1 / 21

Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease. 浙江大学医学院附属邵逸夫医院 曹 倩. 学习目标. 掌握 IBD 的发病机制 掌握 IBD 临床表现和治疗 掌握溃疡性结肠炎和克罗恩 病的鉴别. 炎症性肠病 Inflammatory Bowel Disease (IBD). chronic, relapsing, immunologically-mediated inflammatory condition of the GI tract

keona
Download Presentation

Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Inflammatory Bowel Disease:Ulcerative Colitis & Crohn’s Disease 浙江大学医学院附属邵逸夫医院 曹 倩

  2. 学习目标 • 掌握IBD的发病机制 • 掌握IBD临床表现和治疗 • 掌握溃疡性结肠炎和克罗恩 病的鉴别

  3. 炎症性肠病Inflammatory Bowel Disease (IBD) • chronic, relapsing, immunologically-mediated inflammatory condition of the GI tract • Presentation varies widely • Characterized by exacerbations & remissions • Affects males and females equally

  4. IBD1 IBD2 IBD3 IBD4 SevereDisease MildDisease Spectrum of Disease Ulcerative Colitis Crohn’s Disease Limited to colon+rectum Continuous mucosal “Mouth to anus” Transmural Skip lesions granulomas Indeterminate Colitis 5-10%

  5. Inflammatory Bowel Disease (IBD)

  6. Mucosal Immune System (Immuno-regulatory Defect) Genetic Predisposition IBD Environmental Triggers (Lumenal Bacteria, Infection) Etiologic Theories in Inflammatory Bowel Disease

  7. 炎症性肠病是怎么发生的？

  8. Key Differences Between UC and Crohn’s Crohn’s Mouth to anus Transmural Skip areas granulomas UC Colorectal Mucosal continuous

  9. UC Extraintestinal Manifestations

  10. Clinical Presentation: CD • Patchy, transmural inflammation • Affects any part of the GI tract • Can have skip lesions • Stricturing • Obstructions • Fistulizing • Entero-enteric, entero-vesical, anal • Hemorrhage is less common than UC

  11. CD Diagnosis Colonoscopy • Serpiginous ulcers • “Cobblestoning” • Skip areas Biopsy • Transmural inflammatory infiltrate • Noncaseating granulomas

  12. Medical Treatment of IBD 5-ASA medications -blocks production of PG and LT, inhibits bacterial peptide-induced neutrophil chemotaxis, scavenges reactive oxygen metabolites, inhibits NF-kB 6-MP / azathioprine -suppresses T cell function Steroids Infliximab - binds soluble TNF, may lead to monocyte apoptosis Cyclosporine - Inhibits lymphocyte activation

  13. Treating severe CD (and UC) • Infliximab (Remicade) • Chimeric anti-TNF monoclonal Ab • Strong anti-inflammatory effect • Effective in both active and fistulizing CD • Needs repeated infusions Remission: 39-45% at 30 weeks* Fistula closure: initial response 69% complete response at 12 mths: 36%** *ACCENT-1, **ACCENT-2

  14. Ileal pouch – anal anastomosis(IPAA)

  15. Surgery for CDGeneral Guidelines Indications: • Failure of medical therapy • Complications • Suspicious for CA • Surgery is not curative • Repeated operations may be necessary • Principle: Bowel conservation

  16. Summary • IBD is a chronic inflammatory condition of the GI tract with unclear etiology and no known cure • A spectrum of disease • Requires multidisciplinary approach

More Related