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
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