Inflammatory Bowel Disease IBD Ppt Powerpoint Presentation slides-Medical Slideshow Epidemiology and Aetiology of Inflammatory Bowel Disease IBD

Inflammatory Bowel Disease IBD

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Slide 1 :

Inflammatory Bowel Disease (IBD) AM Report April 3, 2007 Maya Styner

Slide 2 :

Overview History of IBD Clinical highlights Crohn's Disease (CD), Ulcerative Colitis (UC) Pathogenesis Diagnosis Therapy

Slide 3 :

HISTORY OF IBD Crohn's: In 850 AD King Alfred, "England's Darling” had a GI illness that began at age 20 At the time the illness was thought to be due to witchcraft, or a punishment for the King's infidelities. It is now thought to be Crohn's disease

Slide 4 :

HISTORY OF IBD Crohn's: In 1913 Dr. Dalziel described transmural intestinal inflammation in 13 autopsied patients. The medical community was not receptive to his findings at the time. In 1930 Burril Crohn's described “terminal ileitis” in a landmark publication in JAMA Ulcerative Colitis: A Greek physician with the unfortunate name of Soranus first described the diarrheal d/o in 130 AD First officially described by Wilks and Moxon in 1875 Before this discovery, all diarrheal diseases were believed to be caused by infectious agents and bacteria.

Slide 5 :

THE IBD COMPARISON

Slide 6 :

IBD COMPARISON CONTINUED

Slide 7 :

Pathogenesis of IBD: Leading theories Inappropriate activation of the mucosal immune system Driven by the normal luminal flora Facilitated by defects in the barrier function of the intestinal epithelium and the mucosal immune system Genetics are non-Mendelian (multiple genes thought to contribute) and likely more important in CD than UC 7% risk in first-degree relatives of dz Endothelial defect with microthromboembolic dz also thought to play a role (hence possible tx w/ Viagra) NOD2/CARD 15 is the most promising CD candidate gene located on chromosome 16 in the IBD1 locus

Slide 8 :

NOD2/CARD15 NOD2/CARD 15 in macrophages binds to muramyl dipeptide (MDP) an important bacterial cell wall component in order to sense and clear intracellular bacteria A loss of function mutation in NOD2 attenuates induction of NF-?B- dependent pro-inflammatory cells. N Engl J Med 347 (6) 2002

Slide 9 :

Pathogenesis Crohn's Strongly debated recently Previously thought to be T-cell mediated Recent work shifting away from T-cell adaptive immunity and towards an aberrant innate immune response, which subsequently leads to T-cell activation

Slide 10 :

Diagnosis of IBD Send stool WBC, O&P, Cdiff, exclude infection Establish diagnosis via endoscopy P-ANCA and ASCA serology can be useful in indeterminant cases UC with continuous and circumferential involvement, with no normal areas of mucosa. Courtesy of James B McGee, MD. Uptodate 2007

Slide 11 :

Diagnosis of IBD Crohn's disease with the characteristic patchy erythema (left panel) and ulceration (right panel) that occur next to areas of normal mucosa. Courtesy of James B McGee, MD. From Uptodate 2007

Slide 12 :

Sulfasalazine and 5-ASA mild to moderate CD/UC and maintenance in UC ? use sulfasalazine for CD ileitis, instead use 5-ASA compounds such as Asacol or Pentassa Sulfasalazine, not mesalamine, may ameliorate arthropathy in ankylosing spondylitis associated with inflammatory bowel disease IBD Therapy per AGA 2006 Guidlines

Slide 13 :

Antibiotics Active luminal CD (esp metronidazole) Fistulizing CD Postop recurrence No evidence in UC Pouchitis Infectious complications IBD Therapy per AGA 2006 Guidlines

Slide 14 :

IBD Therapy per AGA 2006 Guidlines Steroids: Budesonide : ileal and R sided colonic CD Prednisone: moderate to severe dz, failure of 1st line tx such as mesalamine (UC) or budesonide (CD) Topical hydrocortisone or budesonide for d. colon inflammation Perianal fistulas: steroids not useful IV steroids/ hospitalize if severe dz and failure of PO Not recommended as maintenance tx for CD/ UC If unable to taper steroid, this is indication for antimetabolite and/or infliximab Monitor: bone mineral density, ophtho exam, adrenal insuff, glucose intolerance

Slide 15 :

Azathioprine and 6-MP: For steroid- dependent IBD in order to attempt to d/c steroids Measure CBC w/diff q2wk during dose adjustment Thiopurine methyltransferase genotype ? post-op recurrence in CD Perianal and enteric fistulae Remission maintenance in CD ? steroid use in UC IBD Therapy per AGA 2006 Guidlines

Slide 16 :

Methotrexate: IV MTX for induction in active CD or maintenance of remission in inactive CD Induction w/ steroid withdrawal in active CD Weekly IM MTX is effective for chronic active CD Do not use in pregnancy Insufficient evidence for induction or maintenance in UC Monitor: CBC, LFT IBD Therapy per AGA 2006 Guidlines

Slide 17 :

Mycophenylate mofetil Lack of evidence for efficacy in IBD Cyclosporine Induction in UC Efficacy for CD w/ high doses (?toxicity) Fistulizing CD w/ IV cyclosporine Severe steroid-refractory UC Concomitant steroids used in severe UC Goal to bridge to AZA or 6-MP as maintenance tx ? use in luminal CD Fistulizing CD with bridge to AZA or 6-MP IBD Therapy per AGA 2006 Guidelines

Slide 18 :

Infliximab (TNF-? antibody) CD with inadequate response to conventional tx If used for induction, continue w/ maintenance Fistulizing CD UC patients without adequate response to conventional tx Withdraw or taper concomitant steroids Avoid: active infection, demyelinating d/o, CHF, malignancy, screen for TB IBD Therapy per AGA 2006 Guidlines

Slide 19 :

References Podolsky DK. Inflammatory Bowel Disease. N Engl J Med 2002 ;347(6):417-29 Korzenik JR. Is Crohns disease due to defective immunity? Gut 2007. 56: 2-5 Weber CR, Turner JR. Inflammatory bowel disease: is it really just another break in the wall? Gut 2007: 56: 6-8 Uptodate 2007 Sands B.

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3 Apr 2007Is Crohns disease due to defective immunity? Gut 2007. 56: 2-5; Weber CR, Turner JR. Infl more 3 Apr 2007Is Crohns disease due to defective immunity? Gut 2007. 56: 2-5; Weber CR, Turner JR. Inflammatory bowel disease: is it really just another ... less

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