Treatment of inflammatory bowel disease - Ulcerative Colitis and Crohn's disease

This article tells about Inflammatory bowel disease like Ulcerative Colitis and Crohn's disease. Read to know about the factors responsible for IBD and how to treat IBD.

Inflammatory bowel disease encompasses spectrum of Ulcerative colitis (UC),Crohn's disease(CD) and indeterminate colitis (IC), which may evolve later into any of the two. Incidence and prevalence are much lower in developing world compared to the West, which partly was beleived due to under detection but even with recent availability and use of modern equipments for better diagnosis, the statistics remain the same albeit showing a trend to increase in this world compared to the 1980s. This is due to rapid Westernisation of lifestyle, diet and environment here. Typical example is India and Asia Pacific region where reported incidence and prevalence have been 4.5 to 10.8/million and 4.6 to 44.8/million for Ulcerative colitis and 0.5 to 2.3/million and 1.8 to 5.2/million for Crohn's disease respectively.

Factors responsible for Inflammatory bowel disease

The main pathogenetic factors are susceptible genetic background ( positive family history, NOD gene) on which a number on environmental factors act to manifest the disease e.g. smoking (nicotine), high sugar consumption, appendicectomy and change of intestinal flora due to frequent antibiotic use. Intestinal parasitic infestation is found to be protective.

Clinical features of Inflammatory bowel disease

The main clinical features of Ulcerative colitis are bloody diarrhea which can be life threatening at times and that od Crohn's disease are diarrhea with or without blood, weight loss, oral ulcers, recurrent anal fissure, intestinal fistula and obstruction.

Extraintestinal manifestation in both case are cutaneous (pyoderma gangrenosum, erythema nodosum), arthritis, liver (primary sclerosing cholangitis, cholangiocarcinoma), blood ( increased coagulbility) and eye (uveitis, scleritis).

Treatment of inflammatory bowel disease

Mainstay treatment are aminosalycilate drugs ( Mesalamine, Pentasa, Balsalazide) and steroids (hydrocortisone, budesonide) as oral tablets or enemas. Later on immunosuppressive drugs (Azithioprine) can be added.

A recurrent advancement to treatment has been infliximab which is a TNF alpha blocker. Fulminant ulcerative colitis may need cyclosporine, infliximab or colectomy. Severe fistulising and perianal Crohn's disease may need infliximab and intestinal obstruction may need judicious surgery.
Treatment may need to be continued life long

More public awareness of these diseases are needed as early diagnosis may prevent complication and need of toxic drugs and surgery.



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