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  • Image not available. The exact cause of inflammatory bowel disease (IBD) is unknown, although there are components that appear to be infectious and other components that suggest immune dysregulation. Genetic variations explain some of the increased risk of disease occurrence.
  • Image not available. Ulcerative colitis (UC) is confined to the rectum and colon, causes continuous lesions, and affects primarily the mucosa and the submucosa. Crohn's disease (CD) can involve any part of the gastrointestinal (GI) tract, often causes discontinuous (skip) lesions, and is a transmural process that can result in fistulas, perforations, or strictures.
  • Image not available. Common GI complications of IBD include rectal fissures, fistulas (CD), perirectal abscess (UC), and colon cancer, while possible extraintestinal manifestations include hepatobiliary complications, arthritis, uveitis, skin lesions (including erythema nodosum and pyoderma gangrenosum), and aphthous ulcerations of the mouth.
  • Image not available. The severity of UC may be assessed by stool frequency, presence of blood in stool, fever, pulse, hemoglobin, erythrocyte sedimentation rate, C-reactive protein, abdominal tenderness, and radiologic or endoscopic findings. The severity of CD can be assessed using similar parameters, in addition to the CD activity index, which includes stool frequency, presence of blood in stool, endoscopic appearance, and physician's global assessment.
  • Image not available. The goals of IBD treatment are resolution of acute inflammation and complications, alleviation of systemic manifestations, maintenance of remission, and for some patients surgical palliation or cure.
  • Image not available. The first line of treatment for mild to moderate UC or Crohn's colitis consists of oral aminosalicylates, such as sulfasalazine or mesalamine; mesalamine or steroid enemas or suppositories may be used for distal disease. Certain delayed-release oral formulations of mesalamine may be used for Crohn's ileitis. Controlled-release budesonide may be used for CD confined to the ileum and/or ascending colon.
  • Image not available. Corticosteroids are often required for acute UC or CD. The duration of steroid use should be minimized and the dose tapered gradually over 3 to 4 weeks.
  • Image not available.Infliximab is a treatment option for patients with moderate to severe active UC and for those patients with UC who are dependent on corticosteroids. Azathioprine or mercaptopurine may be used for maintenance of remission as an alternative to infliximab for patients with UC who have failed aminosalicylates and for patients who are corticosteroid dependent.
  • Image not available. Intravenous continuous infusion of cyclosporine may be effective in treating severe colitis that is refractory to corticosteroids as an option to delay or prevent the need for surgery.
  • Image not available. Sulfasalazine and mesalamine derivatives can prevent recurrence of acute disease in many patients, while steroids are ineffective for this purpose.
  • Image not available. Other drugs that are useful for treatment of CD include infliximab, adalimumab, and certolizumab (for moderate to severe or fistulizing disease); methotrexate, azathioprine, or mercaptopurine (for inadequate response or to reduce steroid dosage); metronidazole (for perineal disease); and cyclosporine (for refractory disease).

Upon completion of the chapter, the reader will be able to:

  • 1. Characterize the epidemiologic difference between ulcerative colitis (UC) and Crohn disease (CD).
  • 2. Discuss the proposed etiologies underlying the development of inflammatory bowel disease (IBD).
  • 3. Explain the main immunologic mechanisms involved ...

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