Inflammatory Bowel Diseases (IBDs): Crohn’s Disease & Ulcerative Colitis

Overview

• Canada has the highest prevalence worldwide.
• Approximately 5 million Canadians suffer from IBD.
• IBDs are characterized by chronic inflammation of the intestines.

1.  Crohn’s Disease

• Typically affects the terminal ileum and sometimes the colon.
• Lesions: Skip lesions (patchy inflammation with normal tissue in between).
• Pathology:
  • Ulcers can enlarge to form fissures (deep cracks).
  • Can penetrate all layers of the intestinal wall (transmural).
  • Fibrosis leads to lumen narrowing and obstructions.
  • Skip lesions and abscesses may develop.
  • Fistulas: abnormal connections between different sections of intestine or to other organs.
• Impacts:
  • Impaired absorption (malnutrition, weight loss).
  • Diarrhea, sometimes steatorrhea.
  • Anemia due to blood loss and poor nutrient absorption.
  • Low serum proteins.
  • Right lower quadrant pain.
• Motility:
  • Inflammation can either increase motility (diarrhea) or decrease it (obstruction).

2.  Ulcerative Colitis

• Affects the colon starting at the rectum and extending upward.
• Lesions:
  • Limited to mucosa and submucosa.
  • Continuous lesions without skip areas.
• Impacts:
  • Diarrhea with blood.
  • Ulcers cause bleeding.
  • Less malabsorption compared to Crohn’s but can cause anemia.
  • Pain and cramping.

Pathophysiology and Common Features

• Autoimmune and immune-mediated.
• Elevated antibodies and cytokines.
• May coexist with arthritis (similar to rheumatoid arthritis).

Complications

• Fibrosis causing strictures.
• Fistulas (abnormal connections).
• Abscesses.
• Malnutrition and weight loss.
• Anemia from blood loss and poor absorption.
• Delayed growth and puberty in children.
• Increased risk of colon cancer over time.
• Perforation risk in severe cases.

Diagnosis

• Endoscopy with biopsy.
• Imaging studies showing skip lesions in Crohn’s.
• Blood tests for inflammation markers.
• Stool tests for blood, infection.

Management

• Anti-inflammatory agents (e.g., corticosteroids).
• Immunosuppressants.
• Antimicrobials to prevent or treat infections.
• Nutritional supplements for malnutrition.
• Surgery in cases of obstruction, fistulas, or perforation.
• Lifestyle:
  • Diet modification.
  • Avoid triggers like spicy foods or smoking.

Summary

• Both Crohn’s disease and ulcerative colitis are autoimmune, chronic, and inflammatory.
• Require medication, nutritional support, and sometimes surgical intervention.
• Early diagnosis and management improve quality of life and prevent severe complications.