 2 MAJOR GROUPS : 1. ULCERATIVE COLITIS – colon involved 2. CROHN’S DIDEASE – the hole GI tract EPIDEMIOLOGY  most common in whites than in blacks and Orientals, with increased incidence in Jews compared to non-Jews  both sexes are equally afected  UC is most common than CD  2,5% of persons with IBD will have ≥ 1 relatives affected  hereditary basis ± strong environmental component A. GENETIC FACTOR : monozygotic twins, NO single marker B. INFECTIONS : Pseudomonas, Yersinia enterocolitica (self limited, acute ileitis) C. IMMUNOLOGIC: humoral antibodies to colon cells, bacterial antigens (E.coli, lipopolysacharides, foreign proteins), immune complexes –extraintestinal manifestations of IBD D. PHYHOLOGICAL FACTORS: loss of a family member, anger, anxiety, depression are important in modifying the course of these disease and the response to therapy

 CD  CD-often discontinuous : severely involved segments of bowel are separated from each other with segments of apparently normal bowel producing “skip areas”; in the ~ 50% of CD of the colon, the rectum may be separated. The transmural inflammatory process affects serosa, mezentery, fistula and abcess formation.  UC – the involvement is contigous and the rectum is almost always involved  CD - As a result of serosal inflamation, adiacent loops of small intestine may become adherent and matted together by a fibrinous peritoneal reaction leading to palpable mass, most often in the right lower quadrant  Microscopically, granulomas ≠ UC (in rectal or colonoscopic biopsies). Chronic inflamation involving all layers of the intestinal wall  most caracteristic  30% small intestine (terminal ileum)  30% colonic involvement  40% ileocolonic (ileum + right colon)

 Major symptoms:  bloody diarrhea  abdominal pain  fever (in severe forms)  weight loss (in severe forms)  frequent liquid stools with blood and pus  severe cramps (signs of dehidratation, anemia)  Physical findings in UC are usually nonspecific (abdominal distension, tenderness along the course of the colon)  Mild cases – general examination is normal.  EXTRACOLONIC MANIFESTATIONS: 1. Arthritis ~ 25 % (knees, ankles, wrists ) ( FR,ANB,LE – for specific artritis) 2. Skin changes 15% 3. Liver disease

 reflect the degree and severity of bleeding and inflamation :  iron deficiency anemia  leukocytosis, ↑ VSH  hypokalemia  hypoalbuminemia- luminal protein loss from ulcerated mucosa 1. Peripheral arthritis in patients with colonic than small bowell involvement alone. Central artritis (ankylosing spondylitis )+ IBD is unrelated to the activity of the underlying bowel disease; HLA- B27 + ankylosing spondylitis whether or not IBD 2. Erythema nodosum, pyoderma gangrenosum, aphthous ulcers (in active disease and than resolved), ocular manifestations (5%) ( episcleritis, recurrent iritis, uveitis ) 3. Liver function ALT, AST, AF ↑ = non specific focal hepatitis or fatty infiltration; non-progressive, remision  Pericholangitis – lesions of intrahepatic form of sclerosing colangitis; non progressive and requires no therapy  Colangiocarcinoma in the extrahepatic biliary tree  Chronic active hepatitis  cirrhosis

 The clinical course of UC is variable.  Most of the patients will suffer a relapse within 1 year of the first attack  recurrent nature of the disease  periods of remission with only minimal symptoms  in general, the severity of symptoms reflects the extend of colonic involvement and the intensity of the inflammation  limited colonic involvement (proctosigmoiditis  mild disease) with minimal systemic manifestation ( non extensive disease)  MAJOR SYMPTOMS: rectal bleeding + tenesmus  85 % mild and moderate of intermittent nature that can be managed without hospitalisation  15 % - fulminant course – entire colon- with systemic signs and symptoms  risc to develop toxic dilatation and perforation of the colon  medical emergency

CROHN’S DISEASEULCERATIVE COLITIS