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Inflammatory Bowel Diseases and Drugs
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Inflammatory Bowel Diseases
• Ulcerative Colitis
• Crohn’s Disease
• Diverticulitis
• Irritable Bowel Syndrome*
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Common Factors
• Chronic/episodic
• Uncertain cause
• Genetic component
• Inflammation
• Alterations in epithelial cell function
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Ulcerative Colitis
• From rectum into colon• Demographics
– Onset 20 - 40– Family history– Jewish descent– More prevalent in white and northern European
• Dietary component• Bacterial or viral origin?• Immunologic component
– IgG antibodies– T cells
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Pathophysiology of UC
• Primary Lesions– Limited to mucosa– Most severe in rectum/sigmoid colon– Inflammation and leukocytic infiltration
• Secondary lesions– Erosion of primary lesion: hemorrhage– Crypt abcesses
• Necrosis• Edema and thickening of muscularis: narrowed lumen
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Clinical Manifestations of UC
• Intermittent remission and exacerbation– Diet– Stress– Watery diarrhea– Bleeding– Pain– Urge to defecate– Purulent mucus
• Mild– Minimal symptoms– Limited Colon involvement
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Clinical Manifestations of UC
• Severe– Entire colon– Fever, tachycardia– 10 - 20 BMs/day– Dehydration– Weightloss– Complications
• Toxic Megacolon• Anal fissures• Hemorrhoids• Abcesses• Hemorrhage - shock
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Ulcerative Colitis
• Extraintestinal symptoms (5 - 15%)– Polyarthritis and sacroilitis– Osteoporosis (also r/t steroids)– gall stones
• Evaluation– History & Physical– ABD radiology– Labs & stool cultures– Colonoscopy
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Treatment of UC
• Treatment based on severity• Diet: avoid triggers; increase fiber• Stress management• Drugs
– Steroids– Salicylates– Immunosuppression
• Severe– Hospitalization– TPN– Surgical resection/colostomy
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Crohn’s Disease
• Affects any part of the GI tract– Mouth to Anus– Distal small intestine– Proximal large intestine
• Genetic factors– Macrophage activation
• Demographics– Younger onset (teens)
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Pathophysiology of Crohn’s
• Inflammation– Submucosa– Mucosa– Serosa
• Skip lesions
• Longitudinal and transverse fissures
• Granulomas
• Fistulas
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Manifestations of Crohn’s
• Usually starts as "irritable bowel"
• Diarrhea
• Bypass fistulas
• Abcesses
• Malabsorption
• Psychosocial issues
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Crohn’s Disease
• Eval & Treatment– Similar to UC– Surgery
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Diverticular Disease
• Diverticulosis• Asymptomatic• Decreased fiber• Increased intracolonic
pressure• Genetic
• Diverticulitis• Diarrhea• Constipation• Distension• Abcess or perforation
– Fever– Pain– Leukocytosis– Septic shock– Death
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Diverticulosis/itis
• Evaluation– Usually found by accident
• Treatment– Fiber– Avoid nuts***– Probiotics– Antibiotics– Surgery
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Irritable Bowel Syndrome
• Functional “Disease”– Diarrhea– Constipation– Mixed
• Demographics
• Evaluation– Exclusion
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IBS
• Treatment– Triggers– Fiber– Exercise– Medications
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Nonspecific IBS Drugs
• Antispasmodics– Hyoscyamine– Dicyclomine (Bentyl)
• Bulk-forming agents
• Antidiarrheals
• TCAs
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IBD Drugs
• Salicylates– Unsure mechanism
• Reduces inflammation• Reduces symptoms
• Glucocorticoids• Immunomodulators
– Azathioprine & Mercaptopurine– Cyclosporine– Infliximab
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Steel Cut Oatmeal
• Ingredient list– 1 tablespoon butter– 1 cup steel cut oats– 3 cups boiling water– 1/2 cup whole milk– 1/2 cup plus 1 tablespoon low-fat buttermilk– 1 tablespoon brown sugar– 1/4 teaspoon cinnamon
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Steel Cut Oatmeal
• Directions– In a large saucepot, melt the butter and add the oats.
Stir for 2 minutes to toast. Add the boiling water and reduce heat to a simmer. Keep at a low simmer for 25 minutes, without stirring.
– Combine the milk and half of the buttermilk with the oatmeal. Stir gently to combine and cook for an additional 10 minutes. Spoon into a serving bowl and top with remaining buttermilk, brown sugar, and cinnamon.