0:01 Hello everyone. Today in this video we'll talk about inflammatory bowel disease. But first, let's look at two clinical cases. Ivan, 21, is a university student. He has been experiencing frequent attacks of abdominal pain and bloody diarrhea for two months. Peter, also 21, is also a student. He has been experiencing painful mouth ulcers, intermittent abdominal pain, and non-bloody diarrhea for many years. He also has a history of recurrent kidney stones. After a thorough examination, a colonoscopy is scheduled in both cases. In Ivan's case , there is circumferential inflammation extending throughout the rectum and colon. On the other hand, in Peter's case, there are isolated areas of
0:46 colonic damage interspersed with normal mucosa, while the rectum is unaffected. Ivan and Peter have inflammatory bowel disease, or IBD, which is characterized by chronic inflammation of the gastrointestinal tract due to autoimmune reactions, as well as systemic symptoms such as fatigue, fever, and unexplained weight loss. IBD typically develops before age 30. The exact cause is unknown, but there is definitely a genetic component, as it tends to run in families. Currently, there are two types of IBD: Crohn's disease and ulcerative colitis. So, let's look at each disease separately, starting with Crohn's disease, which is primarily caused by an abnormal response of class I lymphocytes. Smoking is a risk factor. In Crohn's
1:33 disease, inflammation can occur anywhere in the gastrointestinal tract, from the mouth to the anus, but the rectum is often spared. The most severe form occurs in the terminal ileum. Gastrointestinal symptoms include cramping abdominal pain and watery diarrhea, which may or may not be bloody. Malabsorption, or malabsorption , may also occur. This manifests as malnutrition, or poor absorption of nutrients, strep throat, and vitamin B12 deficiency. A common manifestation of Crohn's disease is autothous stomatitis. Some people may also experience esophageal involvement, manifesting as adinophagia or dysphagia . Extraintestinal manifestations include arthritis, uveitis, and episcleritis, as well as skin lesions such as pyoderma gangrinosum and nodular rhytem. Crohn's disease is also known to increase the risk of kidney and gallstones. This is because damage to the terminal ileum reduces the absorption of fats and bile salts in the intestine. Fats bind to calcium,
2:59 preventing it from binding to axalates. Free axalates are absorbed into the intestines, eventually leading to the formation of calcium axalate kidney stones. Bile salts, on the other hand, typically bind to cholesterol, making it water-soluble. When bile salt absorption is reduced, cholesterol can accumulate and form gallstones. Over time, Crohn's disease can lead to complications such as strictures, which can lead to intestinal obstruction. Another complication is fistulas or suppositories. These are abnormal openings that allow two hollow organs to communicate with each other, for example, one part of the intestine to another, or the intestine to another organ, such as the bladder. Sometimes, a phlegmon can develop, which is a localized inflammation in the intestinal wall that can become infected, developing into an abscess. In some cases, people develop peritoneal abscesses, fissures, and fistulas. Finally, patients with Crohn's disease are at increased risk of developing colorectal cancer. Now let's move on to ulcerative colitis, which is primarily caused by an abnormal class II tech reaction. Surprisingly, smoking has a protective effect in ulcerative colitis.
