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Inflammatory Bowel Disease PowerPoint Presentation

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This medical PowerPoint presentation talks about Inflammatory bowel disease (IBD), a chronic inflammatory condition that affects the digestive tract. The two most common types of IBD are Crohns disease and ulcerative colitis.

Tags : inflammatory bowel diseases, digestive tract, Crohns disease, ulcerative colitis, abdominal pain, diarrhea, bloody stools, Digestive System, Digestive System PowerPoint presentation

Published on : Mar 27, 2023 | Views : 1618 | Downloads : 1

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Slide 1-

Inflammatory Bowel Disease
Slide 2-

Definition Inflammatory bowel disease (IBD) is a term encompassing a number of chronic inflammatory disorders leading to damage of the gastrointestinal tract.
Slide 3-

Crohns disease
Slide 4-

Symptoms of CD The presentation depends on the site, extent, severity, and complications of intestinal and extraintestinal disease. Fevers, night sweats, and weight loss. Abdominal pain Nausea and vomiting Diarrhea Rectal bleeding
Slide 5-

Extraintestinal Manifestations of Inflammatory Bowel Disease Musculoskeletal Peripheral arthritis Sacroiliitis Ankylosing spondylitis Osteoporosis Dermatologic Erythema nodosum Pyoderma gangrenosum Aphthous stomatitis Hepatobiliary Disease Primary sclerosing cholangitis Ocular Uveitis Scleritis Episcleritis Vascular Thromboembolic events Renal Nephrolithiasis
Slide 6-

Physical Examination in CD Weight loss and pallor. Clubbing of the fingers. Abdominal distension Tenderness in the area of involvement Abnormal bowel sounds. Presence of an inflammatory mass are common. Perianal abscess, fistula, skin tags, or anal stricture.
Slide 7-

Laboratory Studies Anemia Deficiencies of iron, vitamin B12, or folic acid Anemia of chronic disease. Leukocytosis Thrombocytosis Elevated ESR and C-reactive protein levels Decreased Serum albumin levels Urinalysis commonly demonstrates calcium oxalate crystals. Stoolanalysis for fecal leukocytes Serologic markers with high specificity for CD. Anti-Saccharomyces cerevisiae antibody(ASCA) Antibody to the outer core membrane of E. coli (OmpC)
Slide 8-

Imaging Studies Plain abdominal x- ray Barium studies Small bowel enema (enteroclysis) / follow-through Large bowel enema U/S Abdomen and Pelvis / Transrectal U/S CT Abdomen and Pelvis MRI
Slide 9-

CD Aphthoid ulceration of terminal ileum (small arrows)- Note also "cobblestoning" (larger arrows). Typical features of Crohn's disease of the distal ileum including fissure ulcers (small arrows), longitudinal ulcers (arrowhead), "cobblestoning" (open arrows), aphthoid ulcers (curved arrow) and stricturing. ic=ileocaecal valve.
Slide 10-

Endoscopy Upper and Lower Endoscopy Capsule Endoscopy
Slide 11-

CD
Slide 12-

CD
Slide 13-

CD
Slide 14-

Granuloma in CD
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ACG Practice Guidelines:Definitions of Disease Severity Ambulatory patients Patients who are able to tolerate oral alimentation Patients without manifestations of Dehydration Toxicity ( high fever, rigors, prostration ) Abdominal tenderness Painful mass Obstruction >10% weight loss Mild – Moderate CD : Hanauer et al A J Gastroenterology 2001,96,635
Slide 16-

ACG Practice Guidelines:Definitions of Disease Severity (cont.) Patients who have failed to respond to treatment for mild-moderate disease Patients with more prominent symptom of: Fever Significant weight loss Abdominal pain or tenderness Intermittent nausea or vomiting (without obstructive findings) Significant anemia Moderate-Severe CD: Hanauer et al A J Gastroenterology 2001,96,635
Slide 17-

