Inflammatory Bowel Disease

(Ulcerative Colitis , Crohn's

Disease)
Clinical Immunology
Inflammatory bowel disease (IBD):

is a term for two conditions (Crohn's disease

and ulcerative colitis) that are characterized
by chronic inflammation of the
gastrointestinal (GI) tract. Prolonged
inflammation results in damage to the GI tract.
Ulcerative Colitis UC
is a chronic inflammatory condition of the colon
that is marked by remission and relapses.
Etiology of UC
Exact cause of UC remains unclear
Three characteristics that define the etiology
Genetic susceptibility
Altered response to gut microorganisms
Immune dysregulation
 Pathogenesis
Under physiologic conditions , homeostasis normally
exists among
1. The commensal gut flora
2. Epithelial cells that line the interior of the
intestines
3. Immune cells within the tissues .
This homeostasis is disrupted in susceptible host by
 Specific environmental (e.g. diet, antibiotics , entero -
pathogens , stress) a
 Genetic factors
• Resulting in :
Hyper-activation of T helper 1 (Th1) and Th17 cells,
increase in tight junction permeability, leading to
uncontrolled chronic inflammation (UC)
are multiprotein
junctional complexes
prevent leakage of
solutes and water and
seals the paracellular
pathway.
 Pathology
Inflammation is limited to the mucosal layer of the colon.
• Proctitis/ proctosigmoiditis
• Left sided colitis/ extensive colitis
• Pancolitis fulminant disease where inflammation extend
beyond the mucosal layer and can develop a toxic
megacolon.
complications of ulcerative colitis can involve other
parts of the body :
-inflammation of the joints (arthritis).
-low back pain due to arthritis of the sacroiliac joints.
-tendency to form blood clots.
 Diagnosis
Diagnosis relies on a combination of
• Clinical features
• Endoscopic appearances
• Histologic findings
• Disease mimickers should be excluded
 Laboratory studies
 CBC
 Leukocytosis
 Anemia
 Thrombocytosis
Inflammatory markers
• ESR and CRP correlates with disease activity

• Fecal calprotectin (FC): a calcium binding protein

which is released from migrant neutrophils.

High levels of calprotectin in stool may signal IBD,

colorectal cancer, or infection. Moderate or low
levels mean there's little to no inflammation present
in the intestines
Stool assays: Used to exclude other causes and to
rule out infectious enterocolitis.
Tests include:
• Evaluation of fecal blood or leukocytes
• Ova and parasite studies
• Viral studies
• Culture for bacterial pathogens
• Clostridium difficile titer
 Serological studies
Antineutrophil cytoplasmic antibodies ANCA
Positive in 60%-80% of patients,

 helpful in predicting disease activity.

 Associated with an earlier need for surgery

Colonoscopy/ Sigmoidoscopy
Imaging Studies
 Plain Abdominal X-ray:
 Barium Enema
 CT scan
 Crohn’s disease
An autoimmune condition causes the immune system to
mistakenly attack the body, sometimes causing
inflammation.
What causes Crohn’s disease?

1. Immune System
2. Genes
3. Environment
 Types Of Crohn’s Disease

1. Ileocolitis: This is the most common type of Crohn’s disease. It

affects the small and large intestines.

2. Ileitis: This form of the condition only affects the small intestine.

3. Gastroduodenal Crohn’s disease: This affects the stomach and

the beginning of the small intestine.

4. Jejunoileitis: This causes spots of inflammation in the upper

portion of the small intestine, called jejunum.

5. Crohn’s colitis: This only affects the colon.

 Crohn’s Diagnosis

 Blood tests to detect anemia and inflammation.

 A stool test to detect blood in the GI tract.
 Endoscopy to get a better image of the inside
of upper gastrointestinal tract.
 Colonoscopy to examine the large bowel.

 Imaging tests like CT scans and MRI scans give

more detail than an average X-ray.
 Biopsy, taken during an endoscopy or
colonoscopy for a closer look at the intestinal
tract tissue.
Treatment for Crohn’s disease

A cure for Crohn’s disease isn’t available yet, but the

disease can be managed by Medications:

• Anti-inflammatory drugs

• Immunomodulators

• Antibiotics

• Biologic therapies
ANY QUESTIONS
What is Crohn's disease?
A. Caused by an allergy to gluten
B. Closely related to celiac disease
C. A chronic inflammatory disease of the intestines
D. A curable digestive disease
What causes Crohn's disease?
A. Stress
B. Lack of vitamin D
C. Inflammation of the bowel by specific
chemicals
D. The cause of Crohn's disease is unknown
How does Crohn's disease affect the intestines?
A. Crohn's disease causes ulcerations in the
intestines.
B. Crohn's disease causes the intestines to
narrow.
C. Crohn's disease causes the intestines to stiffen.
D. All of the above.
How is Crohn's disease treated?
A. Antibiotics
B. Surgery
C. Inflammation suppressant medications
D. All of the above
Crohn's disease is closely related to ulcerative colitis.
• True
• False
Symptoms of Crohn's disease can include rectal bleeding.
• True
• False
There usually are no complications as a result of Crohn's disease.
• True
• False
Crohn's disease can stunt growth in children.
• True
• False
Ulcerative colitis affects the colon. The colon is
also referred to as the...
A. Small intestine
B. Large intestine
C. Sphincter
D. Appendix
Ulcerative colitis is related to what similar condition?
A. Indigestion
B. Acid reflux disease (GERD)
C. Anorexia
D. Crohn's disease
Symptoms of ulcerative colitis can include...
A. Rectal bleeding
B. Abdominal pain
C. Diarrhea
D. All of the above
A person who suffers from ulcerative colitis for a long
period of time is at risk for...
A. Hemorrhoids
B. Colon cancer
C. Fecal incontinence
D. Parkinson's disease
Ulcerative colitis can be cured with antibiotics.
 True
 False

Smokers are more likely to develop ulcerative

colitis.
 True
 False

Complications of ulcerative colitis are limited to the

intestines.
 True
 False