Inflammatory Bowel Disease - Illinois Gastroenterology Group
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Transcript Inflammatory Bowel Disease - Illinois Gastroenterology Group
Inflammatory Bowel
Disease
Crohn’s Disease
And
Ulcerative Colitis
Goals
To review the characteristics of the two major
inflammatory bowel diseases: Crohn’s
Disease and Ulcerative Colitis
To review the major ways to image the GI
tract in an effort to diagnose and differentiate
the two conditions
Definition
Idiopathic disorders of
the GI tract
characterized by
unexplained patterns of
inflammation
Characteristic Patterns
of Inflammation
Epidemiology
1 million patients with IBD
Males = Females
Crohn’s > Ulcerative Colitis
Most patients between 15 and 35
Jewish 5 times more likely to have IBD
$2 billion spent annually
Patterns of Inflammation
Crohn’s Disease
Location
Can involve the entire
gut
Predilection for the
terminal ileum and
Colon
Transmural Involvement
Ulcerative Colitis
Location
Only the Colon
Left sides vs Pancolitis
Occasionally the bile
ducts
Histologic Involvement
Mucosa only
Crohn’s Disease
Ulcerative Colitis
Pathophysiology
Autoimmune etiology
Heredity
Lupus like etiology
Early life intestinal infections
Hygiene Theory
15-20% have one sibling
Monozygotic twins concordance 44%
Multiple Genes are involved (Nod2 on C16)
Environmental
Occult Infection: mycobacterium, paramyxovirus
Signs and Symptoms
Abdominal Pain
Diarrhea
Rectal Bleeding
Constitutional Symptoms
Arthralgias
Skin Rash
Anorexia
Weight Loss
Complications
Crohn’s Disease
Abcesses
Fistulas
Obstruction
Perianal Disorders
Other
Malnutrition
Anemia
Arthritis
Kidney Stones
Ulcerative Colitis
Toxic Megacolon
Colon Cancer
Other
Anemia
Arthritis
Skin Rash
Sclerosing Cholangitis
Diagnosis
Blood Tests
Imaging Studies
pANCA: CUC
ASCA: Crohn’s
Barium Studies
CT
Endoscopy
Colonoscopy
Radiology Imaging Tools
Plain X-Rays
Barium Studies
UGI, BE, SBFT, Enterolysis
Ultrasound
CT
Plain X-rays
Utility
Benefits
Gas Patterns
Calcifications
Inexpensive
Easy to do
Noninvasive
Limitations
Limited Detail of hollow organs
Example 1
Example 2
Example 3
Barium Studies
Indications
Benefits
Evaluation of Hollow Organs
Mucosal Evaluation
Relatively inexpensive
Easy to do
Limitations
Patient Resistance to Barium
Limited sensitivity
Radiation exposure
Normal Small Bowel
Crohn’s Disease
Ultrasound
Indications
Benefits
Evaluation of the Biliary Tree, Liver, and Pancreas
Noninvasive
No Radiation dose
Patient Tolerance
Limitations
Poor visualization of hollow GI organs
Limited visualization in obese or distended patients
Immobile (Usually not done at bedside)
Gallbladder Ultrasound
Nuclear Medicine Studies
Indications
Benefits
Liver and Biliary Scanning
GI Bleeding
Gastric Emptying
Noninvasive
Good Patient Compliance
Limitations
Poor Imaging detail
Inconclusive results
Example 1
Normal Biliary Imaging
Example 2
Cholecystitis
GI Bleeding Scans
CT Scanning
Indications
Benefits
Evaluation of Solid organs, ie: Liver, Pancreas, Spleen
Requires IV Contrast
Bowel Wall Evaluation
Requires Oral Contrast
Easily Done
Good Patient Compliance
Limitations
Hollow organs not visualized in detail
Immobile (Cannot be done at bedside)
CT Overview
Slices
Crohn’s Disease
Colonoscopy
Utility
Benefits
“Gold Standard”
Low risk of complications
Limitations
Most accurate method of visualizing the Colon
Diagnostic and Therapeutic
Prep
Sedation
Cost
Video
Normal Colonoscopy
Colitis
Endoscopic Ultrasound
Indications
Benefits
Intramural Lesions
Differentiation of benign vs malignant
Pancreatic Diseases
Biliary Disorders
Increased accuracy over standard US and CT
Limitations
Expensive
Advanced training necessary
Example 1
Intramural Lesion
Example 2
Pancreatic Mass
Capsule Endosco
Capsule Endoscopy
Conclusions
Hollow Organs
Solid Organs
Bleeding
Endoscopy
Small Bowel Capsule Endoscopy
Pain
CT, Ultrasound
CT, Ultrasound, EUS
Screening
Colonoscopy
Medical Therapy
Corticosteroids
Salicylate Preparations
Sulfasalazine: Azulfidine
Mesalamine: Asacol, Pentasa, Colazal
Immune Modulators
Azathioprine/6MP
Methotrexate
Cyclosporin
Entocort
Infliximab: Remicade
Humira
Surgical Therapy
Only done in the face of surgical
complications or medical failure
Small Bowel Resections
Stricturoplasty
Fistula Resections
Proctocolectomy
Other Therapies
Antibiotics
Nicotine
Flagyl, Cipro
Opposite effects in CD and CUC
Nutritional Therapy
Stress Management
Support Groups