Inflammatory bowel disease: definition, epidemiology, etiologic aspects, and immunogenetic studies (original) (raw)

Differentiating Crohn’s Disease from Ulcerative Colitis - New Factors

Biomedical Journal of Scientific and Technical Research, 2019

Crohn's disease (CD) and ulcerative colitis (UC) have been known to physicians for decades. Unfortunately, so far there are many unknowns regarding CD and UC. There are numerous descriptions of clinical cases, different locations of disease symptoms, and descriptions of symptoms located both in the gastrointestinal tract and symptoms accompanying the disease. All this information sheds light on the etiology of inflammatory bowel disease (IBD) do not completely resolve their complexity. An analysis of the literature presented in the work indicates that the characteristics of diseases are often unambiguous. This contributes to the fact that IBD diagnostics are often difficult and create many problems [1-3]. Despite many years of research on inflammatory bowel diseases, they are still of interest to scientists today. Nonspecific inflammatory bowel disease is a term referring to chronic and recurrent gastrointestinal disease. A number of clinical symptoms distinguish between CD and UC, whose clinical picture is relatively diverse. However, in many cases the diagnosis is not straightforward, which contributes to the interest of researchers worldwide in the disorders under discussion. The inflammatory changes in the course of UC are continuous and limited to the mucous membrane of the large intestine. UC-related inflammation usually involves the mucosa and submucosa usually begins in the rectum and spread proximal to the colon. The affected tissue is swollen, with the presence of erosions and ulcers, which lead to spontaneous bleeding. In most cases, UC initially occurs smoothly, with worsening symptoms within a few weeks. It happens, however, that the disease begins suddenly and goes very quickly. In such cases, due to the lack of the effect of conservative treatment, surgical treatment is already implemented in the early stages of the disease. However, in most cases, after the first shot of the disease, it goes into remission, after which it becomes more severe again. Such continuous conditions of illness and remission may last even several dozen years [1,2]. In the case of CD, the condition most often includes the small intestine and caecum, which accounts for 40% of cases, only small intestine (30% of patients) and only large intestine (25% of cases). In situations where only the large intestine is covered, two forms of the disease are recognized. The first one concerns about two thirds of cases and consists in taking the entire length of the large intestine with the disease state, while the second involves the occurrence of staple

Disease Characteristics of Inflammatory Bowel Disease (IBD)

Journal of Gastrointestinal Surgery, 2011

Background Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD), which are chronic inflammatory conditions affecting the gastrointestinal tract. There are only few published data on disease characteristics of IBD related to South Asia. Objective To provide the disease characteristics of the IBD patients who presented to a tertiary care hospital in South Asia. Methods Patients with an established diagnosis of IBD were identified after a review of their medical records and demographics, and disease characteristics and indications for surgical treatment were analyzed. Results A total of 184 patients (women=101, 54.9%; UC=153, 83.2%) were included. Female preponderance was observed for UC (male/female ratio =1:1.5) and male for CD (male/female=2:1). Mean age at the time of diagnosis was 36.3 (range 7-71) years. CD was diagnosed at a significantly younger age than UC (27.35±10.22 vs. 38.14±13.05 years, p<0.0001). CD showed a peak age of onset in the third decade and that for UC was in the fourth decade. The mean duration of IBD was 8.17 (range 1-28) years. Presenting complaint of the majority (73.7%) of UC patients was blood and mucous diarrhea and that for CD (77.4%, 24/31) was left-sided abdominal pain. Only 9.5% (n=18) had at least one extra-intestinal manifestation. Among UC patients, 51.7% (n=79) had left-sided colitis and panproctocolitis was found in 18.3% (n=28). In IBD patients, 14.1% (n=26) underwent surgery. Only one patient developed malignancy. Conclusions The majority of UC patients had left-sided colitis. CD compared to UC was diagnosed at a younger age. However, compared to data reported for some Western countries, extra-intestinal manifestations and malignancy rates were lower.

The epidemiology and the pathogenesis of inflammatory bowel disease

European Journal of Radiology, 2000

The etiology of inflammatory bowel disease (IBD) is still unknown. However, a satisfactory solution cannot be far away. IBD actually encompasses two diseases, i.e. Crohn's disease (CD) and ulcerous colitis (UC). These diseases resemble each other so closely that they cannot be distinguished even pathologically, but differ from each other sufficiently to regard them as independent entities. Epidemiological observations may be helpful in identifying the true causative factors of this evasive disease. Geographically, the prevalence of the disease has a slope from North to South and, to a lesser degree, from West to East. The Western-Eastern discrepancy can be attributed to a difference in Western life styles. The incidence of the disease has been increasing world-wide of late, but its spread has been slowing down in highly affected countries. Racial and ethnic relations in different populations and immigration studies offer interesting data which can reflect genetic, inherited, environmental and behavioural factors. The disease seems to have a characteristic racial -ethnic distribution: the Jewish population is highly susceptible everywhere, but its prevalence in that population nears that of the domestic society in which they live. In Hungary, the Roma (Gypsies) have a considerably lower prevalence than the average population. This can be attributed to a genetic or environmental influence. According to age, the onset of the disease occurs more often in the second or the third decade of life, but there also is another peak in the 60s. Regarding sexual distribution, there is a slight preponderance of colitis ulcerosa in men and of Crohn's disease in women. It may correspond to the stronger auto-immune affection in the process of Crohn's disease. Environmental factors and behavioural influences also are investigated. Diet, the role of the early ages, smoking habits and the influence of hormonal status and drugs are viewed as useful contributing factors in the manifestation of the disease. Genetic studies show that one-fourth of IBD patients have an affected family member. HLAB27 histocombatibility also plays an important, but not determining role in the development of the disease. Genetic factors seem to have a stronger influence in Crohn's disease than ulcerative colitis. The existence of multiple sclerosis -IBD families may reflect the common genetic background or the similar microbial effect as well. A great number of bacterial and viral factors has been suspected of being infectious factors in IBD, mostly in CD. Mycobacteria, Yersinia, Campylobacter, Clostridium, Clamidias, etc. as well as bacteria and some viruses such as herpes and rotavirus and the primary measles virus. None of them has been proven as a real and exclusively pathogenic factor. Immunological background has an important function in the manifestation of the disease. If an individual has a genetic susceptibility to infections, the down regulation of an inflammation in the bowel wall does not occur in a proper way. This initiates the auto-immune process which is a self-increasing cycle. Extra-intestinal manifestations of IBD are of high importance because they can not only follow intestinal symptoms, but precede them by years. Hepatic and biliary disturbances (primary sclerosing cholangitis), are the most serious complications. Mucocutaneous manifestations can be the first appearance of the main disease (in the mouth). Auto-immune consequences (erythema nodosum) or complications caused even by the therapy can occur. Ocular and musculoskeletal manifestations supposedly have the same genetic background and often precede the intestinal symptoms. Considering the epidemiological, genetic and immunological data, we can conclude that ulcerative colitis and Crohn's disease are heterogeneous disorders of mutifactorial etiology in which hereditary (genetic) and environmental (microbial, behaviour) factors interact to produce the disease.

