Review of Inflammatory Bowel Disease

2016 ◽  
Author(s):  
Joshua Guttman ◽  
Frederick Davis
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Supportive Therapy ◽  
Signs And Symptoms ◽  
Aminosalicylic Acid ◽  
Gi Tract ◽  
Hospital Patients ◽  
Inflammatory Bowel

Inflammatory bowel disease (IBD) is an inflammatory condition of the gastrointestinal (GI) tract made up of ulcerative colitis (UC) and Crohn disease (CD). These diseases are differentiated based on the location in the GI tract and findings on colonoscopy and biopsy. Management in the emergency department is similar for these two conditions. Patients presenting with exacerbations of known IBD should be classified according to severity and managed accordingly. Mild to moderate disease will require only a limited workup consisting of testing for anemia and electrolyte abnormalities. These patients may be discharged with a 5-aminosalicylic acid (5-ASA) agent, or if the condition is refractory to 5-ASA, then with oral budesonide. Severe or fulminant disease will need intravenous hydration, intravenous corticosteroids, computed tomography (CT) to assess for intestinal complications, and admission to the hospital. Patients with abscesses, colitis, or ileitis on CT will need antibiotics. Additionally, patients should be evaluated for both intestinal complications, such as strictures and fistulas, and extraintestinal manifestations, the majority of which are dermatologic and ophthalmologic. Patients with fulminant complications, toxic megacolon and intestinal perforation, should receive intravenous antibiotics, hydration, and immediate surgical consultation. Patients presenting with signs and symptoms of IBD but without a known diagnosis should receive supportive therapy. If discharged, they should be referred to a gastroenterologist for colonoscopy to make an appropriate diagnosis and to initiate therapy.   Key words: Inflammatory bowel disease (IBD), gastrointestinal (GI) tract, ulcerative colitis (UC), Crohn disease (CD), colonoscopy, fulminant complications   This review contains highly rendered 5 figures, 5 tables, and 30 references.

scholarly journals Crohn’s disease and ulcerative colitis patient-reported outcomes signs and symptoms for the remote management of inflammatory bowel disease during the COVID-19 pandemic

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Sergio Pinto ◽  
Erica Loddo ◽  
Salvatore Paba ◽  
Agnese Favale ◽  
Fabio Chicco ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Bowel Disease ◽  
Patient Reported Outcomes ◽  
Signs And Symptoms ◽  
Patient Reported ◽  
Inflammatory Bowel ◽  
Active Patients ◽  
Active Disease

Abstract Background and aims The COVID-19 pandemic has led to a deep reorganization of hospital services including inflammatory bowel disease (IBD) units. In this situation, conversion of in-person routine follow-up visits into phone consultations might be necessary. Here we explored the feasibility of using the validated Crohn’s Disease (CD) or Ulcerative Colitis (UC) Patient-Reported Outcomes Signs and Symptoms (CD- and UC-PRO/SS) to collect data about abdominal symptoms (abdominal/S) and bowel signs and symptoms (bowel/SS) remotely. Methods CD- and UC-PRO/SS were collected during phone consultations and compared among patients with active and inactive disease. The effectiveness of therapeutic intervention in patients with active disease was assessed by PRO/SS variation. Results Twenty-one CD and 56 UC patients were evaluated by phone. Six (28.6%) CD and 15 (26.8%) UC patients were considered to have active disease. In CD the bowel/SS but not the abdominal/S module was significantly higher in active patients (mean bowel/SS 2.50 [SE ± 0.44] active vs 0.76 [SE ± 0.18] remission, p = 0.008, AUC 0.87; mean abdominal/S 1.11 [SE ± 0.38] active vs 0.24 [SE ± 0.13] remission, p = 0.066). UC-PRO/SS measures were significantly higher in active patients as compared to patients in remission (median bowel/SS 1.63 [SE ± 0.24] active vs 0.33 [SE ± 0.04] remission; p < 0.0001, AUC 0.91; mean abdominal/S 1.03 [SE ± 0.24] vs 0.37 [SE ± 0.12]; p = 0.009, AUC 0.71). Therapy was escalated in 12 patients (3 CD and 9 UC) due to disease relapse. Therapy escalation resulted in the reduction of PRO/SS as evaluated at the subsequent phone consultation. Conclusions PRO/SS might represent a feasible tool to evaluate disease activity and therapy outcome in IBD patients during periods of limited access to outpatient clinics.