ACG Practice Guidelines:Definitions of Disease Severity (cont.) Patients with persistent symptoms despite the introduction of steroids as out patient Individuals presenting with: High fever Persistent vomiting Evidence of intestinal obstruction Rebound tenterness Cachexia, or Evidence of abscess Sever –Fulminant CD: Hanauer et al A J Gastroenterology 2001,96,635
Slide 18-

ACG Practice Guidelines:Definitions of Disease activity Patients who are asymptomatic or without inflammatory sequelae Patients who have responded to acute medical intervention or have udergone surgical resection without gross evidence of residual disease NB: Patients requiring steroids to maintain well-being are considered to be “steroid-dependen”and are usually not cosidered to be “in remission.” CD in remission: Hanauer et al A J Gastroenterology 2001,96,635
Slide 19-

Long-term disease evolution behavior in CD Cosnes J et al. Inflamm Bowel Dis 2002;8;244
Slide 20-

Medical treatment of IBD Yousef A. Qari MD,FRCPC,ABIM Consultant Gastroenterologist King Abdulaziz University Hospital Jeddah, Saudi Arabia
Slide 21-

Current Expectations for IBD Therapy Induce clinical remission Maintain clinical remission Improve quality of life Plus Heal mucosa Decrease hospitalization / surgery / overall costs Minimize disease- related and therapy-related complications
Slide 22-

ACG Practice Guidelines:Recommended treatment Aminosalicylates Sulphasalazine (3-6g/d) Mesalamine (3.2-4.0g/d) 40-50% Antibiotics (CD involving colon) Metronidasole (10-20mg/kg) 50% Ciprofloxacin (1g/d) Metro+Cipro (250mg 2-3 times/d +500mg 2 times/d) 76% Budesonide (CIR) (9mg/d) For ileal & Rt colonic disease 69% Mild – Moderate CD : Remission
Slide 23-

ACG Practice Guidelines:Recommended treatment Corticosteroids Appropriate antibiotics therapy or drainage (surgical/percutaneous) required for infection or abscess Inflximab infusion Effective adjunct Possible alternative to steroid therapy in selected patients in whom corticosteroids are contraindicated or ineffective. Moderate –Severe CD
Slide 24-

Oral Budesonide for active CD Greenberg etal . N Engl J Med 1994;331;836-41
Slide 25-

ACG Practice Guidelines:Recommended treatment Corticosteroids Budesonide 9mg/d or Prednisone (0.5-0.75mg/kg) or 40mg/d 5o-70% remission rate in 8-12 weeks Until resolution of symptoms and resumption of weight gain, generally 7-28 days. Steroid refractory & steroid dependent ≈ 50% Smooking Colonic disease Not effective for maintenance Moderate –Severe CD:
Slide 26-

Clinical response and remission in Infliximab-treated patients Clinical response : ≥70 points decrease in CDAI from baseline Clinical remission : a CDAI of < 150 Targan SR et al, N Engl J Med. 1997:337:1029 Moderate-Severe CD:
Slide 27-

Clinical Response at Week 52* P<0.001 P<0.001 P=NS *Week-2 Responders
Slide 28-

Clinical Remission at Week 54* P<0.007 P<0.001 P=NS *Week-2 Responders
Slide 29-

ACG Practice Guidelines:Recommended treatment Hospitalization required for : patients with persistent symptoms despite introduction of oral steroids or infliximab Patients presenting with high fever, frequent vomiting, evidence of intestinal obstruction, rebound tenderness, cachexia, or an abscess Surgical consultation is warranted for patients with obstruction or tender abdominal mass. Severe-Fulminant CD: Hanaur S et al. Am J Gastroenterology; 96; 635
Slide 30-

ACG Practice Guidelines:Recommended treatment Exclude abscess Abd US Abd CT Parentral corticosteroids equivalent to 40-60mg prednisone If abscess has been excluded If the patient has been receiving oral setroids Severe-Fulminant CD: Drainage Percutaneous Surgical
Slide 31-

