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InflammatoryBowelDisease
炎症性肠病
OverviewIntroduction/EpidemiologyPathogenesisClinicalManifestationsConventionalTherapiesPrognosis
IntroductionDefinition:Chronicautoimmuneinflammatorydisorders,involvingsomeoralllayersofthegutwall.UlcerativeColitis(UC)Mucosal/submucosalonlyCrohn’sDisease(CD)Alllayersofwallatrisk
UlcerativeColitisCrohn’sDiseaseEndoscopicAppearanceNormalcolonFriabilityExudatebleedingDiffuseulcerationCobblestoningFocalulceration
Histology/DepthofIBDMucosalandsubmucosalonlyNogranulomasseen*Transmuraldisease*GranulomasoccasionallyseenUlcerativeColitisCrohn’sDisease
UlcerativeColitisvsCrohn’sDisease
EpidemiologyIncidence:5-29per100,000peopleperyearPrevalence:~1.3millionpersonsNewcases:estimated20,000-100,000peryear*Genderdistribution:Crohn’sdisease:SlightfemalepredominanceUlcerativeColitis:SlightmalepredominanceAgeincidence--BimodaldistributionPeakonset:15to25yearsofageSecondpeakincidence:50to65yearsofage
Anti-inflammatoryPro-inflammatoryTNFIL-1bIL-12/IL-18IFNgIL-4/IL-13IL-1RaTGFbIL-10PGE2Pathogenesis
PathogenesisofInflammatoryBowelDiseaseImmuneDysregulationIBDGenetic
SusceptibilityEnvironmental
Triggers
EnvironmentRiskfactors:OccupationsassociatedwithoutdoorphysicallaborHighersocioeconomicstatusWomenwhouseoralcontraceptivesIncreasedintakeofrefinedsugarsandapaucityoffreshfruitsandvegetablesinthedietSmokingStress
RiskFactorsKnownFamilyhistoryofIBDCigarettesmokingRiskforCDProtectiveforUCAppendectomyRiskforCDProtectiveforUCPossibleOralcontraceptivesDiet:sugar,fatBreastfeeding(protective)ChildhoodinfectionsMeaslesinfectionMycobacteriumparatuberculosisinfection
Therelativeriskamongfirst-degreerelativesis14to15timeshigherthanthatofthegeneralpopulationEthnicityplaysaroleaswellTheconcordancerateamongmonozygotictwinsisashighas67%forCrohnsdiseasebutonly13%to20%fo
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