What is Inflammatory Bowel Disease?

Inflammatory bowel disease (IBD) is an idiopathic intestinal inflammatory disease involving the ileum, rectum, and colon. Clinical manifestations of diarrhea, abdominal pain, and even bloody stools. The disease includes ulcerative colitis (UC) and Crohn's disease (CD). Ulcerative colitis is a continuous inflammation of the colonic mucosa and submucosa. The disease usually affects the rectum first and gradually spreads to the entire colon. Crohn's disease can affect the entire digestive tract. It is a discontinuous full-thickness inflammation. Terminal ileum, colon, and perianal.

Basic Information

English name: inflammatory bowel disease
Visiting department: Gastroenterology

Common locations: Ileum, rectum, colon
Common causes: Related to environmental, genetic, infection and immune factors
Common symptoms: Diarrhea, abdominal pain, bloody stools

Causes of inflammatory bowel disease

The etiology and pathogenesis have not been fully clarified. It is known that the inflammatory response caused by the abnormal response of the intestinal mucosal immune system plays an important role in the pathogenesis of IBD. It is believed to be caused by multiple factors, including environmental, genetic, infection and immune factors .

Clinical manifestations of inflammatory bowel disease

Onset is usually slow with a few rushes. The condition varies. It is easy to have recurrent attacks. The triggers include mental stimulation, excessive fatigue, eating disorders, and secondary infections.

Abdominal symptoms

(1) Diarrhea Bloody diarrhea is the main symptom of UC, and blood, pus and mucus are present in the stool. Mild patients 2 to 4 times a day, severe cases can reach 10 to 30 times, showing bloody water; CD diarrhea is a common symptom, most of the stool 2 to 6 times a day, pasty or watery, generally no pus or blood or mucus Compared with UC, there is less blood in the stool and less blood color.

(2) Abdominal pain UC is usually limited to paroxysmal cramps in the left lower abdomen or lower abdomen. After the pain, there may be a will, and the pain is temporarily relieved after defecation. Most CDs have abdominal pain, which are mostly faint pain, paroxysmal exacerbations, or recurrent attacks, some of which are more common in the right lower abdomen, and are associated with terminal ileal lesions, followed by umbilical or total abdominal pain.

(3) The acute aftermath is caused by rectal inflammation.

(4) Abdominal mass may appear in some CD of abdominal mass. It is more common in the right lower abdomen and the umbilical cord. It is caused by intestinal adhesions, thickening of the intestinal wall and mesentery, enlargement of mesenteric lymph nodes, formation of internal fistula and intraabdominal abscess. Abdominal mass.

2. Systemic symptoms

(1) Anemia often has mild anemia, and severe anemia is caused by a large amount of bleeding during an acute outbreak of the disease.

(2) Fever with severe fever and symptoms of systemic toxemia. One third of patients with CD may have moderate or low fever with intermittent appearance due to active intestinal inflammation and toxin absorption after tissue destruction.

(3) Malnutrition is caused by intestinal malabsorption and excessive consumption, often causing patients with weight loss, anemia, and hypoproteinemia. Young patients are accompanied by signs of growth retardation.

Inflammatory bowel disease test

Hematological examination

(1) Hemoglobin and plasma proteins are usually mild or only slightly reduced, and moderate or severe may have mild or moderate declines, and even severe anemia and low protein edema. The decrease in Hb can be attributed to chronic inflammatory hemorrhage and protein loss, iron or other hematopoietic substances deficiency or malabsorption, especially Crohn's ileum disease is prone to vitamin and mineral malabsorption and bone marrow hematopoietic inhibition related to chronic inflammation. In addition, despite normal renal function, insufficient erythropoietin secretion also plays an important role in the formation of inflammatory bowel disease anemia.

(2) White blood cell count is normal in most patients. Moderate and severe patients may have a slight increase, a few severe patients may be as high as 30 × 10 ⁹ / L, and sometimes neutrophil elevation is the main cause. In severe cases, the neutrophil nucleus may shift to the left and poisonous particles may appear. Ulcerative Colitis increased white blood cell count may be related to inflammatory activity, systemic application of glucocorticoids can also increase granulocytes.

(3) Platelet count Platelet count can increase when patients with ulcerative colitis and Crohn's disease relapse. Relatively mild to moderate ulcerative colitis, platelet counts greater than 400 × 10 ⁹ / L are more common in severe patients.