A Review on Inflammatory Bowel Disease

Asian Journal of Pharmaceutical and Clinical Research, 2023

The gastrointestinal tract commonly known as the digestive tract is one of the most important canals in the body. It consists of the passage from mouth to anus including organs that help in the digestion. The food is taken into the mouth and all essential nutrients, and vitamins are absorbed from the digestive tract. The tract consists of important digestive organs such as the pharynx, esophagus, stomach, intestine, and rectum. Although the word gastrointestinal includes the entire tract, most commonly it is the stomach and intestine. The process of digestion is complex including a variety of minor processes. This includes mastication of food, mixing with saliva to form a bolus, mixing with various gastric enzymes to form chyme, mixing with intestinal, pancreatic and hepatic juices, absorption, and extraction, removal of water and fecal compaction and elimination. These processes are very disciplined, round-the-clock, and systematic. However, there may be chances of certain problems...

Etiopathogenesis and Clinical Management of Inflammatory Bowel Disease

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.

The epidemiology and the pathogenesis of inflammatory bowel disease : Modern GI-Imaging

European Journal of Radiology, 2000

The etiology of inflammatory bowel disease (IBD) is still unknown. However, a satisfactory solution cannot be far away. IBD actually encompasses two diseases, i.e. Crohn's disease (CD) and ulcerous colitis (UC). These diseases resemble each other so closely that they cannot be distinguished even pathologically, but differ from each other sufficiently to regard them as independent entities. Epidemiological observations may be helpful in identifying the true causative factors of this evasive disease. Geographically, the prevalence of the disease has a slope from North to South and, to a lesser degree, from West to East. The Western-Eastern discrepancy can be attributed to a difference in Western life styles. The incidence of the disease has been increasing world-wide of late, but its spread has been slowing down in highly affected countries. Racial and ethnic relations in different populations and immigration studies offer interesting data which can reflect genetic, inherited, environmental and behavioural factors. The disease seems to have a characteristic racial -ethnic distribution: the Jewish population is highly susceptible everywhere, but its prevalence in that population nears that of the domestic society in which they live. In Hungary, the Roma (Gypsies) have a considerably lower prevalence than the average population. This can be attributed to a genetic or environmental influence. According to age, the onset of the disease occurs more often in the second or the third decade of life, but there also is another peak in the 60s. Regarding sexual distribution, there is a slight preponderance of colitis ulcerosa in men and of Crohn's disease in women. It may correspond to the stronger auto-immune affection in the process of Crohn's disease. Environmental factors and behavioural influences also are investigated. Diet, the role of the early ages, smoking habits and the influence of hormonal status and drugs are viewed as useful contributing factors in the manifestation of the disease. Genetic studies show that one-fourth of IBD patients have an affected family member. HLAB27 histocombatibility also plays an important, but not determining role in the development of the disease. Genetic factors seem to have a stronger influence in Crohn's disease than ulcerative colitis. The existence of multiple sclerosis -IBD families may reflect the common genetic background or the similar microbial effect as well. A great number of bacterial and viral factors has been suspected of being infectious factors in IBD, mostly in CD. Mycobacteria, Yersinia, Campylobacter, Clostridium, Clamidias, etc. as well as bacteria and some viruses such as herpes and rotavirus and the primary measles virus. None of them has been proven as a real and exclusively pathogenic factor. Immunological background has an important function in the manifestation of the disease. If an individual has a genetic susceptibility to infections, the down regulation of an inflammation in the bowel wall does not occur in a proper way. This initiates the auto-immune process which is a self-increasing cycle. Extra-intestinal manifestations of IBD are of high importance because they can not only follow intestinal symptoms, but precede them by years. Hepatic and biliary disturbances (primary sclerosing cholangitis), are the most serious complications. Mucocutaneous manifestations can be the first appearance of the main disease (in the mouth). Auto-immune consequences (erythema nodosum) or complications caused even by the therapy can occur. Ocular and musculoskeletal manifestations supposedly have the same genetic background and often precede the intestinal symptoms. Considering the epidemiological, genetic and immunological data, we can conclude that ulcerative colitis and Crohn's disease are heterogeneous disorders of mutifactorial etiology in which hereditary (genetic) and environmental (microbial, behaviour) factors interact to produce the disease.