scholarly journals News and controversy in inflammatory bowel disease treatment

2013 ◽  
pp. 179-186
Author(s):  
Giulia Straforini ◽  
Ramona Brugnera ◽  
Rosy Tambasco ◽  
Fernando Rizzello ◽  
Paolo Gionchetti ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Topical Treatment ◽  
Preventive Treatment ◽  
High Dose ◽  
First Choice ◽  
Oral Steroids ◽  
Inflammatory Bowel

Background: The treatment of Inflammatory bowel disease comes from many years of esperience, clinical trials and mistakes. Discussion: In patients with active Crohn disease steroids are considerated the first choice, but recently, the introduction of anti-TNF alfa agents (infliximab and adalimumab) has changed the protocols. Anti-TNF are also used for closing fistula after surgical curettage. An efficently preventive treatment of Crohn disease still has not been found but hight dose of oral salicylates, azatioprine or 6-MP and antibiotics might be useful. In severe attacks of ulcerative colitis, high dose iv treatment of steroids are required for a few days. Later on, a further treatment with anti- TNF might delay the need of surgery. In patients with mild to moderate attacks of ulcerative colitis, topical treatment is preferred, it consists of enemas, suppositories or foams containing 5-aminosalycilic acid, traditional steroids, topical active steroids. Topical treatment can be associated with oral steroids or oral salicylates. Oral salicylates or azatioprine are used for prevention of relaps.

scholarly journals FREQUENCY OF OPHTHALMOLOGICAL POSTERIOR SEGMENT FINDINGS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

2018 ◽  
Vol 55 (2) ◽  
pp. 188-191 ◽  
Author(s):  
Luis Filipe NAKAYAMA ◽  
Vinicius Campos BERGAMO ◽  
Marina Lourenço de CONTI ◽  
Lívia BUENO ◽  
Nilva Simeren Bueno de MORAES ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Posterior Segment ◽  
Oct Angiography ◽  
Ophthalmological Examination ◽  
Study Objective ◽  
Systemic Inflammatory Disease ◽  
Inflammatory Bowel

ABSTRACT BACKGROUND: Inflammatory bowel disease is a systemic inflammatory disease classified as Crohn disease or ulcerative colitis. It could present extra intestinal findings, such as fever, weight loss, arthralgia, mucocutaneous lesions, hepatic, renal and ophthalmological involvement. Among ophthalmological findings, posterior segment findings are present in less than 1% of patients with inflammatory bowel disease, however, these findings could bring definitive visual impairment. OBJECTIVE: Our study objective was to evaluate ocular posterior segment findings is patients with inflammatory bowel disease, through retinal mapping, color fundus retinography, optical coherence tomography (OCT) and OCT angiography, and compare our results to literature. METHODS: We evaluated eighty patients with inflammatory bowel disease through complete ophthalmological examination and posterior segment assessment. Color fundus retinography, OCT and OCT angiography was performed with Topcon Triton (Topcon ® , Tokyo, Japan). Macula and posterior pole were evaluated with binocular indirect ophthalmoscopy and fundus biomicroscopy. RESULTS: Participants mean age was 44.16 years (18.08-68.58), 28 (35%) male patients and 52 (65%) female patients. Thirty-five (44%) with diagnosis of Crohn disease, 41 (52%) patients with diagnosis of ulcerative colitis and 3 (4%) had non-conclusive Crohn disease or ulcerative colitis classification. We found abnormal exams in 21 (26.25%) patients. CONCLUSION: Our study found similar prevalence of ophthalmological posterior segment commitment compared to previous literature prevalence. The findings were predominantly unrelated to inflammatory bowel disease, rather than primarily related to it. The most prevalent, and non-previous reported, finding was increased arteriolar tortuosity, probably occurs due to systemic vascular impairment in inflammatory bowel disease.