2. stool test

(1) Routine examination of feces is based on the observation of pasty mucus pus and blood. The most common fecal matter is very few, and a small number of patients are mainly bloody, with a small amount of mucus or no mucus. Microscopic examination showed a large number of red blood cells, white blood cells, and eosinophils. A large number of multinuclear macrophages were common in fecal smears during acute attacks.

(2) Etiological examination The purpose of the pathogenic examination of inflammatory bowel disease is to exclude infectious colitis, which is an important step in the diagnosis of this disease.

3. ESR test

In patients with inflammatory bowel disease, the ESR generally increases during the active phase, and the ESR generally reflects the disease activity. According to foreign reports, the average ESR of patients in remission is 18mm / h, light activity is 43mm / h, moderate activity is 62mm / h and severe activity is 83mm / h. ESR changes reflect changes in the concentration of certain proteins in the active phase of the disease. ESR changes when certain protein concentrations in the serum, especially gamma-globulin, fibrinogen and Y-globulin, and hematocrit change. Due to the long half-life of serum proteins associated with ESR, if clinical symptoms improve quickly, ESR often does not decrease until a few days after clinical symptoms have resolved.

Diagnosis of inflammatory bowel disease

The main methods for diagnosing inflammatory bowel disease include history collection, physical examination, laboratory examination, imaging, endoscopy and histological features.

Differential diagnosis of inflammatory bowel disease

Chronic bacterial dysentery

There is often a history of acute bacterial dysentery, dysentery bacillus can be isolated by stool examination, and the positive rate of mucus purulent secretion culture by colonoscopy is high, and antibacterial treatment is effective.

2. Amoeba enteritis

It mainly invades the right colon and may also involve the left colon. The colon ulcers are deep, the margins sneak, the intermucosal mucosa is more normal, and fecal examination can find amoeba trophozoite cysts, and anti-amoeba treatment is effective.

3. Schistosomiasis

There is a history of contact with epidemic water, often with hepatosplenomegaly. Schistosomiasis eggs can be found in fecal examination, and hatching hairy maggots are positive. Proctoscopy shows yellow-brown mucosa granules in the acute phase, and schistosomiasis eggs can be found on biopsy mucosal compression or tissue disease.

4. Colorectal cancer

Seen after middle age, mass can be touched by digital rectal examination, colonoscopy and X-ray barium enema examination are valuable for diagnosis.

5. Irritable bowel syndrome (IBS)

The stool had mucus but no pus and blood, the microscopic examination was normal or only a few white blood cells were seen, and the colonoscopy showed no evidence of organic lesions.

6. Other

(1) Intestinal tuberculosis Intestinal tuberculosis mainly involves the ileocecal part, sometimes involving the adjacent colon, but it does not show segmental distribution. Fistula and anorectal lesions are rare; tuberculin test is positive.

(2) Malignant lymphoma of the small intestine Primary malignant lymphoma of the small intestine is often localized in the small intestine and / or adjacent mesenteric lymph nodes for a long time. Some patients may have a multifocal distribution of tumors. For example, X-ray examination shows that the small intestine and colon are affected at the same time. Segmental distribution, fissure ulcers, cobblestone signs, fistula formation, etc. are helpful for the diagnosis of Crohn's disease; if the examination shows extensive invasion in the intestinal segment, there are large pressure marks or filling defects, and the B-mode or CT examination of the intestine The wall is significantly thickened, and the abdominal lymph nodes are more swollen to support the diagnosis of malignant lymphoma of the small intestine. Surgical exploration can be performed if necessary.

Inflammatory bowel disease treatment

General treatment

Emphasize diet conditioning and nutritional supplements, and give high-nutrition, low-residue diets. Appropriately give folic acid, B ₁₂ and other vitamins and trace elements. Abdominal pain and diarrhea may be given anticholinergic or antidiarrheal drugs when necessary, and patients with concurrent infections may be given broad-spectrum antibiotics by intravenous route.

2. Drug treatment

(1) Aminosalicylic acid preparation: SASP has a certain effect on the control of light and medium-sized patients, and it is mainly suitable for those with localized lesions in the colon.

(2) Glucocorticoids: The most effective drugs for controlling disease activity, applicable to the active period of the disease. Strong activity can be added with aminosalicylic acid preparations or immunosuppressants.

(3) Immunosuppressive agents: For patients with chronic active phase who have poor glucocorticoid treatment or glucocorticoid dependence, the use of such drugs can reduce the amount of glucocorticoid and even stop using it.

3. Surgical treatment

Indications for surgery: Complete intestinal obstruction, fistula and abscess formation, acute perforation or uncontrollable massive bleeding.