Expertise Details



• Inflammatory bowel diseases are chronic inflammatory disorders of gastrointestinal tract characterised by a relapsing and remitting course.

• Inflammatory bowel diseases include several conditions, most common being-

   • Ulcerative colitis                                                  • Crohn's disease




• Ulcerative colitis is an inflammatory disease affecting mainly the large intestine, characterised clinically by recurrent attacks of bloody diarrhoea and pathologically by diffuse inflammation of colonic mucosa.


• Familial or genetic

   • Strong family history

   • Occurrence in monozygotic twins

• Infectious

• Possible pathogens include-        

 *Mycobacterium (M. avium paratuberculosis)                      *Measles virus                                     

 *Listeria monocytogenes                                                            *Yeast                                                    

 * Endogenous bacteria- Bacteroides & E.coli

• Dietary factors

   • Deficiency or excess of certain nutrients (butyric acid, sulphides, L-arginine and glutamine)

• Smoking

   • Patients with Crohn's disease are more likely to be smokers and smoking can exacerbate it.

   • There is an increased risk of ulcerative colitis in non-smokers.

• Psychological

   • Characteristic personality and major psychological stresses are related to flare-ups and precipitation of symptoms



• Primarily involves the colonic mucosa.

• Mucosa) involvement is uniform and continuous with no intervening areas of normal mucosa.

• Rectum is involved in 95% of cases (proctitis).

• From the rectum the disease extends proximally into the colon in a continuous fashion.

• Back wash ileitis is involvement of a few centimetres of ileum, when the entire colon is involved.

• Macroscopically, the mucosa appears hyperaemic, haemorrhagic or ulcerated. Ulcers do not usually extend deeper beyond the submucosa.


Clinical Features

• Severity of symptoms reflects the extent of colonic involvement and the intensity of inflammation

• Exacerbations and remissions are characteristic

• Bloody diarrhoea with mucus and pus

• Abdominal pain, especially lower abdominal

• Fever, weight loss and loss of appetite

• Symptoms and signs of dehydration and anaemia



• Anaemia, raised ESR and leucocytosis    • Electrolyte abnormalities

• Hypoproteinaemia      • Abnormal liver function tests

• Blood culture in septicaemia    • Stool examination and culture to exclude infective pathology

• Barium enema • Sigmoidoscopy

• Colonoscopy    • Rectal biopsy shows mucosa! inflammation



• Parenteral nutrition through a central venous line in seriously ill patients

• High-protein and low-residue diet

• Blood and plasma infusions

• Correction of dehydration and electrolyte imbalance

• Correction of septicaemia





• Crohn 's disease is characterised by patchy and transmural inflammation, which may affect any part of the gastrointestinal tract.

• It may be defined by location (terminal ileal, colonic and ileocolic, upper gastrointestinal) or by pattern of disease (inflammatory, fistulating or stricturing)



• Factors listed under "ulcerative colitis".



• Affects small and large bowels, but more common in small bowel. Can affect any part of the gastrointestinal tract from mouth to anus.

• Inflammation extends through all the layers of the intestinal wall.

• Characteristically the involvement is discontinuous. Involved segments of intestine are separated from each other by intervening segments of normal bowel.

• Bowel wall is greatly thickened and leathery with the lumen narrowed (stenosis).

• Mucosa has a nodular cobble stoned look.


Clinical Features

• Chronic disease with exacerbations and remissions

• Young adults with history of fatigue, weight Joss, diarrhoea, fever and pallor

• Abdominal pain occur due to peritoneal involvement or intestinal obstruction

• Right lower quadrant pain, tenderness, guarding and mass

• Mass palpable per abdomen and rectally reflects adherent loops of intestine and abscess

• Recurrent episodes of colicky abdominal pain with nausea, vomiting and excessive borborygmi suggest subacute intestinal obstruction

• Stool usually does not contain frank blood, mucus or pus unless colon is involved



• Normochromic normocytic or macrocytic or hypochromic anaemia

• Raised ESR and leucocytosis

• Abnormal liver function tests

• Hypoproteinaemia

• Stool culture and routine examination to exclude infectious causes of diarrhoea

• Schilling test for malabsorption of vitamin B 12

• Sigmoidoscopy and colonoscopy

• Barium meal follow through and barium enema



• Diet and nutrition

  • High-protein and high-energy diet

  • Enteral feeding by nasogastric tube. Total parenteral nutrition in very ill patients

  • Plasma or blood transfusion

  • Low residue diet in colic and subacute obstruction

  • Low-fat diet and low linoleic acid in diet

  • Milk-free diet in lactose intolerance

  • Treatment for bacterial colonisation of gut

  • Supplementation of iron, folic acid, calcium, zinc, vitamins D, B 12, and electrolytes




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