Description
Crohn's disease is a type of IBD that can affect any part of the digestive tract, causing inflammation and ulcers. It commonly involves the end of the small intestine (ileum) and the beginning of the large intestine (colon). Ulcerative colitis is characterized by inflammation and ulcers in the lining of the large intestine (colon) and rectum. It typically starts in the rectum and can extend continuously into the colon. Some cases of IBD cannot be clearly classified as Crohn's disease or ulcerative colitis due to overlapping features or atypical presentations. This is referred to as indeterminate colitis.Microscopic colitis includes two subtypes: collagenous colitis and lymphocytic colitis. These conditions are characterized by chronic inflammation of the colon lining visible only under a microscope. While primarily known for causing mouth sores and skin lesions, Behçet's disease can also involve the gastrointestinal tract, leading to ulcers and inflammation resembling Crohn's disease.
Résumé
- Dr. Rajendra discussed inflammatory bowel disorders (IBD), emphasizing Crohn's disease, ulcerative colitis, and indeterminate colitis, also briefly covering microscopic colitis and Behçet's disease. The spectrum of these disorders depends on etiology, pathogenesis, clinical phenotype, disease course, and prognosis, varying in presentation based on patient age and whether the course is relapsing-remitting.
- IBD involves inflammation in the colon, small bowel, and upper GI tract, and can manifest as extraintestinal symptoms. The pathogenesis involves host genetics, immune response, changes in gut microbiota, and environmental triggers. Disease phenotypes include Crohn's, ulcerative colitis, indeterminate colitis, and autoimmune overlaps.
- The main types of classical IBD range from ulcerative proctitis to extensive ulcerative colitis and Crohn's colitis/ileitis. Disease behavior can be inflammatory, structuring, or penetrating, with extraintestinal inflammation and varying age of onset.
- In 2005, ulcerative colitis and Crohn's were classified using the Montreal classification for different clinical presentations. Ulcerative colitis classification considers location (E1-E3) and severity (S0-S3). Crohn's classification includes age, disease location (L1-L4), and behavior (B1, structuring, penetrating).
- IBD is also classified into simple IBD, IBD plus extraintestinal manifestations, and IBD 2 plus other autoimmune disorders. Location-based classification includes ulcerative colitis, Crohn's disease, and indeterminate colitis. Age-based classification includes very early onset, early onset, regular onset, and late onset, with early onset having higher risk for complications.
- Ulcerative colitis typically presents with urgency, rectal bleeding, and diarrhea. Crohn's disease varies based on phenotype, including recurrent abdominal pain and abscesses. Ulcerative colitis is mucosal, while Crohn's is transmural. Radiologic features are important for Crohn's to assess transmural involvement and complications.
- Microscopic colitis causes persistent watery diarrhea with normal colonoscopy findings, mainly diagnosed through biopsies. It includes lymphocytic and collagenous colitis, with treatment primarily symptomatic, involving antidiarrheals and sometimes intestinal steroids.
- Behçet's disease presents as painful orogenital ulcers with potential involvement of the skin, eyes, joints, and blood vessels. Diagnosis requires recurrent oral ulcers plus two minor criteria such as genital ulcers, uveitis, or skin manifestations. Treatment includes steroids and sometimes immunosuppressants. Stress is an important environmental factor that can trigger underlying inflammatory bowel disease.
Exemple de certificat
À propos des intervenants
Dr Rajendra Patel
Gastro-entérologue consultant principal, hôpitaux AIG, Hyderabad
Divulgation financière
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