A3- Inflammatory Bowel Disease & Irritable Bowel Syndrome Flashcards
What are the several subtypes of IBS?
- IBS-A = alternating
- IBS-B = bloating
- IBS-C = constipation
- IBS-D = diarrhoea
does IBS affect women more or men
women
•1 in 10 of population – globally
What are the Two main subtypes of IBD
- Crohn’s disease - subtypes – ileocolonic, SB, colonic; varying patterns
- Ulcerative colitis – subtypes – (proctitis), left-sided, extensive (?pancolitis)
Compare IBS CD and UC SYMPTOMS
How do you differentiate between IBS vs IBD
Calprotectin
if calprotectin is in the stool then the bowel is ?
inflamed
Causes of IBS
- Family history often positive (? Shared environment vs shared genes)
- Diet (dysbiosis)
- Stress …
- Post-infection (dysbiosis) - ? up to 10%
- Antibiotics
Differentials for IBS
•IBD
•Coeliac disease
•Watery diarrhoea – drug side effects, microscopic colitis, bile acid
diarrhoea
•Older people differential always includes colorectal cancer
•Does diverticulosis cause symptoms (debatable)
What does IBS diagnosis consist of?
- History – easier in young patients
- Normal examination
- ? Normal calprotectin
- In ‘older patients (>45y?)’ consider investigation
Treatment for IBS
Positive clinical diagnosis supported by negative calprotectin
•History – diet / stress / post-infection IBS
•Diet – advice / low FODMAPs
•Gluten -free, avoid milk, stone fruit, frutans
•Stress – talking therapies (CBT , mindfulness etc), SSRI/ tricyclics
•PI-IBS – supportive, symptomatic, diet
What are the symptoms you find in ileal disease?
pain (RIF?), looser stools
•Pain is constant ache (inflammation) or colicky (narrowing / stenosis /
stricture)
What are the symptoms you find in colonic disease?
diarrhoea, ? bleeding, ?? pain in LIF / lower
What are the symptoms you find in perianal disease?
severe pain (abscess), later discharge (fistula) and or bleeding (fissure)
Constitution symptoms – fatigue, weight loss, extra-intestinal
manifestations (ulcers, eyes, joints, rash)
Crohn’s Disease: investigation
FBC / iron studies / B12, folate, vitamin D)
•CRP / LFTs
•Faecal calprotectin
•Colonoscopy
•Small bowel imaging (MR/ CT/ video capsule endoscopy (VCE))
•(Ultrasonography)
•(Serology)
Complications of Crohns?
Stenosis
inflammation
distended lumen
Fistula
UC
Younger or older
F/M
smoker or non smokers?
- Younger people
- F=M
- Non-smokers
- Family history
- Western life-style
How do symptoms present in colonic disease and distal disease
- Colonic disease: diarrhoea, (?) bleeding
- Distal disease (proctitis): bleeding, constipation> diarrhoea
Constitution symptoms – fatigue, weight loss, extra-intestinal
manifestations (ulcers, red/painful eyes, joints ache,
erythema nodosum
Where is the common location of UC
Ulcerative colitis: investigation
- FBC / iron studies
- CRP / LFTs
- Faecal calprotectin
- Colonoscopy
Inflammatory Bowel Disease: treatment
Ulcerative colitis: 5-ASA
- 5-aminosalicylic acid (aka mesalazine)
- Topically acting anti-inflammatory
- Oral – tablets / granules
- PR – suppositories / foam / enema
- Used to treat mild to moderate UC
- Used to maintain remission
- May reduce risk of colorectal cancer
Ulcerative colitis: What steroids can you use?
Mild-moderate UC – oral – beclomethasone (Clipper) / budesonide –
fewer / milder systemic side effects
•Moderate to (Severe) UC - oral – Prednisolone 40mg od – taper over 8
weeks
•(with bone protection)
•‘Acute severe’ UC – IV -hydrocortisone
•(Enemas and suppositories also used)
IBD immunosupression options?
•Azathioprine
•Mecaptopurine / allopurinol
•Methotrexate
•As steroid sparing, second line medication – with due attention to
safety, risks and monitoring
•Slow action
•Role in maintenance (?overshadowed by biologic agents)
What are the IBS immunosupression risk
Current biological agents used for IBD
Anti-TNFs (infliximab, adalimumab, golimumab) – for CD, UC
•Anti-a4b7 (vedolizumab) – for CD, UC
Small oral inhibitors for IBD
JAK Stat pathway
•Tofacitanib -UC (CD)
Surgery options for IBD
- Colectomy
- Local resection
