of further complication (i.e. Abscess, fistula, perforation, peritonitis, obstruction)

17. Diverticular bleed • Ruptured artery • Painless rectal bleeding • Most have minor bleed • Mostly stopped spontaneously • 25% recurrence rate • Available endoscopic therapy • < 1% require surgical intervention

18. Polyps • Protuberance into the lumen from a normally flat colonic mucosa • Usually asymptomatic • Altered bowel habit, bleeding, obstruction • Classified as • Non-adenomatous - non cancerous (hyperplastic, inflammatory) • Adenomatous - pre cancerous (FAP, HNPP, villous, tubular, tubulovillous)

19. Polyps Adenomatous Polyp • Two-thirds of all colonic polyp • Approximately 30% of population over age 50 have one or more adenomas • Cumulative cancer risk is only 5%

20. Polyps 100% Malignant Potential • FAP (Familial Adenomatous Polyposis) • 1% of all colorectal carcinoma • HNPCC (Hereditary Non-Polyposis Colorectal Cancer) • 2-6% of colorectal carcinoma

21. Polyps Polyp features and the frequency of high-grade dysplasia

22. Polyps

23. Polyps

24. Polyps

25. size characteristic location frequency

26. Polyps Management Detected coincidentally during investigation of other colonic diseases Excision through biopsy forceps or snare polypectomy Surveillance colonoscopy if adenoma

27. Polyps Screening Colonosocpy Secondary prevention of Colorectal Carcinoma

28. THANK YOU!