Inflammatory Bowel Disease (UC n Crohn's)

Question 1

What is IBD?

Answer 1

Inflammatory bowel disease is the umbrella term for two main diseases causing inflammation of the GI tract: Ulcerative Colitis and Crohn’s disease. They both involve inflammation of the walls of the GI tract and are associated with periods of remission and exacerbation.

Question 2

Describe Crohn’s

Answer 2

Crohn’s (crows NESTS)

N – No blood or mucus (less common)

E – Entire GI tract

S – “Skip lesions” on endoscopy

T – Terminal ileum most affected and Transmural (full thickness) inflammation

S – Smoking is a risk factor (don’t set the nest on fire)

Crohn’s is also associated with weight loss, strictures and fistulas.

Question 3

Describe UC

Answer 3

Ulcerative Colitis
(remember U – C – CLOSEUP)

C – Continuous inflammation

L – Limited to colon and rectum

O – Only superficial mucosa affected

S – Smoking is protective

E – Excrete blood and mucus

U – Use aminosalicylates

P – Primary Sclerosing Cholangitis

Question 4

How does IBD present?

Answer 4

Diarrhoea
Abdominal pain
Passing blood
Weight loss

Question 5

Testing

Answer 5

Routine bloods for anaemia, infection, thyroid, kidney and liver function
CRP indicates inflammation and active disease
Faecal calprotectin (released by the intestines when inflamed) is a useful screening test (> 90% sensitive and specific to IBD in adults)
Endoscopy (OGD and colonoscopy) with biopsy is diagnostic
Imaging with ultrasound, CT and MRI can be used to look for complications such as fistulas, abscesses and strictures.

Question 6

Managing Crohn’s - inducing remission

Answer 6

First line: Steroids (e.g. oral prednisolone or IV hydrocortisone)
If steroids alone don’t work, consider adding immunosuppressant medication under specialist guidance:

Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab

Question 7

Maintaining remission in Crohn’s

Answer 7

First line:

Azathioprine
Mercaptopurine
Alternatives:

Methotrexate
Infliximab
Adalimumab

Question 8

Surgical intervention in Crohn’s

Answer 8

When the disease only affects the distal ileum it is possible to surgically resect this area and prevent further flares of the disease. Crohns typically involves the entire GI tract

Surgery can also be used to treat strictures and fistulas secondary to Crohns disease.

Question 9

Management of UC - inducing remission

Answer 9

Mild to moderate disease

First line: aminosalicylate (e.g. mesalazine oral or rectal)
Second line: corticosteroids (e.g. prednisolone)
Severe disease

First line: IV corticosteroids (e.g. hydrocortisone)
Second line: IV ciclosporin

Question 10

Maintaining remission UC

Answer 10

Aminosalicylate (e.g. mesalazine oral or rectal)
Azathioprine
Mercaptopurine

Question 11

surgery UC

Answer 11

Ulcerative colitis typically only affects the colon and rectum. Therefore, removing the colon and rectum (panproctocolectomy) will remove the disease. The patient is then left with either a permanent ileostomy or something called an ileo-anal anastomosis (J-pouch). This is where the ileum is folded back in itself and fashioned into a larger pouch that functions a bit like a rectum. This “J-pouch” which is then attached to the anus and collects stools prior to the person passing the motion.