GI diseases: IBD

Question 1

GI diseases accounted for X deaths in 2016

Answer 1

1.4 mil

Question 2

GI tract diseases make up X% of primary care appointments

Answer 2

10%

Question 3

CRC = X most common cancer globally

Answer 3

Third

Question 4

What are relatively common GI tract diseases (also among younger people):

Answer 4

• Coeliac disease
• Inflammatory Bowel Diseases (IBD): Crohn’s Disease and Ulcerative Colitis
• Irritable Bowel syndrome (IBS)
• Diarrhoeal disease

Question 5

Small intestine: from…until…. what happens here?
Same for large intestine?

Answer 5

• ileocecal valve (small-LI) until pyloric sphincter (stomach-SI): most absorption and digestion of nutrients
• Ileocecal valve - anus: absorb remaining water + nutrients

Question 6

What is wrong when you have coeliac disease?

Answer 6

Immune system disorder: gluten triggers immune cells to attack cells in small intestine and produce antibodies.
-> genetically predisposed

Question 7

Coeliac disease:
- How many people affected worldwide?
- what is the cure?
- who is more effected?

Answer 7

• 1 in 100 people
• cure = eat gluten-free
• more women than men effected

Question 8

What happens when gluten-rich foods are eaten by people with coeliac disease?

Answer 8

Eating foods rich in gluten -> hyper-immune response + antibodies. Results in severe immune reaction in the gut + blunting of the small intestinal villi -> malabsorption -> anaemia and other nutritional deficiencies

Question 9

What are the symptoms of coeliac disease?

Answer 9

• bloating
• diarrhea
• malabsorption that can result in fat in the stool
• decreased appetite
• failure to thrive and grow (children. Also diarrhoea and bloating).

However, symptoms vary.

Question 10

How is coeliac disease diagnosed? What enzymes are measured?

Answer 10

Anti-bodies called
- anti-tissue transglutaminase
- gliadin peptide
- endomysial antibodies

are produced. These can be measured via an antibody blood test

Question 11

What coeliac test is the most accurate? What is another way to diagnose coeliac disease?

Answer 11

 anti-tissue transglutaminase (tTG)-IgA test
 Intestinal biopsies to confirm the presence of flattened villi

Question 12

1. What is IBD?
2. What happens?

Answer 12

• term for two immune-mediated conditions (Crohn’s disease and ulcerative colitis), characterized by chronic inflammation of the (GI) tract -> results in damage
• immune system responds incorrectly to environmental triggers, which causes inflammation of the GI tract.

Question 13

1 What is UC (ulcerative colitis)?
2 Where is it present + what layers?
3 What are primary and secondary causes of disease?

Answer 13

1. Autoimmune, continuous, chronic inflammation of the colon,
2. present only in the mucosa + submucosa. Can only affect the large intestine and rectum (continuous ulcers)
3. T-cells target the colon lining. Environmental conditions are secondary.

Question 14

By what cells/molecules is UC characterized?

Answer 14

• accumulation of white blood cells (T-cells) in the mucosa
• increase in IgE antibodies produced by plasma cells (a specialized type of white blood cell, a B-cell)

Question 15

Which is more common: UC or CD?

Answer 15

UC

Question 16

1. What is CD (Crohn’s disease)? What happens?
2. Where is it present?

Answer 16

1. Autoimmune (or, better term: immune-related because it is triggered by pathogens), chronic inflammatory condition affecting the GI tract. Immune reaction to pathogens is unregulated and out of proportion, leading to tissue destruction.
2. Any part of the GI tract (from the mouth to the anus)—Most often the portion of the small intestine before the large intestine/colon. Damage extends beyond submucosal layer into intestinal wall (worse ulcers than UC, they are not continuous but in patches).

Question 17

What are two important risk factors of CD?

Answer 17

smoking, certain bacteria (E. coli, pseudomonas, mycobacteria)

Question 18

So, in summary, how does Ulcreative Colitis differ from CD?

Answer 18

UC
- only affects the large intestine + colon
- affects only the mucosa + submucosa
- Circumferential + continuous

Crohn’s:
- Can affect all of the GI-tract
- Damage extends beyond submucosal layer into intestinal wall
- Not continuous

Question 19

Who are most at risk for UC?

Answer 19

Family history, young women teens-30s, Caucasians + eastern European jews.

Question 20

What are symptoms of UC?

Answer 20

pain in left lower quadrant, severe + frequent diarrhea, sometimes with blood in the stools.

Question 21

What may increase the risk of developing IBD or worsen the disease?

Answer 21

• Use of Nonsteroidal anti-inflammatory medications (NSAID’s) may increase the risk of developing IBD or worsen the disease
• Genetics also play a role.

Question 22

What are general IBD symptoms?

Answer 22

• persistent diarrhea
• abdominal pain
• rectal bleeding/bloody stools
• weight loss
• fatigue

Question 23

How is IBD diagnosed?

Answer 23

• using a combi of endoscopy (for Crohn’s), colonoscopy (for UC. Sometimes also biopsies) and imaging, such as radiography, MRI, CT.
• Stool samples may also be taken to exclude infection.
• Blood tests may also be taken.

Question 24

How is IBD treated?

Answer 24

Medication: anti-inflammatory + immune suppressing
- and the newest class —the “biologics”

• Vaccinations to prevent infections.
• Severe IBD: surgery to remove damaged portions of the gastrointestinal tract (= colectomy).