Inflammatory Bowel Diseases (IBD) Clinical aspects Nitsan Maharshak M.D., IBD Center, Department of Gastroenterology and Liver Diseases Tel Aviv Soura
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1 Inflammatory Bowel Diseases (IBD) Clinical aspects Nitsan Maharshak M.D., IBD Center, Department of Gastroenterology and Liver Diseases Tel Aviv Sourasky Medical Center Tel Aviv, Israel
2 IBD- clinical features Chronic inflammatory diseases of the GI tract characterized by periods of exacerbations and remissions. Diarrhea Abdominal pain Rectal bleeding Fever
3 IBD History- ulcerative colitis Wilks and Moxon- were the first to identify the disease as being from a non-infectious cause.
4 IBD History- Crohn s intestinal obstruction, inflamed gut, involving jejunal, ileal and colonic areas with transmural inflammation BMJ- T. Kennedy Dalziel: 13 patients JAMA- Burril Crohn- terminal ileitis Crohn s disease.
5 IBD history Crohn s disease T. Kennedy Dalziel, reported (BMJ) treating 13 patients who had suffered from intestinal obstruction. On autopsy he found that all had inflamed gut, in the jejunal, ileal and colonic areas with transmural inflammation Burril Crohn- JAMA- terminal ileitis.
6 Global map of Crohn's disease incidence. Ng S C et al. Gut doi: /gutjnl Copyright BMJ Publishing Group Ltd & British Society of Gastroenterology. All rights reserved.
7 Crohn s disease
8 ULCERATIVE COLITIS AND CROHN S DISEASE
9 EXTRAINTESTINAL MANIFESTATIONS
10 SKIN LESIONS
11 EYE LESIONS
12 ENDOSCOPIC SPECTRUM OF SEVERITY
13 ANATOMIC DISTRIBUTION
14 INFLAMMATION
15 OBSTRUCTION
16 FISTULIZATION
17 The many faces of Crohn s disease
18 RISK OF COLORECTAL CANCER
19 More than 2 million patients around the world
20 In Israel Incidence 10/ , /year for each of the diseases Over 20, patients. 20,000000
21 Inflammatory bowel diseases: An increasing burden on patients and families, health systems, economy Admissions, surgeries, procedures Increasing incidence Symptomsfrom mild to debilitating The burden of IBD Chronic disease Young patien ts Importance Psychosocial for finding a cure Loss of school/ workdays distress Treatment, t side effects, cost Young age at diagnosis Chronic-lifelong l diseases 21
22 Genetic- IBD Risk factors Common in twins and family members. More common in Jewish people. More than 160 susceptible genes loci.
23 GWAS in IBD Total of 163 IBD loci Jostins, L. et.al. Nature 491, (01 November 2012) Anderson, C. A. et al. Nature Genet. 43, (2011) Franke, A. et al. Nature Genet. 42, (2010) Most loci contribute to both phenotypes CD 30 IBD 110 UC 23 Jostins, L. et.al. Nature 491, (01 November 2012) Many variants are associated with the immune system, however most do not have an obvious function
24 IBD- Environmental factors - Northern areas- Hygiene theory / Old friends - Industrialization- Food (refined sugars, high fat, less vegetables) - vaccination - Air pollution - Protective- Multiple siblings, rural areas
25 IBD- Environmental factors - Northern areas-
26 IBD- Environmental factors
27
28
29 Hygiene theory / Old friends
30 IBD- Environmental factors Cigarette smoke Stress (?) NSAIDs
31 ..inappropriate and ongoing activation of the mucosal immune system driven by the presence of normal luminal flora, in a genetically susceptible host. Gut microbiota Increased pro-inflammatory Decreased beneficial Genetic susceptibility Environmental triggers Barrier function Infection Bacterial killing NSAIDS Immunoregulation Smoking Stress Diet Effector immune response Increased Th1 and Th17 Defective innate responses
32 IBD Diagnosis Clinical presentation, background Laboratory studies Colonoscopy, gastroscopy CT Enterography MR Enterography Capsule endoscopy Serologies? Genetics?
33 p-anca AND ASCA IN IBD
34 DIFFERENTIAL DIAGNOSIS OF INFECTIOUS AND ULCERATIVE COLITIS
35 DIFFERENTIAL DIAGNOSIS OF IBD AND IBS
36 CONVENTIONAL DRUG THERAPIES Anti-chemokine rec.
37 Downloaded from: StudentConsult (on 24 October :39 PM) 2005 Elsevier
38 Hypersensitivity Biologics side effects: Immediate (22% vs. 9% placebo) Delayed (serum sickness-like) Infections (36% vs. 26% placebo) TB, fungal, bacterial and viral infections Abscess in fistula patients Auto antibodies ( %) /Lupus-like HACA Malignancies: Lymphoproliferative; skin cancer? Neurologic events: demyelinating i disease Cardiovascular deterioration Skin manifestations
39 UC- surgery
40 Crohn s disease- surgery
41 POSTOPERATIVE RECURRENCE RATES IN CROHN S DISEASE
42 Experimental therapies Helminths- ova of Trichuris suis Fecal transplantation
43 רבה תודה
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