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Understanding Inflammatory Bowel Disease (IBD)

May 5, 2025

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Inflammatory Bowel Disease (IBD)

IBD is a chronic inflammatory condition that affects the gastrointestinal tract (GIT) and follows a relapsing and remitting course. Two main types of IBD are discussed: Ulcerative Colitis and Crohn's Disease.

Types of IBD

Ulcerative Colitis

  • Mainly affects: Rectal and sigmoid colon (40-50%), referred to as proctitis.
  • Inflammation spread: Can spread proximally from the rectal sigmoid area to the descending colon (30-40% of cases) - termed left-sided colitis. If it reaches the transverse colon, it is known as extensive colitis.
  • Characteristics: Continuous inflammation from distal to proximal areas.

Crohn's Disease

  • Mainly affects: Ileocecal area (cecum and ileum), 40% involve the ileal and ilio-colonic area.
  • Other affected areas: Small intestine (30-40% of cases) with inflammation in segments termed skip lesions; 20% of cases have colon inflammation (Crohn's colitis); small majority have perianal inflammation.
  • Characteristics: Discontinuous patchy inflammation with skip lesions.

Signs and Symptoms of IBD

  • Diarrhea
  • Rectal bleeding
  • Abdominal pain
  • Tenesmus
  • Fever
  • Weight loss
  • Vomiting
  • Cramps and muscle spasms

Differences and Similarities

Gender Incidence

  • Ulcerative Colitis: Affects both genders equally.
  • Crohn's Disease: More common in females than males.

Smoking

  • Ulcerative Colitis: Smoking is a protective factor.
  • Crohn's Disease: Smoking aggravates the condition.

Pathology

  • Ulcerative Colitis: Continuous inflammatory lesion progressing from distal to proximal colon; superficial inflammation.
  • Crohn's Disease: Discontinuous, patchy gut inflammation with skip lesions; transmural inflammation affecting all layers of the colon.

Complications

  • Ulcerative Colitis: Severe bleeding, toxic megacolon, rupture of bowel, colon cancer.
  • Crohn's Disease: More severe; includes stenosis, abscess formation, fistula, colon cancer, perforation.

Histology

  • Ulcerative Colitis: Superficial inflammation with pseudo polyps.
  • Crohn's Disease: Transmural inflammation with complications including abscesses and granulomas.

Next Steps

The following video will cover the pathophysiology, local/systemic complications, and management of inflammatory bowel disease.

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