Lecture 5 - Inflammatory Bowel Disease Flashcards
What is inflammatory bowel disease?
Ulcerative colitis and crohn’s disease
What are ulcerative colitis and crohn’s characterised by?
inflammation, swelling and ulceration of the intestinal tissue
they are chronic with periods of remission
symptoms of IBD?
stomach pain, weight loss, diarrhoea (blood/mucus) and tiredness
What else can IBD cause?
Joint pain, inflamed eyes and rashes
Where does ulcerative colitis effect?
the large bowel
Where does Crohn’s affect?
any area of the GI system from mouth to anus and all layers of tissue can be inflamed
How to diagnose IBD?
symptoms presented
blood tests for anaemia, vit deficiencies and inflammatory markers
xray, CT and MRI scans
sigmoidoscopy and colonoscopy
How to diagnose crohn’s disease?
small bowel enema and small capsule endoscopy
what is a small capsule endoscopy?
A patient swallows a large capsule with a camera in it which sends images back to the computer, patient passes capsule and it is removed
What is a sigmoidoscopy?
small camera inserted into the rectum and moves to the lower part of the rectum
What causes IBD?
genetic links
autoimmune disease
environmental
previous infection
When is IBD most common to occur?
In late teens to early 20s, with most diagnosed by the time they are 30
most common in white ethnic groups
more common in women than men
How many people in the UK are affected?
one in every 350
What are the aims of IBD treatment?
induce and maintain remission
reduce symptoms and improve quality of life
reduce inflammation
reduce autoimmune response
what can be used to reduce inflammation?
Steroids, aminosalicylates, cytokine modulators
What can be used to reduce autoimmune response?
Immunosuppressant drugs
What should we consider when deciding treatment?
Clinical severity of the disease (e.g. how much of the colon is affected) and the patient preference
How are corticosteroids administered?
orally or rectally
Formulations of corticosteroids?
GR or MR formulations, enemas or foams
Examples of corticosteroids?
hydrocortisone
beclomethasone
budesonide
prednisolone
What is an enema?
A liquid that comes in a tube and is administered rectally
What is a foam?
aerosol that the patient can administer themselves, more palatable than the enema
What do corticoseroids do?
reduce inflammatory mediators directly and also have effects on expression of genes associated with inflammatory and anti-inflammatory proteins
Cautions of corticosteroids?
congestive heart failure, hypothryoidism, osteoporosis, untreated infection
Side effects of cortocosteroids?
insomnia, dyspepsia, Cushing’s syndrome, impaired healing, adrenal suppression with long term use
Interactions of corticosteroids?
grapefruit juice increases plasma concentration or oral budesonide, corticosteroids antagonise diuretic effects
What is Cushing’s syndrome?
when there is too much cortisol in the body from the cortisol in corticosteroids
Symptoms of Cushing’s syndrome?
weight gain around chest and tummy area, disproportionate fat deposits in the back of the neck, red and puffy faces
How are aminosalicylates administered?
orally or rectally
Aminosalicylate formulations?
MR tabs/caps, granules, suspensions or foam, suppository, enemas
Examples of aminosalicylates?
balsalazide
mesalazine
olsalazine
sulfasalazine
Rare side effects of aminosalicylates?
blood disorders
What do patients need to report when taking aminosalicylates?
unexplained bleeding, bruising, purpura, sore throat, fever or malaise
What needs to be checked when taking aminosalicylates?
Renal function
should be checked before starting oral therapy, 3 months later then annually
What is a problem with aminosalicylates?
Salicylate sensitivity
Side effects of sulfasalazine?
colours urine and contact lenses orange - tear ducts and tears are eventually orange
decreases concentration of digoxin and absorbs folates
What are cytokine modulators?
Monoclonal antibodies which inhibit pro-inflammatory cytokine, tumour necrosis factor alpha (specialist use)
How are cytokine modulators administered?
By subcutaneous administration
Examples of cytokine modulators?
Infliximab
adalimumab
golimumab
vedolizumab
How do cytokine modulators work?
stop the expansion of activated T cells by interrupting the calmodulin-calcineurin cascade
What effects do immunosuppressants have?
T cell effects
How are immunosuppressants administered?
Orally or by injection
Examples of immunosuppressants?
azathioprine, ciclosporin, mercaptopurine, methotrexate
Why do immunosuppressants require regular monitoring?
Anti cancer drugs with blood toxicity and liver toxicity
need monitoring of blood counts and organ function for safe use
How often is methotrexate taken?
weekly
What is taken alongside methotrexate?
folic acid to reduce the side effects
What tablets of methotrexate are used?
2.5mg
Side effects of methotrexate?
sore throat, bleeding, bruising, mouth ulcer
need to be reported
What needs to be monitored when taking methotrexate?
full blood count, renal and liver function
What is methotrexate classes as in CMS?
high risk drug
What should patients carry when on methotrexate?
Patient safety card incase they are seen by paramedics or medical staff
How is mild disease of IBD treated?
mild disease in rectum and recto-sigmoid is treated locally with steroid or aminosalicylate
How is diffuse or unresponsive IBD treated?
Orally with steroid or aminosalicylate (alone or in combination with rectal therapy)
How is severe IBD treated?
Parenteral administration
steroid, immunosuppression and antibody therapy
Non drug treatment for IBD?
smoking cessation = smoking is the most modifiable risk factor
attention to diet - low residue foods, trigger foods
surgery - stoma and resection operations
What foods should people with IBD avoid?
stick to low residue foods (residue is what sticks in the bowel after digestion)
avoid wholegrains, raw veg, dried fruit, seeds and nuts
What is a stoma operation?
part of the bowel is removed
What is resection surgery?
remove inflamed section and rejoin the bowel to bypass the problem
