ABSTRACT Inflammatory bowel disease, which includes Crohn&apos;s disease and ulcerative colitis, is a relapsing and remitting condition characterized by chronic inflammation at various sites in the GI tract, which results in diarrhea and abdominal pain. This review summarizes the types, epidemiology, aetiology, risk factors, pathogenesis, clinical signs and symptoms, complications, diagnosis and recent advances in clinical management of inflammatory bowel disease

Eswar Tony

M Sathish Kumar

M Sowmya

N Ramarao

Srinivasa Reddy

T Sujith

Y Ragavendra

CiteSeerX

          ISSN: 0975-8585 
January-March      2013           RJPBCS              Volume 4 Issue 1   Page No. 898 
Research Journal of Pharmaceutical, Biological and Chemical 
Sciences 
Etiopathogenesis and Clinical Management of Inflammatory Bowel Disease 
 
M Sathish Kumar*,  M Sowmya, B Srinivasa Reddy, T Sujith, D Eswar Tony, Y Ragavendra, 
N Ramarao  
 
Department of Pharmacology, Chalapathi Institute of Pharmaceutical Sciences, Guntur. 
 
 
ABSTRACT 
 
Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, is a relapsing and 
remitting condition characterized by chronic inflammation at various sites in the GI tract, which results in 
diarrhea and abdominal pain. This review summarizes the types, epidemiology, aetiology, risk factors, 
pathogenesis, clinical signs and symptoms, complications, diagnosis and recent advances in clinical 
management of inflammatory bowel disease. 
Keywords: Inflammatory Bowel Disease, Ulcerative Colitis, Crohn’s Disease, Immunomodulating drugs.   
 
 
 
 
 
 
 
 
 
 
 
 
 
*Corresponding author 
 
          ISSN: 0975-8585 
January-March      2013           RJPBCS              Volume 4 Issue 1   Page No. 899 
INTRODUCTION 
 
Inflammatory bowel disease (IBD) is an idiopathic and chronic intestinal 
inflammation [1]. inflammatory bowel disease (IBD), which includes Crohn's disease (CD) 
and ulcerative colitis (UC), is a relapsing and remitting condition characterized by chronic 
inflammation at various sites in the GI tract, which results in diarrhea and abdominal pain. 
Although Crohn's disease and UC are similar, they can be distinguished in most cases: 
 
Crohn's Disease (CD) 
 
Small bowel is involved in 80% of cases. Recto sigmoid is often spared; colonic 
involvement is usually right-sided.  Gross rectal bleeding is rare, except in 75 to 85% of cases 
of Crohn's colitis. Fistula, mass, and abscess development is common. Perianal lesions are 
significant in 25 to 35% of cases. On x-ray, bowel wall is affected asymmetrically and 
segmentally, with "skip areas" between diseased segments. Endoscopic appearance is 
patchy, with discrete ulcerations separated by segments of normal-appearing mucosa. 
Microscopic inflammation and fissuring extend transmurally; lesions are often highly focal in 
distribution. Epithelioid (sarcoid-like) granulomas are detected in bowel wall or lymph nodes 
in 25 to 50% of cases (pathognomonic).   
 
Ulcerative Colitis (UC) 
 
Disease is confined to the colon. Rectosigmoid is invariably involved; colonic 
involvement is usually left-sided. Gross rectal bleeding is always present. Fistulas do not 
occur. Significant perianal lesions never occur. Bowel wall is affected symmetrically and 
uninterruptedly from rectum proximally. Inflammation is uniform and diffuse. Inflammation 
is confined to mucosa except in severe cases. Typical epithelioid granulomas do not occur. 
 
Epidemiology 
 
IBD affects people of all ages but usually begins before age 30, with peak incidence 
from 14 to 24. IBD may have a second smaller peak between ages 50 and 70; however, this 
later peak may include some cases of ischemic colitis [2]. IBD is most common among 
people of Northern European and Anglo-Saxon origin and is 2 to 4 times more common 
among Ashkenazi Jews than in non-Jewish whites. The incidence is lower in central and 
southern Europe and lower still in South America, Asia, and Africa. However, the incidence is 
increasing among blacks and Latin Americans living in North America. Both sexes are equally 
affected. First-degree relatives of patients with IBD have a 4- to 20 fold increased risk; their 
absolute risk may be as high as 7%. Familial tendency is much higher in Crohn's disease than 
in UC. Several gene mutations conferring a higher risk of Crohn's disease (and some possibly 
related to UC) have been identified. Cigarette smoking seems to contribute to development 
or exacerbation of Crohn's disease but decreases risk of UC. NSAIDs may exacerbate IBD.  
 
Aetiology 
 
Although IBD has been described as a clinical entity for over 100 years, its aetiology 
and pathogenesis have not been definitively elaborated. An unknown factor or agent (or a 
          ISSN: 0975-8585 
January-March      2013           RJPBCS              Volume 4 Issue 1   Page No. 900 
combination of factors) triggers the body’s immune system to produce an inflammatory 
reaction in the intestinal tract that continues without control. As a result of the 
inflammatory reaction, the intestinal wall is damaged leading to bloody diarrhea and 
abdominal pain. Genetic, infectious, immunological and psychological factors have all been 
implicated in influencing the development of IBD [3]. Mutations in a gene called NOD2 tend 
to occur more frequently in people with CD [4]. 
 
