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Inflammatory Bowel Diseases PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Inflammatory Bowel Diseases" by Michael Schultz.
This medical PowerPoint presentation talks about Inflammatory bowel disease (IBD), a chronic condition that causes inflammation in the digestive tract. The two main types of IBD are Crohns disease and ulcerative colitis. Both conditions can cause symptoms such as abdominal pain, diarrhea, weight loss, and fatigue.

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 : 1549 | Downloads : 2

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Slide 1-

Inflammatory Bowel DiseasesUpdate 2020- For Patients - Michael Schultz @GastroOtago @OtagoMedDept Stomach Small intestine Large intestine
Slide 2-

Disclaimer: “The content of this presentation is provided for informational purposes only and is not intended as medical advice, or as a substitute for the medical advice of a physician.”
Slide 3-

What is Inflammatory Bowel Disease? Treatment – now and in the future Agenda
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IBD - Incidence Aluzaite K et al., Intest Inflam Dis 2018
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Total patients: 964 Crohn’s disease: 405 Ulcerative colitis: 239 IBDu: 35 Dunedin 2016 New Zealand 2016 IBD 2016: 20,792 IBD 2026: 41,198 IBD - Prevalence A comparison of prevalence to other conditions in NZ Schizophrenia approx 14,000 people Type 1 Diabetes approx 21,450 people Bipolar between 30,000 and 40,000 people NEW database in 2021: Crohn’s and Colitis Cure
Slide 6-

North South IBD – Disease Mechanisms
Slide 7-

But why is that? Genetic predisposition Bacteria Environment And?
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Ulcerative colitis Crohn’s disease The pathogenesis of IBD is multi-factorial Sartor 2006 Two hit theory! IBD – Disease Mechanisms
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Genes >200 susceptibility loci for IBD 5% pts have a family history Overlap with: Ankylosing Spondylitis Psoriasis Primary Sclerosing Cholangitis NOD2/Card15/IBD1 not necessary and not sufficient (20% controls) mutations account for ~20% conferring a 40-fold risk 8-17% Caucasian CD 0% Japanese CD
Slide 10-

Gut Bacteria Nature Reviews Microbiology 9, 279-290 (April 2011) Aymé Spor, Omry Koren & Ruth Ley
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UC is a disease of NON-SMOKERS Smoking is ‘beneficial’ for UC both passive (childhood) and active (adulthood) smoking decrease the risk of UC Smokers with CD have a 34% higher relapse rate Recommendation CD: encourage patients with CD to STOP smoking UC: inform about the relationship but do not encourage! Environment For example:
Slide 12-

Strongly dependent on location! Crohn’s Disease Diarrhea Weight loss Fever Night sweats Growth retardation Abdominal pain Lab marker WBC Platelets Albumin Iron Hb Faecal calprotectin Ulcerative colitis Bloody diarrhea Lab marker WBC Platelets Iron Hb Faecal calprotectin Crohn’s Disease Ulcerative Colitis IBD - Symptoms Remission & Flare up
Slide 13-

Crohn’s Disease: small bowel, large bowel, extra-intestinal manifestations, complications, etc. Ileocolic 50% Colon 20% Upper GI 5% CD - Treatment
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Distal colitis Pancolitis UC - Treatment
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Treatment Options Treatment options: Systemic Topical Immunomodulators Biologicals
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Salazopyrine Mesalazine 5-ASA Steroids Nutrition Azathioprine MTX 1932 1949 1955 1985 1988 1995 1996 TNFa antibody Burrill Crohn Funded in NZ since August 2009! Treatment Genetics Patient Individualised Treatment The Future
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Sequential Therapy Treatment Side effects of treatment Steroids - weight gain - acne - mood disturbances - infections Thiopurines - malignancy - pancreatitis - myelosuppression Anti-TNF - opportunistic infections - malignancy Surgery - infertility - complications
Slide 18-

CD - Treatment Aim
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Oral 5-ASA (Pentasa/Asacol) Oral steroids (~3 months) i.v. steroids (~5 days) Acute Flare Azathioprine/6-MP/MTX Oral 5-ASA (Pentasa/Asacol)? Surgery Remission Complications Biologicals O/P Hospital O/P Hospital CD - Treatment
Slide 20-

