8. Etiology
Diet
Patients with chron’s disease :
Increase intake of
sweet , fatty or
refines food
Decrease intake of
fructose , fruits
, water , K , Mg &
vitamin C
9. Etiology
Infective agents
Patholoical similarities between chron’s
& TB focus attention on mycobacterium
species
Have higher fecal counts of aerobic gram
–ve rods & gram +ve coccoid rods from
cporococcus & peptosterptococcus
10. Clinical
Manifestation
Depending on the severity & site of activity
so the patient can present with systemic &
intestinal symptoms
Anorexia
&
Nausea
Diarrhea
Abdominal
pain
Wieght
loss
Most
Significant
Non Specific
Abdominal
tenderness
12. Endoscopy
Colonoscopy
Most reliable diagnosis as it allow direct
visualization of colon & terminal ileum
Finding of patchy
distribution of disease
with involvement of
colon or ileum but not
rectum
indicate
Chron’s disease
21. Clinical
Manifestation
Patients complain from systemic & intestinal symptoms
Proctitis = Only intestinal symptoms
Proctosigmoiditis = More severe symptoms
Abdominal
pain
Diarrhea
mixed with
blood &
mucous
Elderly suffering
from
proctosigmoiditis
may complain of
constipation
22. Clinical
Manifestation
Determination of severity of ulcerative colitis
quantitavily by monitoring:
The number
of bowel
motions
Macroscopic
appearance
of blood in
stools
Anemia
Erythrocyte
sedimentation
rate
26. Laboratory tests
Haematological & biochemical
values
Iron deficiency anemia
Low ESR
Microbiological examination of
stool
High WBC counts
Low serum albumin
May provide evidence of
infection as a cause of colonic
inflammation
28. NonPharmacological
No specific dietary restrictions are
recommended for patients with IBD
Nutritional strategies :
in patients with long-standing
Administratio
n of vitamin
B12 & folic
acid
Administration
of fat-soluble
vitamins, &iro
n
In severe
cases, enteral
or parenteral
nutrition may
be needed to
achieve
adequate
caloric intake
Patients should
receive a
baseline bone
density
measurement
prior
to receiving
corticosteroids
Vitamin D &
calcium & oral
biphosphonate
should be used
in all patients
receiving longterm
corticosteroids.
41. Immuno
suppressants
Used in patients unresponsive
to steroid & amino salicylates
Eg
Azathioprine
Dose:
1.5–2.5 mg/kg per day orally
Inhibit purine biosynthesis &
reduce IBD-associated GI
inflammation
42. Immuno
suppressants
Used in patients unresponsive
to steroid & amino salicylates
Eg
6Mercaptopurine
Dose:
1.5–2.5 mg/kg per day orally
Active form of
Azathioprine
44. Immuno
suppressants
Used in patients unresponsive
to steroid & amino salicylates
Eg
Cyclosporine
Dose:
4 mg/kg per day
Effective in patients refractory
to cenventional drug therapy
45. Immuno
suppressants
Eg
Infliximab
Effective in patients whose
conventional therapy failed
Dis advantages
Intravenous administration
Significant drug cost
Potential for adverse effects
Adverse
effects
Fever
Chest
Pain
Hypotension
Dyspnea
infusion-related reactions
Associated
with
reactivation
of serious
infections
Exacerbation
of heart
failure
47. Other agents
Eg
Metronidazole
Used in chrons disease &
maybe effective in U.colitis
Dose:
Adults : 500mg 3times for 7-10 days.
Children : 125-250mg./8Hrs.for 7-10 days.
53. Treatment of IBD in Special
Populations
Elderly Patients
Children & Adolescents
Pregnant Women
54. Elderly Patients
Special consideration should be
given to some of the medications used
May
Corticosteroids
According to
Priority
Amino
salicylates
worsen
May
exacerbate
Diabetes
Hypertension
Heart failure
Osteoporosis
Colitis
Immuno
suppressants
Used
Infliximab
In caution with
heart failure
55. Children & Adolescents
major issue in children with IBD is the risk of growth
failure secondary to inadequate nutritional intake
Amino
salicylates
According to
Priority
Azatioprine &
6-mercaptopurine
viable options for
treatment and
maintenance of IBD
in pediatric patients
infliximab
Corticosteroids
higher risk for IBDassociated bone
demineralization
56. Pregnant Women
Amino
salicylates
According to
Priority
Safe to use in
pregnancy, but
sulfasalazine is associated
with folate malabsorption
Corticosteroids
For active disease not
maintenance of remission
Azatioprine &
6-mercaptopurine
Cyclosporine
infliximab
Methotrexate
Minimal risk in
pregnant
Abortifacient &
contraindicated during
pregnancy