3:44 Inflammation typically begins in the rectum and spreads up the colon, but spares the rest of the gastrointestinal tract. Gastrointestinal symptoms include colicky abdominal pain, bloody diarrhea due to inflammation, and a false urge to urinate, or tenesmus. Extraintestinal symptoms may include iron deficiency anemia due to blood loss, as well as arthritis, uveitis, and episcleritis. Primary sclerosing cholangitis is characterized by skin lesions such as pyoderma gangrinosum and rhythema nodosum. Finally, complications of ulcerative colitis include severe gastrointestinal bleeding and fulminant colitis, characterized by continuous bleeding and more than ten bowel movements per day. Another dangerous complication is toxic megacolon, in which nerves and
4:29 muscles are damaged, and the colon becomes lax and dilated. In severe cases, this can lead to perforation and peritonitis, which causes fever and severe abdominal pain. Finally, it is important to know that ulcerative colitis increases the risk of colorectal cancer even more than Crohn's disease. Therefore, to diagnose IBD, an endoscopy or colonoscopy with biopsy is necessary. With Crohn's disease, you will see cobblestone-like lesions in the mucosa. In some people, fatty tissue from the mesentery can envelop the intestine, causing it to thicken, a condition called the creeping fat sign. On the other hand, ulcerative colitis is characterized by circumferential inflammation that extends throughout the rectum and colon . There may also be areas of superficial or deep ulceration. Another
5:15 important thing to note with ulcerative colitis is that the mucosa can be so sensitive that even the slightest touch of a colonoscope can cause bleeding. Furthermore, if we perform a biopsy, we will see that in Crohn's disease, the damage to the gastrointestinal wall is transmural. This means it affects the entire thickness and can lead to the formation of fissures. White blood cells can penetrate these fissures and accumulate in the mucosa, resulting in the formation of non-casual granulomas. The inflamed areas can also swell or scar, forming a narrowing of the intestine called a stricture. This can lead to obstruction. In barium X-rays, only a small stream of contrast material passes through the narrowing, known as the string sign. In prismatic colonitis, damage is limited to the
6:01 mucosa and submucosa. In this case, crypt abscesses may develop, which are leukocyte deposits in the crypts of Lieberkuhn. Crypts are invaginations of the intestinal epithelium into the lamina propria. In prismatic colonitis, peripheral inflammation can destroy the haustra, leading to effacement of the colon. This is known as the drainpipe sign. An important difference from Crohn's disease is that ulcerative colonitis does not have granulomas. Once diagnosed, treatment depends on the type and severity of IBD. Treatment involves step therapy, in which less potent anti-inflammatory drugs are prescribed initially, and if they are ineffective, they are replaced with more potent ones. Therefore, the usual treatment for Crohn's disease includes corticosteroids. If there is no response, aminosalicylic acid is an
6:48 alternative. Antibiotics such as ciprofloxacin and metronidazole are another option. Antibiotics are thought to help control symptoms by reducing gut bacteria levels and also by moderating the immune response, as some antibiotics also have anti-inflammatory effects. Finally, in more severe cases, the biologic drug Inflicimap may be used to suppress the immune system, which can be combined with an immunomodulator such as azothiaprine. Aminosalicylic acid is typically prescribed initially when treating ulcerative colitis. In more severe cases, immunosuppressants such as corticosteroids are prescribed. If these are ineffective, biologic therapies such as Inflicimap may be used. Another treatment option is surgery to remove the affected tissue. But one really important difference is
7:35 that with Crohn's disease, surgery isn't a cure because inflammation can occur anywhere in the gastrointestinal tract. Ulcerative colitis, on the other hand, affects only the colon, so surgery can be helpful, but you must carefully consider the benefits and risks of such surgery. So, let's summarize what we've learned. Crohn's disease can affect any part of the gastrointestinal tract and lead to fistulas and kidney stones. Ulcerative colitis, on the other hand, affects only the rectum and colon. Acute complications include bleeding, fulminant colitis, and toxic megacolon, while chronic complications include strictures and colorectal cancer. Diagnosis is based on colonoscopy with biopsy. With ulcerative colitis, colonoscopy will reveal inflammation of the mucosa and submucosa in the rectum
8:21 and colon. In Crohn's disease, we see a transmural lesion with a cobblestone appearance. Treatment involves anti-inflammatory medications and depends on the type and severity of IBD . Now, let's return to our patients. Ivan had bloody diarrhea, which suggests he most likely has ulcerative colitis, while Peter suffered from non-bloody diarrhea and a history of kidney stones. All of this points to Crohn's disease. The colonoscopy results confirm this, as Ivan has lesions affecting the rectum and colon, while Peter has a segmental lesion with a cobblestone appearance that spares the rectum. A biopsy may be performed to confirm the diagnosis. This video is an adapted translation of the original. Thank you all for watching, and we'll
9:08 see you soon.
