الفهرس 
INFLAMMATORY BOWEL DISEASEOnly 14 pages are availabe for public view
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Abstract
IBD is a general term used to discribe the two desease UC&CD with increased the incidence from 3.9 in 1987 to 7.0 in 2003.
Pathogenesis of IBD:
Genetic factors: which are the important factors in the development of IBD.
Environmental factors: cigarette smoking is a risk factor for CD but paradoxically protects against UC.
Comparison between CD& UC:
Ulcerative colitis:
Is a chronic inflammatory disease involving primarily the larg intestine.
Epidemiology & pathphysiology :
There is higher probability of proximal extention and pancolitis in children more than adults 90% of newly diagnosed children compared to 37% of newly diagnosed adults.
Pathlogy:
Gross pathology:
The macroscopic appearance of the colon in UC varies with the extent of the disease as well as the degree of activity.
Histology:
The histologic feature of UC are those of a chronic idiopathic colitis.
UC typically shows atrophic crypts that do not extend to muscularis mucosae which is infiltrated by neutrophils.
Diagnosis:
Chronicity is an important part of the diagnosis. Intestinal manifestations; diarrhea, tenesmus, urgency and abdominal pain.
Extra intestinal manifistation; pyoderma gangrenosum, sclerosing cholangitis.
Laboratory marker; children with IBD often present with anemia, elevated ESR, CRP.
Fecal marker; non invasive way of measuring inflammation of bowel in the diagnosis and monitoring of IBD.
Serological biomarkers; specific microbial antigen used to screen patients with IBD and distinguish between CD and UC.
Endoscopy; a safe and well-tolerable procedure with low complication rates for the diagnosis of UC.
Ultrasound; detection of inflammatory hyperperfusion and morphological changes of intestinal wall at site of inflammation.
Magnetic resonance imaging ; essential for stage accurately, location, extent and type of intestinal inflammation.
Computed tomography; less expensive, less time consuming and greater availability.
Crohn’s disease;
an idiopathic chronic inflammatory condition that can affect the entire bowel from mouth to anus.
Clinical picture:
Intestinal manifestations; diarrhea, bleeding, cramping, epigastric pain, vomiting, fistulae.
Extra intestinal manifestations; oral aphthus ulcer, peripheral arthritis.
Pathlogy:
Gross pathology; segmental and deep inflammation represent the hallmark feature of CD.
Histology; CD represents a chronic inflammatory process with degrees of activity.
Diagnosis:
Routine laboratory screening; ESR, CRP, and CBC.
Serological biomarkers; there are five biomarkers avialable for predict the severity of the disease.
Fecal markers; are proteins that released from activated neutrophil in bowel mucosa.
Ultra sound; detect complication of CD as abscess.
Magnetic resonance imaging; less invasive examination and detect extra-intestinal complications.
Computed tomography; detect segmental thickening, extra luminal lesions and complication.
Endoscopy; essential in establishing the diagnosis of IBD and distinguishing CD from UC.
Vediocapsular endoscopy; if other modalities not avialable.
Treatment of IBD:
Treatment of UC:
Medical therapy:
Nutritional therapy; nutritional intervention are critically important therapies for children with IBD.
Pharmacological treatment:
Sulfasalazine and 5-aminosalicylates; locally active medication for both induction and maintenance therapy in UC.
Corticosteroid; highly effective anti-inflammatory but increasingly avoided due to its toxicities.
Immunomodulators; cyclosporine, tacrolimus, methotrexate which blok the production of interleukine-2.
Remision maintenance therapy :
Immunomodulator; 6-mercaptopurine .
Biological treatment:
Infliximab; one of the more important proinflammatory cytokinees in both UC and CD.
Antibiotic; metronidazol and ciprofloxacin
Probiotic; VSL#3, E-coli Nissle 1971, fermented milk.
Surgical therapy:
For failure of medical treatment, patients at risk for colonic mucosal aneuploidy and neoplasia.
Restorative proctocolectomy is the most common operation.
Prognosis; the course of UC marked by remission and exacerbation.
Treatment of CD:
Aim of treatment are relieving the symptoms and prevent the complications.
Nutritional treatment; nutritional modalities have shown promising as primary therapy for children with CD, due to nausea and vomiting, and is essential before surgery.
Pharmacological treatment :
Salfasalazine and 5-aminosalicylate.
Corticosteroid; used in the majority of children with CD with moderate to severe disease.
Immunomodulators; methotexate, cyclosporine, tacrolimus, 6-mercaptopurine and azathioprine.
Biological therapy; Infliximab wich used in active disease.
Antibiotic; ciprofloxacin and ornidazole.
Probiotic; VSL#3 and non pathogenic yeast.
Surgical therapy :
Stricture, haemorage, intra-abdominal abscess and perianal disease.
Prognosis:
CD is a chronic disease that is associated with high morbidity but low mortality.
Nearly all individuals with CD eventually require surgery.
Other types of IBD:
Collagenous colitis
Lymphocytic colitis
Ischaemic colitis
Divertion colitis
Behcet’s colitis
Indeterminate colitis
General health maintenance of IBD:
Vaccination
Laboratory examination
Colonoscopy
Tobacco cessation
Osteoporopsis
Depression