Risk factors 
 
I) Modifiable: Smoking – CD, higher socioeconomic class, white colour jobs, 
psychological factors, NSAIDS, oral contraceptives, diet. 
II) Unmodifiable: Genetic- Ist  degree relative, ethnic, age and gender.    
 
Pathogenesis 
 
Exogenous factors such as infectious agents (Mycobacterium paratuberculosis, 
Paramyxovirus, Helicobacter species); psychosocial factors such as illness or death in family, 
divorce or separation, interpersonal conflict, acute daily stress and inflammatory cascade 
results in T cell activation that causes acute immune  inflammatory response which releases 
inflammatory cytokines, such as Interleukin - 1 (IL-1), as Interleukin - 6 (IL-6)  and tumor 
necrosis factor (TNF) that promotes fibrogenesis, collagen  production, activation of tissue 
metalloproteinases,   production of other inflammatory mediators that results in 
inflammation (i.e. due to imbalance between pro-inflammatory and anti-inflammatory 
mediators [5,6].  
 
Clinical signs and symptoms 
 
Abdominal pain, vomiting, diarrhoea, rectal bleeding, weight loss and various 
associated complaints or diseases like arthritis, pyoderma gangrenosum and primary 
sclerosing cholangitis [7]. 
 
Complications 
 
Profuse bleeding from the ulcers, perforation (rupture) of the bowel, strictures and 
obstruction, fistulae (abnormal passage) and perianal disease – more common in person’s 
with CD, toxic megacolon, malignancy (i.e. colon cancer) and arthritis.  
 
Diagnosis 
 
History and physical examination are the first steps and may reveal risk factors. 
Blood tests may help establish the diagnosis and are also routinely used to identify anaemia 
and nutritional deficiencies. In some cases, stool cultures may be used to identify bacterial 
infections that can trigger the disease. Abdominal X–ray and CT scan can aid in diagnosis, 
rule out other diseases, and evaluate for complications, including bowel obstruction and 
abscess. Colonoscopy with biopsy is usually recommended to diagnose and observe the 
extent of disease, and rule out other diseases that may appear similar to IBD, such as cancer 
          ISSN: 0975-8585 
January-March      2013           RJPBCS              Volume 4 Issue 1   Page No. 901 
and haemorrhoids. However, colonoscopy should be avoided in patients with severe disease 
because it increases the risk of colon perforation. 
 
Treatment 
 
Treatment involves medications in mild to moderate cases, or surgery in severe and 
recurrent cases. Common medications include sulfasalazine, corticosteroids (e.g., 
prednisone), azathioprine, and cyclosporine. In addition, antibiotics (e.g., ciprofloxacin, 
metronidazole, and ampicillin) are often used when infection is a concern. Additional 
medications are used for symptomatic relief, including antidiarrheals (e.g., loperamide), iron 
supplements, and vitamin B12 supplements. Surgery to address complications of the 
disease, such as abscess formation, or to remove all or part of the colon may be necessary 
for severe disease. However, it usually will not cure the disease. Lifestyle factors may affect 
the disease. Limited evidence indicates that stress reduction reduces symptoms in patients 
with Crohn’s disease, and results in less pain and decreased need for anti–inflammatory 
medication in patients with ulcerative colitis. However, additional clinical trials are 
necessary to learn more about the psychological aspects [8-11].  
 
CONCLUSION 
 
Because inflammatory bowel disease (IBD) is a chronic, often lifelong disease that is 
frequently diagnosed in young adulthood, increasing patient knowledge improves medical 
compliance and assists in the management of symptoms. 
 
REFERENCES 
 
[1] Arthur K, Sebastian Z, Richard SB. Annu Rev Immunol 2010; 28:573–621. 
[2] Thia KT, Loftus EV Jr, Sandborn WJ, Yang SK. Am J Gastroenterol 2008; 103:3167–82.  
[3] Sadlack B, Merz H, Schorle H, Schimpl A, Feller AC, Horak I. Cell 1993; 75:253–61. 
[4] Cho JH. Nat Rev Immunol 2008; 8:458–66. 
[5] Agrawal D, Rukkannagari S, Kethu S. Minerva Gastroenterol Dietol 2007; 53(3):233-
48. 
[6] Bengtson MB, Solberg IC, Aamodt G, Jahnsen J, Moum B, Vatn MH. Inflamm Bowel 
Dis 2010; 16(5):847-55. 
[7] Mokrowiecka A, Daniel P, Slomka M, Majak P, Malecka-Panas E. 
Hepatogastroenterology 2009; 56(89):162-66. 
[8] Li CY, Zhang BL, Chen CX, Li YM. J Zhejiang Univ Sci B 2008; 9(11):857-62. 
[9] Gisbert JP. Inflamm Bowel Dis 2010; 16(5):881-95.   
[10] Ha C, Kornbluth A. Curr Gastroenterol Rep 2010; 12(6):471-78.  
[11] Maher MM. Front Biosci 2012; 1 (4):1638-47. 


Etiopathogenesis and Clinical Management of Inflammatory Bowel Disease

http://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=2ECC52A8C8704FFBC1C83EEE7548E34D?doi=10.1.1.1046.679&rep=rep1&type=pdf

Etiopathogenesis and Clinical Management of Inflammatory Bowel Disease

Abstract

Similar works

Full text

Available Versions

CiteSeerX