scholarly journals Overview of 5-ASA in Therapy of Inflammatory Bowel Disease

1994 ◽  
Vol 8 (6) ◽  
pp. 379-382 ◽  
Author(s):  
CN Williams
Keyword(s):  
Ulcerative Colitis ◽  
Drug Delivery ◽  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Bowel Disease ◽  
Therapeutic Benefit ◽  
Effective Dosage ◽  
Free Oxygen Radicals ◽  
Aminosalicylic Acid ◽  
Inflammatory Bowel

There are two forms of 5-aminosalicylic acid (5-ASA) drug delivery. First, a pro-drug form in which 5-ASA, the active principal, is attached to a c.arrier molecule and released in the intestine by bacterial cleavage. An example of this is sulfasalazine, originally developed in the 1940s and found to be effective, cheap, but limited by side effects due to the sulfapyridine component. The second drug delivery system depends on an enteric coating for delayed pH-dependent release or for a timed-released mechanism. 5-ASA inhibits 5-lipoxygenase, modulates leukocyte function and inhibits soluble mediator release, and is an effective scavenger action of free oxygen radicals, the relative importance of which is unknown. The multiplicity of action is probably its strength because drugs that have only one of these actions are relatively ineffective in inflammatory bowel disease. 5-ASA compounds are effective in treating mild to moderate acute ulcerative colitis and in maintaining remission, and are equivalent to sulfasalazine in this regard. 5-ASA used topically in enema or suppository form is highly efficient in both acute disease and in maintaining remission. 5-ASA is also effective in active Crohn’s disease, but not as effective as in maintenance therapy compared with ulcerative colitis. The pro-drugs tend to have more side effects. Slow release compounds are well tolerated with few side effects, allowing increases to effective dosage. In patients intolerant of sulfasalazine, switching to a 5-ASA preparation usually results in tolerance and therapeutic benefit, with an occasional allergic reaction to the 5-ASA molecule limiting its use.

Ulcerative Colitis and Crohn Disease in Children

1987 ◽  
Vol 9 (4) ◽  
pp. 109-120
Author(s):  
Kathleen J. Motil ◽  
Richard J. Grand
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Correct Diagnosis ◽  
Age Groups ◽  
Growth Failure ◽  
Clinical Findings ◽  
Chronic Inflammatory Bowel Disease ◽  
Inflammatory Bowel

Once considered rare in pediatric practice, chronic inflammatory bowel disease is now recognized with increasing frequency in children. Ulceractive colitis and Crohn disease constitute the two major entities, and it is still not clear whether these are two separate entities or different portions of the spectrum of one disease. Abdominal pain, diarrhea, rectal bleeding, weight loss, and anemia are prominent findings in both ulcerative colitis and Crohn disease; however, extraintestinal manifestations may dominate the clinical findings, masquerading as juvenile rheumatoid arthritis, idiopathic growth failure, or even anorexia nervosa. Often, it is not until intestinal manifestations are recognized that a correct diagnosis is made.1 EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE Since 1950, there has been an increase, in the incidence of Crohn disease, ranging from 100% to 400% in all age groups.2 In contrast, the incidence of ulcerative colitis has not changed significantly. Ulcerative colitis is diagnosed in 15% of patients before the age of 20 years, usually in adolescence. Although ulcerative colitis may occur in infancy, inflammatory disease of the colon during the first year of life is more often due to food allergy3 or infectious disease. Certain groups of children are at greater risk for the development of inflammatory bowel disease. Ulcerative colitis and Crohn disease occur more commonly among Northern European, Anglo-Saxon races, in urban rather than rural dwellers, and in Jewish individuals living in Europe and North America.

