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IBD Inflammatory Bowel Disease

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Presentation on theme: "IBD Inflammatory Bowel Disease"— Presentation transcript:

1 IBD Inflammatory Bowel Disease
Dr. László Orosz Surgical Department University Of Debrecen

2 IBD Crohn’s Disease Ulcerative colitis

3 Suspicion of IBD Diarrhoea for more than 4 weeks
Opening the bowels more than twice a day wet/fluid-like stool Abdominal pain Stool containing blood, mucus or pus

4 Ulcerative colitis Chronic inflammatory bowel disease that is only localised in the mucus membrane of the colon/rectum. There are ulcers and signs of inflammation in the rectum and the colon. It is a recurrent disease. Diarrhoea, bloody stool, crampy abdominal pain, weight loss, loss of appetite Diffuse ulceration in colon mucus membrane, crypt abscess, infiltration.

5 Crohn’s disease Chronic, segmental or multy-segmental. All the layers of the intestine is affected Both small intestines and the colon might be affected Cramp-like abdominal pain, weight loss, diarrhoea, fever Local inflammation, micro-erosions, fissures, granuloma, fistulas , infiltrations, lymphatic vessel enlargement




9 Localisation Ulcerative Colitis Sigmoid-rectum 54% Left colon 27%
Pancolitis % Crohn’s disease Small intestine and colon 50% Ileitis % Colitis % Anorectal %

10 Distribution of gastrointestinal Crohn's disease.

11 Epidemiology Young age Incidence has not changed in the recent years Crohn’s disease: 6/100000 Ulcerative Colitis: 2-3/ in the developped countries 10-20 x frequent in afected families genetical predisposition: In1996-ban Hugot et al found IBD1 locus on the 16 chromosome, which predispose for CD, IBD2 that predispose for CU


13 Ethiology Unknown!! Infective: herpes, measeles, E. coli, M. paratuberculosis Genetic background: familiar disposition Diet? Immune system: autoimmune? Emmotional status

14 Symptoms Ulcerative Coilits Crohn’ disease Bleeding 80% 22%
Diarrhoea % % Abdominal pain 47% % Fistulas % % Weight-loss % % Fever % % Anaemia % % Joint pain % % Eye symptoms % %

15 Extraintestinal symptoms
Arthritis, polyarthritis % Erythema nod., Pyoderma gangr % Fatty liver, Chr. Active hepatitis, PSC % Iridocyclitis, Uveitis % Oral, stomatitis aphtosa % Alveolitis, lung fibrosis <1%


17 Diagnostics: Crohn’s disease
Colonscopy, (biopsy) capsule-endoscopy X-ray, Barium anema and meal UH, CT Laboratory (blood) tests ( Sedimentation, WBC, CRP, liver enzymes, stool culture )


19 Endoscopy image of colon showing serpiginous ulcer, a classic finding in Crohn's disease


21 Crohn's disease can mimic ulcerative colitis on endoscopy
Crohn's disease can mimic ulcerative colitis on endoscopy. This endoscopic image is of Crohn's colitis showing diffuse loss of mucosal architecture, friability of mucosa in sigmoid colon and exudate on wall, all of which can be found with ulcerative colitis.

22 Endoscopic image of colon cancer identified in the sigmoid colon (anatomy) on screening colonoscopy for Crohn's disease.

23 Diagnostics: Ulcerative colitis
Colonscopy, (biopsy) capsule-endoscopy X-ray, Barium anema and meal UH, CT Laboratory (blood) tests ( Sedimentation, WBC, CRP, liver enzymes, stool culture )



26 Endoscopic image of a sigmoid colon afflicted with ulcerative colitis
Endoscopic image of a sigmoid colon afflicted with ulcerative colitis. Note the vascular pattern of the colon granularity and focal friability of the mucosa.

27 Colonic pseudopolyps of a patient with intractable ulcerative colitis
Colonic pseudopolyps of a patient with intractable ulcerative colitis. Colectomy specimen.

28 Patients with ulcerative colitis can occasionally have aphthous ulcers involving the tongue, lips, palate and pharynx

29 Endoscopic image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.

30 Biopsy sample (H&E stain) that demonstrates marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.

31 H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis

32 Medical therapy Pentasa Steroids, imuran, (budesonid)
Anti-TNF-alfa (Remicade) Ciprofloxacin, metronidazol Nutritional advices

33 Crohn’s disease: Therapy
Acute fulminate: exclusion of abscess than Steroid mg, wide spectrum antibiotics Subacute disease: Steroid in decreasing dosage Budenofalk, sulfasalazin, Pentasa, Salofalk, metronidasol Chronic: constant low dose steroid, Imuran, 5-aminosalicyl

34 Ulcerative colitis :Therapy
Acute inflammation: Steroid, antibioticum, 5-ASA Chronic : 5-ASA, Imuran

35 Crohn’s disease: complications
Stenosis, ileus (bowel obstruction) Fistula formation Abscess formation Bleeding Toxic megacolon Malignant transformation


37 Ulcerative colitis: complications
Stenosis, ileus (bowel obstruction) bleeding Perforation, abscess formation, peritonitis Toxic megacolon Malignant transformation

38 Crohn’disease: Surgical therapy
Maximally conservative !!! Resection (preserving as much small intestine as possible!) Srticturopalsty (small intestine)









47 Toxic megacolon

48 Ulcerative colitis: Surgical treatment
In acute case: Hartmann procedure Proctocolectomy Elective operation: Proctocolectomy with ileostomy Total colectomy with ileo-rectal anastomosis Proctocolectomia , ileo-analis anastomisis with ileum pauch Proctocolectomia, Koch-reservoir

49 Colon J-pouch

50 J-pouch





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