ibd

Question 1

epidimeology and tobacco use

Answer 1

• Idiopathic ‘Inflammatory Bowel Disease’
(IBD)
– Crohn’s Disease and Ulcerative Colitis

• Epidemiology:
– 1.4 million Americans with peak onset in
persons 15 to 30 years of age
• Tobacco:
– smokers are at increased risk for
Crohn’s disease (more severe in
smokers)
– former smokers and nonsmokers are at
greater risk for ulcerative colitis.

Question 2

clinical manifestations of each

Answer 2

Crohn’s vs. Ulcerative Colitis
Crohn’s Ulcerative Colitis
Hematochezia* Rarely Commonly
Location Ileum (~always) Rectum (~always)
Pattern Discontinuous(skip lesions)Continuous
Upper GI Tract Yes No
Extra-GImanifestations-Common Common
Fistulas Common Rare
Inflammation Transmural Mucosal

Question 3

IBD and Extraintestinal Manifestations %?

Answer 3

25%

Question 4

IBD etiology

Answer 4

IBD Etiology
• inappropriate inflammatory response to intestinal
microbes in a genetically susceptible host
• Genetic Factors
– nucleotide oligomerization domain 2 (NOD2)
– interleukin-23–type 17 helper T-cell (Th17) pathway
– autophagy genes
• Rising Prevalence
– Changes in diet
– Antibiotic use,
– Altered intestinal colonization (e.g., the eradication of
intestinal helminths)
– tobacco

Question 5

how do you diagnose a pt with crohns

Answer 5

Do a careful work-up considering important
diff erential diagnoses
• Establish the complete disease phenotype including
extraintestinal symptoms
• Screen for predictors and biomarkers of a complicated
disease course
• Individualise therapeutic guideline recommendations to
your patient
• Consider involving an infl ammatory bowel disease expert
for optimum treatment choice
• Educate and counsel your patient about disease and
therapy associated risks and complications
• Enrol your patient in surveillance programmes and
follow-up the patient closely