IBS IBD Flashcards
Discuss epidemiology of IBD
- Generally 1st world problem ,increasing 3rd world
- Increasing incidence in Australia 29 per 100,000
Prevalence 200 – 400 per 100,000 (65,000 Australians)
Can occur at any age
Peak age of onset between 15 and 30 years
Affects males and females equally
Discuss theories of IBD aetiology
toxic response to luminal contents
* specific microbial pathogen
* abnormal luminal constituents
* increased absorption of luminal macromolecules
enhanced immune response to normal constituents
autoimmune response
* to epithelial cell or mucous glycoprotein
* molecular mimicry
* to immune cells
Discuss pathogenesis of IBD
Genetics
Infection
* Mycobacterium paratuberculosis
* measles virus
* microbiome
Smoking
Diet
Medications: aspirin, NSIADs, OCP
Stress
Evidence of genetic influence
Prevalence varies among different populations
Risk increased (5 - 20-fold) among first degree relatives
Child of a parent with IBD has 5% risk of developing IBD
Greater concordance among monozygotic (50 - 70%) than dizygotic (5 – 10%)
twins
Identification of “susceptibility genes” (NOD2/CARD 15)
Describe UC features and histology
Diffuse mucosal inflammation
Always involves rectum
Extend proximally in a continuous fashion
Limited to colon
Location/Extent not static
Mucosal / Submucosal
Lymphocytic infiltrate
Goblet cell depletion
Crypt distortion
Cryptitis
Crypt abscesses
No granulomas
Describe Crohns features and histology
Segmental transmural inflammation
Skip lesions separated by areas of normal bowel
May affect any part of GIT
Transmural inflammation
Infiltrate of lymphocytes
and macrophages
Granulomas in >50% of
cases
Compare and contrast UC and Crohn’s ant vs path, location, symptoms
anatomy and pathoglogy
- UC 95% rectal, 75% lieft sided colitis, 15-25% pancolitis
- Crohn’s: 40% only SI, 30% ileocolonic, 30% colon only
Pain more likely in cROHN;S
MALAISE in both, slighyly more common in UC
fever in both
Diarrhoea overwhelmingly in UC
Stools way more bloody in UC
More pus and mucusin Crohns’
Discuss how to establish a diagnosis of IBD and the role of biomarkers
History and examination
* Findings depend on disease location, extent and severity
Laboratory tests
* CRP, ESR, platelet count, faecal calprotectin
Endoscopy and histology
Imaging
* CT, MRI
Serology
* ASCA, ANCA generally unhelpful
Biomarkers can help: eg CFP, FCP
- diagnosis ie to distinguish from functional disease ie IBS
- evaluate dusease activity
- predict therapeutic effect at start of treatment
- predict remission/recurrence
Ala Mayo iscore and Crhon;’s index fro UC and Crhn’s
List systemic complications of IBD
Oral ulcers
Large joint arthritis and ankylosing spondylitis
Episcleritis, iritis and uveitis
Erythema nodosum
Pyoderma gangrenosum
Sclerosing cholangitis
Gallstones and renal stones
Discuss therapy goals for IBD
Short-term: Induce remission
* Relieve symptoms
* Improve quality of life
Long-term: Maintain remission
* Control inflammation (without need for steroids)
* Prevent recurrence of symptoms (flares)
* Prevent complications (of disease and treatment)
* Reduce need for hospitalisation and surgery
* Maintain quality of life
Discuss an optimised therapeutic approach
Early diagnosis
Rapid induction of remission
Clear definition of
* Goals of therapy
* Time frame required to achieve goals
Minimal side effects of treatment
Adherence and compliance
Recognising when therapy is ineffective
Escalating therapy in timely manner
List therapeutic options
5-ASAs - more for UC
FMT - mixed data, efficaicy aafety and patient acceptability
CS to induceNOT to maintain - in both
AZA/6-MP
anti TNF - require drug monitoring, switch out of class or escaate or switch to antohte
anti integrin
anti cytokin
Discuss surgical optioons
creating a pouch eg J , W, S
Stool frequency 6 to 8 per day
Reduced fertility
Pouchitis
* Affects 15 –50%
* Predictors include PSC, pANCA, non-smoking
* Treatment with Ciprofloxacin, metronidazole
* Prophylaxis with Probiotics (VSL#3
87% of patients (failed medical therapy, complications,
initial presentation)
Stricturoplasty
Resection
Treatment of fistulas/setons
Ileostomy
inevitably recurs after: resect, perforates, smoke
note risk of cancer with IBD
What are some other management issues in IBD
Smoking cessation
Nutrition
Osteoporosis
Psychological wellbeing
Vaccination
* COVID-19, flu, pneumococcus, HBV, HPV, VZV (live vaccine)
Cancer prevention
* Skin checks, Pap smears, colonoscopy
Discuss pregnancy and IBD
Increased rates of adverse outcomes (active disease)
* SGA, LBW, preterm birth, foetal loss
Conflicting data regarding rates of congenital anomalies
Most medications are safe
Best outcomes if remission prior to conception and during
pregnancy
all but MTX ruled in
Describe diagnostic criteria in IBS
Recurrent abdominal pain on average at least 1
day/week in the last 3 months, associated with two
or more of the following criteria:
* Related to defaecation
* Associated with a change in frequency of stool
* Associated with a change in form (appearance) of stool
* Criteria fulfilled for the last 3 months with symptom
onset at least 6 months prior to diagnosis
