Inflammatory bowel disease

Ulcerative Colitis

Ulcerative colitis is a form of inflammatory bowel disease that causes inflammation and ulcers in the colon. Ulcerative colitis affects the colon and rectum only, occasionally involving the last part of terminal ileum.
Ulcerative colitis is often characterised by periods of exacerbation and remission requiring medical management to achieve remission. Surgery is needed only if there is failure of medical management.
The disease is more prevalent in northern and western countries of the world. Although UC has no definite known cause, there is a presumed genetic component to susceptibility. The disease may be triggered in a susceptible person by environmental factors.
Ulcerative colitis often presents with diarrhoea mixed with blood. Other presentations include weight loss and anemia. Patients may have abdominal pain or may present with extra-intestinal symptoms.
The best test of diagnosis of ulcerative colitis is endoscopy. This may be a flexible sigmoidoscopy or colonoscopy and biopsies are taken to confirm the diagnosis.
Management of ulcerative colitis is with anti-inflammatory drugs (including oral medication and rectal preparations), immunosuppression, and biological therapy targeting specific components of the immune response. Colectomy is occasionally needed if the disease is severe, does not respond to treatment, or if significant complications develop. A total proctocolectomy (removal of the entirety of the large bowel and rectum) can cure ulcerative colitis as the disease only affects the large bowel and rectum and does not recur after removal of the latter.
Ileo-anal pouch can be constructed after colectomy in ulcerative colitis patients. Colectomy and pouch formation can be performed laparoscopically in majority of patients and this may improve postoperative recovery.
There is a significantly increased risk of colorectal cancer in patients with ulcerative colitis after ten years. It is recommended that patients have screening colonoscopies with random biopsies to look for dysplasia after eight years of disease activity, at one to two year intervals.

Crohns disease
Crohn’s disease is a type of inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus.
Signs and symptoms may include abdominal pain, diarrhea (which may be bloody), fever, and weight loss. Other complications and symptoms include anemia, skin rashes, arthritis, inflammation of the eye, and tiredness. Bowel obstruction can commonly occur and there is a greater risk of bowel cancer.
The exact cause of Crohns disease is not understood. It is a type of immune response and theories include an infection or autoimmune process.
There are no medications or surgical procedures that can cure Crohn’s disease. Treatment options help with symptoms, maintain remission, and prevent relapse. Steroids, anti-inflammatory medication and newer drugs called biologics are all useful. Stopping smoking can help in remission and prevent relapse. One in five people with the disease are admitted to hospital each year, and half of those with the disease will require surgery for the disease at some point over a ten-year period. Checking for bowel cancer via colonoscopy is recommended every few years, starting eight-ten years after the disease has begun.
Crohn’s disease is historically been more common in the developed world. It tends to start in the teens and twenties, although it can occur at any age. Males and females are equally affected.
Surgery for Crohn’s disease Surgery has a limited but important role in Crohn’s disease. Patients with Crohn’s disease may need surgery for perianal disease or abdominal disease causing obstruction or fistulation. Plyps or cancers may nee intervention.

Perianal disease is extremely challenging and must be managed by an experienced surgeon. Recurrent fistulation and complex disease is common.

Minimally invasive surgery is available for Crohn’s abdominal complications and is recommended if possible. There is a significant risk of repeat surgery and laparoscopic surgery can reduce adhesions and improve recovery.
Crohn’s disease that affects the ileum may result in an increased risk for gallstones. This is due to a decrease in bile acid resorption in the ileum and the bile gets excreted in the stool. As a result, the cholesterol/bile ratio increases in the gallbladder, resulting in an increased risk for gallstones.

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