Transcript Inflammatory Bowel Disease - Illinois Gastroenterology Group

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