ACG Practice Guidelines:Recommended treatment Parentral broad spectrum antibiotics High fever Toxic appearance Inflammatory mass Nutritional support: (Elemental or TPN) TPN in addition to steroids plays no specific role Indications For patients unable to maintain nutritional requirments after 5-7 days Preoperative management Pediatric age groups Severe-Fulminant CD:
Slide 32-

Therapeutic Options for Perianal Fistulas in CD Possible efficacy Antibiotics AZT/6-MP Cyclosporine Proven efficacy Infliximab
Slide 33-

Therapeutic Options for Perianal Fistulas in CD AZT/6-MP 22/41 Compleate healing or decreased discharge΅ Pearson DC et al. Ann Intern Med.1995;122;132
Slide 34-

Therapeutic Options for Perianal Fistulas in CD Infliximab Present DH et al. N Engl J Med. 1999;34;1398 P=0.001 P=0.04
Slide 35-

Newly Diagnosed Crohn (N = 129) Step-up versus Top-down Trial
Slide 36-

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Step Up treatment paradigm driven by cost, safety and adverse events Aminosalicylates Steroids Elemental diet Antibiotics Infliximab Immunosuppressives The classical Step-Up-treatment paradigm Surgery
Slide 39-

Azathioprine is the best conventional drug to maintain clinical remission Candy S et al. Gut. 1995;37:674. 0 15 Remission induced by prednisolone; tapered over 12 wk 100 ster + AZA AZA
Slide 40-

Continuous Immunotherapy is required to treat a Chronic Disease Lemann et al. Gastroenterol. 2005 Jun;128(7):1812-8. Months after randomisation Patients in clinical remission with AZA for at least 3.5 years before randomisation
Slide 41-

Cumulative Probability of Surgical Intervention in CD Munkholm P et al. Gastroenterology. 1993; 105:1716. Years Probability (%) Events (no.) 122 26 15 7 7 4 8 1 8 2 2 2 3 2 1 0 20 40 60 80 100 0 2 5 8 11 14 17 20 Dx
Slide 42-

Ulcerative colitis
Slide 43-

Difinition A chronic disease charecterized by diffuse mucosal inflammation limited to the colon.
Slide 44-

Age distribution of Ulcerative colitis in east and west provinces of Saudi arabia 188 CASES Age(y) at presentation Qari Y et al, under publication 2. Satti M et al, Ann Saudi Med 1996;16(6):637-640.
Slide 45-

Sex distribution of UC in the Gulf Qari Y et al, under publication Hossain J et al. Ann Saudi Med 1991;11:40-6. Satti M et al, Ann Saudi Med 1996;16(6):637-640. 4. Al-Nakib B et al. Am J Gastroenterology 1984;79:191-4 5. Mir-Madjlessi SH et al. Am J Gastroenterology 1985;11:862-6.
Slide 46-

Pattern of UC in the Gulf Qari Y et al, under publication Hossain J et al. Ann Saudi Med 1991;11:40-6. Satti M et al, Ann Saudi Med 1996;16(6):637-640. . 4. Al-Nakib B et al. Am J Gastroenterology 1984;79:191-4 5. Mir-Madjlessi SH et al. Am J Gastroenterology 1985;11:862-6.
Slide 47-

Epidemiological figures comparing East vs West
Slide 48-

Ulcerative colitis
Slide 49-

UC Normal
Slide 50-

UC
Slide 51-

UC
Slide 52-

The goals for the management of acute ulcerative colitis Induction of remission Prevention of relapse Treatment of complications
Slide 53-

