Pathology and Management of Inflammatory Bowel Disease

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Pathology and Management of Inflammatory Bowel Disease

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Pathology and Management of Inflammatory Bowel Disease :

Pathology and Management of Inflammatory Bowel Disease Brian Wells, MS-3, MSM, MPH St. George’s University School of Medicine

I have finally come to the conclusion that a good set of bowels is worth more to a man than any quantity of brains.- Josh Billings (4/20/1818 – 10/14/1885) :

IBD :

Mathematical Description of Transmural Involvement :

Infammatory Bowel Disease :

Crohn’s Disease - How did we get here? :

Crohn’s Disease - How did we get here? Giovanni Battista Morgagni 2/25/1682 – 12/6/1771 First description: 1769 Burrill B. Crohn, MD 6/13/1884 – 7/29/1983 1932 - “Regional ilitius” thought due to Mycobacterium paratuberculosis Similar to Johne’s Disease Thomas Kennedy Dalziel 1861–1924 Chronic interstial enteritis. Br Med J 1913; 2: 1068–1070 Antoni Leśniowski 1/28/1867–4/4/1940 Annals of the Warsaw Medical Association 1903-1905 – “a chronic inflammatory process in the wall of the gut.” © 2010 Brian Wells

Dr. Crohn (center), Dr. Leon Ginzburg (left), and Dr. Gordon D. Oppenheimer (right) :

Epidemiology :

Epidemiology *Centers for Disease Control and Prevention U.S. Population estimate (July 2009): 307,006,550 Overall prevalence (2006): 396/100,000 persons Total estimated cases (July 2009): ~1.2-1.4 M cases *Lakatos PL. Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J Gastroenterol 2006;12(38):6102–08. © 2010 Brian Wells

Epidemiology :

Comparative Summary :

Slide 17:

Horton K M et al. Radiographics 2000;20:399-418 ©2000 by Radiological Society of North America Contrast-enhanced CT scan shows minimal diffuse thickening of the sigmoid colon with minimal inflammatory stranding. Ulcerative colitis in a 27-year-old man

Slide 18:

Horton K M et al. Radiographics 2000;20:399-418 ©2000 by Radiological Society of North America CT scan obtained with oral contrast material shows moderate thickening of the terminal ileum (curved arrow) and cecum (straight arrow) with adjacent inflammatory changes in the pericolic fat. Crohn’s Disease

Medical Management :

Surgical Management :

Surgical Management Indications for surgery in Crohn’s Disease *Medical Management of the Surgical Patient: A Textbook of Perioperative Medicine *ASCRS – American Society of Colon and Rectal Surgeons Most patients with Crohn's disease ultimately require one or more operations in their lifetime. Operative indications are the same no matter where the disease manifests itself. © 2010 Brian Wells

Current Research :

Current Research Was Dr. Crohn right in 1932? Although the role of MAP in CD remains controversial and an area of considerable research, it is currently only of academic interest because there is no clinically useful test to identify the presence of the organism, and no evidence to support the use of antibiotics to eradicate it for the treatment of CD. Awareness of rare extra-intestinal manifestations While certain extraintestinal manifestations of Crohn disease are relatively common and well-known, others, such as metastatic cutaneous involvement, are quite rare and may be difficult to recognize, particularly in the pediatric population. © 2010 Brian Wells

“Imagination is more important than knowledge”Albert Einstein :

Slide 25:

“‘Surely someday we will grasp the central idea of it all as so simple, so beautiful, so compelling that we will all say each to the other, ‘Oh, how could it have been otherwise! How could we all have been so blind for so long.’” - John A. Wheeler © 2010 Brian Wells

Thank you! :

Review Questions :

Review Questions If you wish to target the small bowel with a delayed release form of 5-ASA, which would be most appropriate and why? A) Asacol because the acrylic polymer is most soluble in the small bowel B) Pentasa because the acrylic polymer is most soluble in the small bowel C) Asacol because the ethylcellulose microgranules release in the small bowel D) Pentasa because the ethylcellulose microgranules release in the small bowel E) Both drugs release in a similar fashion and thus are equally appropriate

Review Questions :

Review Questions During a discussion with an attending, the attending mentions that 70% of Crohn’s patients will eventually require surgery. A patient on the floor, Mrs. Smith, has Crohn’s disease. The attending asks you if Mrs. Smith would have a 70% chance of requiring surgery. You respond: A) Yes, she is a Crohn’s patient and thus has a similar risk. B) Yes, because it appeared in a note in the computer. C) No, this is an example of a dicto simpliciter fallacy. D) Mrs. Who? E) Que? No hablo anglais.