Distal colitis Pancolitis 5-ASA (supp.) 5-ASA (enema) Steroid (foam) Oral 5-ASA Oral/i.v. Steroids i.v. cyclosporine Oral 5-ASA Oral Steroids i.v. steroids biologicals surgery Remission Remission Complications Oral 5-ASA/Azathioprine biologicals UC - Treatment
Slide 21-

Individual Medications Steroids Treatment Examples Community - Prednisone 40mg oral once daily for 2 weeks, then reduce by 5mg/week and stop Hospital - Methylprednisolone 40mg morning and 20mg night i.v. for 3-5 days, then reduce by 20mg (night-time dose) for 2 days and then convert to oral
Slide 22-

74 (43%) treated with steroids Immediate Outcome Remission 58% Partial remission 26% No response 16% One year Outcome Prolonged response 32% Dependence 28% Operation 38% Crohn’s disease n = 173 63 (34%) treated with steroids Immediate Outcome Remission 54% Partial remission 30% No response 16% One year Outcome Prolonged response 49% Dependence 22% Operation 29% Ulcerative colitis n = 185 Don’t forget Calcium and Vitamin D Steroids
Slide 23-

Individual Medications Thiopurines Treatment Examples: Azathioprine 2.5mg/kg BodyWeight – usually 150-200mg per day orally Special Situation – shunters: Azathioprine 50mg together with Allopurinol 50-100mg 6-mercaptopurine 1-1.5mg/kg BodyWeight – usually 50-100mg per day orally
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Idiosyncratic (5-10%) allergic /pancreatitis Dose dependent (2-3%) hepatic toxicity myelosuppression Myelosuppression ~ 2% patients from 2 weeks – 11 years dose dependent myelosuppression is unpredictable can be severe and life threatening may be linked to TPMT Postoperative infection rates Pregnancy no evidence of teratogenicity no effect on male fertility Malignancy Increased risk NHL in 4/782 patients (Significantly higher than expected) No increased in risk Controversial Adverse Effects Adverse Effects Randomisation following at least 42 months of Azathioprine Sustained Effect Bahi M et al. 2017 Thiopurines
Slide 25-

Individual Medications Biologicals Treatment Examples: Humira 40mg sub cutaneous injection every 2 weeks (maintenance) Infliximab 5mg/kg BodyWeight infusion every 8 weeks, usually 300-500mg
Slide 26-

ACCENT I Lancet 2002;359:1541 All patients: 5mg/kg at baseline then 8-weekly Group I – Placebo Group II – 5mg/kg Group III–10mg/kg I I II II III III Analysis: 8-weekly better than once only BUT No difference between 5 or 10mg/kg Crohn’s Disease Biologicals - Infliximab
Slide 27-

Complete response (closure of fistula) Response (>50% reduction) ACCENT II NEJM 2004;350:876
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Acute Disease – Ulcerative Colitis Response Remission moderately severe, steroid-refractory (ACT I) or on mesalamine (ACT II) ACT I + III NEJM 2005 Biologics - Infliximab
Slide 29-

Oesophageal candidiasis, candida sepsis CMV Herpes Treatment - Safety
Slide 30-

Infliximab cost at the CDHB
Slide 31-

Crohn’s Disease Ulcerative colitis Options
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2 4 6 8 10 12 0 Months Efficacy 100 (%) 75 50 25 0 Immune suppressants Combination Biologics Therapeutic Gap Infliximab outcomes
Slide 33-

Salazopyrine Mesalazine 5-ASA Steroids Nutrition Azathioprine MTX 1932 1949 1955 1985 1988 1995 1996 TNFa antibody Burrill Crohn Funded in NZ since August 2009! The Future Genetics Patient Individualised Treatment The Future
Slide 34-

The Future - Immunology
Slide 35-

Anti IL12/IL23 p40 subunit Stelara
Slide 36-

Vedolizumab – anti-integrin a4b7 Entyvio
Slide 37-

Crohn’s disease and ulcerative colitis – genetics, bacteria and environment Treatment is effective New treatment options are on the horizon Summary