Therapeutic decisions Disease Activity ?? Extent of Disease ??
Slide 54-

Disease Activity Mild Moderate Severe Fulminant
Slide 55-

Mayo score Schroeder KW et al. N Engl J Med 1987; 317: 1625-9.
Slide 56-

Mayo score Schroeder KW et al. N Engl J Med 1987; 317: 1625-9.
Slide 57-

Mayo score Schroeder KW et al. N Engl J Med 1987; 317: 1625-9.
Slide 58-

Mayo score Schroeder KW et al. N Engl J Med 1987; 317: 1625-9.
Slide 59-

Endoscopy Photo: Sample Scores Endoscopy score 1 Endoscopy score 0 Endoscopy score 2 Endoscopy score 3
Slide 60-

Mayo score Schroeder KW et al. N Engl J Med 1987; 317: 1625-9.
Slide 61-

Mayo score Schroeder KW et al. N Engl J Med 1987; 317: 1625-9.
Slide 62-

Severe colitis A bloody stool frequency of > 6/day with any one of the following: Tachycardia (pulse > 90 beats/min) Temperature (> 37.8 °C) Anaemia (Hg < 10.5 g/dL) Raised ESR (> 30 mm/h)
Slide 63-

Extent of Disease
Slide 64-

Medical Therapy Activity Extent
Slide 65-

Superiority of topical 5-ASA to placebo in treatment of mild to moderate Distal UC. Seven RCTs
Slide 66-

Superiority of topical 5-ASA to placebo in treatment of mild to moderate Distal UC.
Slide 67-

5-aminosalicylic acid preparations (all study arms) compared with placebo in active ulcerative colitis. Adapted from Sutherland et al. Ann Intern Med 1993; 118: 540–9.
Slide 68-

Combined oral and topical treatment with 5-ASA in active extensive UC, proximal to the splenic flexure. Marteau P et al. Gut 2005; 54: 960–5. (NS) P =0.03
Slide 69-

Topical 5-ASA have superior efficacy to oral mesalazine in the maintenance of remission in Distal Colitis Mantzaris GJ et al. Dis Colon Rectum 1994; 37: 58–62.
Slide 70-

RCTs of mesalazine vs. placebo for preventing relapse in patients with UC 27. Ardizzone S et al.Aliment Pharmacol Ther 1999; 13: 373–9. 23. Hanauer S et al .Ann Intern Med 1996; 124: 204–11. 25. Hawkey CJ et al. Gastroenterology 1997; 112: 718–24. 24. Miner P et al. Dig Dis Sci 1995; 40: 296–304.
Slide 71-

The New Aminosalicylates for UC Equivalent to sulfasalazine Inducing remission Maintaining remission Fewer side effects
Slide 72-

Compliance is a problem
Slide 73-

Patient Non-compliance with 5-ASA Treatment Regimens Kane SV et al. Am J Gastroenterol 2001; 96: 2929-33.
Slide 74-

Clinical Impact of Non-adherence to therapy for UC Kane S. Am J Med 2003; 114: 39-43. Greater risk of symptomatic relapse (P = 0.001)
Slide 75-

Clinical Impact of Non-adherence to therapy for UC Greater risk of colorectal cancer (P < 0.001) 175 patients The lifetime risk of colorectal cancer among patients with UC is estimated to be approximately 20% Brentnall TA. Curr Opin Gastroenterol 2003; 19: 64-8.
Slide 76-

Mesalazine 2 g gel enema is as effective as and more convenient than mesalazine 2 g foam enema P<0.05 P<0.005 P<0.05 103 patients 4 weeks Remission rates were comparable between the two groups. Gionchetti P. Aliment Pharmacol Ther 1999; 13: 381-8.
Slide 77-

SPD476* for the induction of remission in patients with mild-moderate UC 280 patients 8 weeks R× A once-daily high-dose 5-ASA formulation using a novel multimatrix technology to delivers 1.2 g of drug per tablet to the entire colon Lichtenstein GR et al, A Phase III study. Am J Gastroenterol. 2005;100:S-291. [Abstract #787]
Slide 78-

SPD476* for the induction of remission in patients with mild-moderate UC Kamm MA et al, Am J Gastroenterol. 2005;100:S-291. [Abstract #786]