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• Presentation varies widely• Characterized by exacerbations & remissions• Affects males and females equally

Ulcerative Colitis Crohn’s Disease

Limited to colon+rectumContinuous

mucosal

“Mouth to anus”TransmuralSkip lesionsgranulomasIndeterminate Colitis

5-10%

Spectrum of Disease

IBD1 IBD2 IBD3 IBD4

SevereDisease

MildDisease

Inflammatory Bowel Disease (IBD)

Etiologic Theories in Inflammatory Bowel Disease

Mucosal Immune Mucosal Immune SystemSystem

(Immuno-regulatory (Immuno-regulatory Defect)Defect)

Environmental Environmental TriggersTriggers

(Lumenal Bacteria, (Lumenal Bacteria, Infection)Infection)

Genetic Genetic PredispositionPredisposition IBD

炎症性肠病是怎么发生的？

Key Differences Between UC and Crohn’s

UC

ColorectalMucosal

continuous

Crohn’s

Mouth to anusTransmuralSkip areas

granulomas

UC Extraintestinal Manifestations

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

CD DiagnosisColonoscopy

• Serpiginous ulcers

• “Cobblestoning”

• Skip areas

Biopsy

• Transmural inflammatory infiltrate

• Noncaseating granulomas

Medical Treatment of IBD

5-ASA medications-blocks production of PG and LT, inhibits bacterial

peptide-induced neutrophil chemotaxis, scavengesreactive 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

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

Ileal pouch – anal anastomosis(IPAA)

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

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