Monocytosis Is a Biomarker of Severity in Inflammatory Bowel Disease: Analysis of a 6-Year Prospective Natural History Registry

2021 ◽  
Author(s):  
Alyce Anderson ◽  
Cynthia Cherfane ◽  
Benjamin Click ◽  
Claudia Ramos-Rivers ◽  
Ioannis E Koutroubakis ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Natural History ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Disease Type ◽  
Care Utilization ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) is associated with alterations of the innate and adaptive immune systems. Monocytes respond to inflammation and infection, yet the relationship between monocytosis and IBD severity is not fully understood. We aimed to characterize the prevalence of monocytosis in IBD and the association between monocytosis and disease severity and IBD-related health care utilization. Methods We used a multiyear, prospectively collected natural history registry to compare patients with IBD with monocytosis to those without monocytosis, among all patients and by disease type. Results A total of 1290 patients with IBD (64.1% with Crohn disease; 35.9% with ulcerative colitis) were included (mean age 46.4 years; 52.6% female). Monocytosis was found in 399 (30.9%) of patients with IBD (29.3% with Crohn disease; 33.9% with ulcerative colitis). Monocytosis was significantly associated with abnormal C-reactive protein level and erythrocyte sedimentation rate, anemia, worse quality of life, active disease, and increased exposure to biologics (all P &lt; 0.001). Compared with patients without monocytosis, patients with monocytosis had a 3-fold increase in annual financial health care charges (median: $127,013 vs. $32,925, P &lt; 0.001) and an increased likelihood of hospitalization (adjusted odds ratio [AOR], 4.5; P &lt; 0.001), IBD-related surgery (AOR, 1.9; P = 0.002), and emergency department (ED) use (AOR, 2.8; P &lt; 0.001). Patients with monocytosis had a shorter time to surgery, hospitalization, and ED visit after stratifying by disease activity (all P &lt; 0.05). Conclusions Patients with IBD with monocytosis, regardless of disease type, are at increased risk for worse clinical outcomes, hospitalization, surgery, and ED use. Peripheral monocytosis may represent a routinely available biomarker of a distinct subgroup with severe disease.

Colonic Disorders

2016 ◽  
pp. 217-228
Author(s):  
Conor G. Loftus
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Chronic Inflammation ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Key Factor ◽  
Inflammatory Bowel

Inflammatory bowel disease refers to 2 disorders of unknown cause: ulcerative colitis and Crohn disease. Other possible causes of inflammation, especially infection, should be excluded before making the diagnosis of inflammatory bowel disease. The presence of chronic inflammation on biopsy is the key factor for making a diagnosis of inflammatory bowel disease.

scholarly journals Five-Aminosalicylic Acid: An Update for the Reappraisal of an Old Drug

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Cristiana Perrotta ◽  
Paolo Pellegrino ◽  
Eliana Moroni ◽  
Clara De Palma ◽  
Davide Cervia ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Immune Response ◽  
Crohn’S Disease ◽  
Mechanism Of Action ◽  
Bowel Disease ◽  
Therapeutic Option ◽  
Aminosalicylic Acid ◽  
Safety And Efficacy ◽  
Inflammatory Bowel

Inflammatory bowel disease (IBD) comprises several conditions with chronic or recurring immune response and inflammation of the gastrointestinal apparatus, of which ulcerative colitis and Crohn’s disease are the commonest forms. This disease has a significant prevalence and it is of an unknown aethiology. Five-aminosalicylic acid (5-ASA) and its derivatives are among the oldest drugs approved for the treatment of the IBD. In this review we reapprise aspects of 5-ASA mechanism of action, safety, and efficacy that in our opinion make it a valuable drug that can be fruitfully tailored in personalised treatments as a therapeutic option alongside other immune-modifying agents.

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