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Inflammatory Bowel Diseases - ECAB

Inflammatory Bowel Diseases - ECAB

Philip Augustine

(2012)

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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