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Book Details
Abstract
Inflammatory bowel disease (IBD) encompasses a spectrum of autoimmmune diseases which include ulcerative colitis, Crohn’s disease, and indeterminate colitis. Ulcerative colitis is a relapsing nontransmural inflammatory disease restricted to colon, which may be classified as proctitis, left-sided colitis, or pancolitis depending on the extent of involvement. Some patients also develop ileal inflammation (backwash ileitis), which occasionally complicates its differentiation from Crohn’s ileocolitis. Crohn’s disease is defined as a relapsing transmural inflammatory disease of gastrointestinal mucosa that may affect the entire gastrointestinal tract (GIT) from the mouth to the anus. There is discontinuous involvement of various portions of the GIT and may get complicated by formation of strictures, abscesses, or fistulas. It closely resembles intestinal tuberculosis both clinically and on investigations.
GI tuberculosis is often suspected on the basis of its clinical, radiological, and endoscopic features, but histological or microbiologic proof of the disease is often difficult to achieve. Therefore, the majority of patients are treated with antitubercular drugs on presumptive diagnosis only. Similar clinical, endoscopic, radiological, and histological features of GI tuberculosis and Crohn’s disease pose a serious challenge to the treating physician. The rate of misdiagnosis of these conditions using conventional diagnostic measures has been reported to be around 50–70%. Thus differentiation and diagnosis of these conditions is difficult but very important for correct treatment of the patients. Recently some serological tests have come up for diagnosing Crohn’s disease and ulcerative colitis, which may help to distinguish these disorders from each other and from GI tuberculosis.
Besides diagnosis, treatment for IBD is also an emerging field in which active research is going on. The traditional drugs used in treatment of IBD include steroids and aminosalicylates. Recent studies have evaluated the role of azathioprine, methotrexate, and cyclosporine. Apart from improving efficacy of therapy in short term, these agents have raised debate on complications of therapy, long-term efficacy, and cost. Management of IBD during pregnancy and fistulising Crohn’s disease are other areas of concern.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Front Cover | ||
Front Matter | ia | ||
ECAB Clinical Update:Gastroenterology/Hepatology | id | ||
Copyright | if | ||
About the Authors | ig | ||
Contents | ii | ||
ECAB Clinical Update InformationInflammatory Bowel Disease | i | ||
Foreword | v | ||
Diagnosis of Inflammatory Bowel Disease | 1 | ||
ABSTRACT | 1a | ||
KEYWORDS | 1a | ||
Epidemiology | 3 | ||
Indian Update | 3 | ||
Etiology | 5 | ||
Pathogenesis | 5 | ||
Molecular Classification of IBD | 6 | ||
IBD and Colorectal Cancer Risk | 7 | ||
Diagnostic Procedures | 8 | ||
Routine Laboratory Screening | 9 | ||
Gastrointestinal Endoscopy | 9 | ||
Videocapsule Endoscopy | 14 | ||
Double Balloon Enteroscopy | 15 | ||
Histopathology | 16 | ||
Serological Biomarkers | 19 | ||
Radiological Procedures | 23 | ||
Barium Studies | 23 | ||
Ultrasound | 23 | ||
Computed Tomography | 23 | ||
Magnetic Resonance Imaging | 24 | ||
MRI studies: Current status | 26 | ||
Advantages and limitations of MRI | 28 | ||
Scintigraphy | 28 | ||
Diagnostic Algorithms | 29 | ||
Recent Advances | 29 | ||
Predicting a Change in Diagnosis from UC to CD | 29 | ||
Is Endoscopic Ultrasound Appropriate for the Diagnosis? | 30 | ||
Conclusion | 31 | ||
Case Studies Diagnosis of Inflammatory Bowel Disease | 35 | ||
Case Study I | 35 | ||
History | 35 | ||
On Examination | 35 | ||
Management | 35 | ||
Discussion | 36 | ||
Case Study II | 36 | ||
History | 36 | ||
On Examination | 36 | ||
Discussion | 37 | ||
Case Study III | 37 | ||
History | 37 | ||
On Examination | 37 | ||
Differentiation of Crohns Disease from Intestinal Tuberculosis | 40 | ||
ABSTRACT | 40a | ||
KEYWORDS | 40a | ||
Changing Epidemiology of the Inflammatory Bowel Disease | 41 | ||
Pathogenesis | 45 | ||
Genetic Factors | 45 | ||
Environmental Factors | 46 | ||
Role of Immunosuppressants | 46 | ||
Clinical Features | 48 | ||
Diagnosis | 49 | ||
Diagnostic Tools | 51 | ||
Tuberculin Skin Testing | 51 | ||
Use of Radiology | 51 | ||
Role of Endoscopy | 54 | ||
Colonoscopic Biopsy | 54 | ||
Role of Laparoscopy in Diagnosis | 55 | ||
Serological Markers | 55 | ||
Anti-Saccharomyces Cerevisiae Antibody | 55 | ||
PCR Assay | 57 | ||
Histological Criteria | 58 | ||
Mycobacterial Culture | 60 | ||
Diagnostic Approach For Suspected Gitb/Cd In India | 61 | ||
Treatment | 64 | ||
Complications | 65 | ||
Conclusion | 66 | ||
Emerging Therapies in Inflammatory Bowel Disease | 73 | ||
ABSTRACT | 73a | ||
KEYWORDS | 73b | ||
Drugs Used in IBD | 74 | ||
Corticosteroids | 74 | ||
Aminosalicylates | 75 | ||
Ulcerative Colitis | 76 | ||
Maintenance of remission | 76 | ||
Crohn's Disease | 76 | ||
Role in induction of remission | 76 | ||
Role in maintenance of remission | 76 | ||
Thiopurines | 76 | ||
Methotrexate | 77 | ||
Crohn's Disease | 77 | ||
Ciclosporin | 78 | ||
Ulcerative Colitis | 78 | ||
Crohn's Disease | 78 | ||
Biological Therapy | 79 | ||
Anti-TNF Therapies | 80 | ||
Infliximab | 80 | ||
Infliximab in CD | 80 | ||
Recommendations and caution | 82 | ||
Adverse effects of infliximab | 83 | ||
Adalimumab | 83 | ||
Certolizumab Pegol (CDP870) | 83 | ||
Natalizumab | 84 | ||
Fish Oil | 84 | ||
Probiotics | 84 | ||
Cytapheresis | 85 | ||
Medical Management of Inflammatory Bowel Disease | 85 | ||
Medical Management of UC | 85 | ||
Induction of Remission for Active Left-sided UC | 85 | ||
Treatment of Severe UC | 85 | ||
Maintenance Therapy in UC | 86 | ||
Medical Management of CD | 87 | ||
Mildly Active Localized Ileocecal CD | 87 | ||
Moderately Active Localized Ileocecal CD | 87 | ||
Severel Localized Ileocecal CD | 87 | ||
Colonic Disease | 88 | ||
Extensive Small Bowel Disease | 88 | ||
Early Relapse | 88 | ||
Corticosteroid-dependent CD | 88 | ||
Corticosteroid Refractory CD | 89 | ||
Maintenance of Remission in CD | 89 | ||
Management of Fistulising CD | 89 | ||
Simple Perianal Fistulas | 90 | ||
Complex Perianal Disease | 90 | ||
Management of Nonperianal Fistulating CD | 91 | ||
CD and Pregnancy | 91 | ||
Summary | 92 | ||
Case Studies Emerging Therapies in Inflammatory Bowel Disease | 100 | ||
Case Study I | 100 | ||
History | 100 | ||
Examination and Management | 100 | ||
Discussion | 101 | ||
Case Study II | 101 | ||
History | 101 | ||
Examination and Management | 101 | ||
Discussion | 102 | ||
Genetics of Inflammatory Bowel Disease | 103 | ||
ABSTRACT | 103a | ||
KEYWORDS | 103a | ||
Crohn's Disease | 104 | ||
IBD 1 | 105 | ||
IBD 4 | 106 | ||
IBD 5 | 106 | ||
IBD 6 | 107 | ||
IBD 7 | 107 | ||
IBD 8 | 108 | ||
IBD 9 | 108 | ||
Other Loci | 108 | ||
Chromosome 2 | 108 | ||
Chromosome 4 | 108 | ||
Chromosome 10 | 108 | ||
Chromosome 11 | 109 | ||
Chromosome 13 | 109 | ||
Genes Involved in Innate Immune Response | 109 | ||
Genes Involved in Disease Modification Rather than Prevalence | 110 | ||
Ulcerative Colitis | 110 | ||
IBD 2 | 110 | ||
IBD 3 | 110 | ||
Communicable Ulcerative Colitis | 111 | ||
Genes Involved in Disease Modification Rather than Prevalence | 111 | ||
Summary | 117 | ||
Other Books in This Series | 118 |