IBD

1. INFLAMMATORY
BOWEL DISEASE
Presentation by Alison, Abby, Ashleigh, Ben, Lawrence, Adina and Lily.

2. Contents of our presentation
1. Introduction into Inflammatory Bowel Disease (IBD)
2. Epidemiology
3. The genetics and pathogenesis behind IBD
4. Signs and symptoms of IBD
5. Diagnosis
6. Treatments for the disease
7. Conclusion

3. Introduction into Inflammatory Bowel Diseases
What is it?
Inflammatory bowel diseases, shortly known as
IBDs, are chronic diseases that manifest as a
group of two important disorders, affecting the
gastrointestinal tract.These include Crohn`s
disease and ulcerative colitis:
• Share common symptoms (abdominal pain,
weight loss etc.)
• Can differ starting from the triggers that
cause them to the specific place in the GI tract
that they target (Figure 1)
Figure 1. Location of Crohn`s disease (left) and location of Ulcerative colitis (right)
(Overview of Ulcerative Colitis, 2020)

4. Cause:A dysbiotic reaction of the intestinal microflora that results in inflammation of the
gut (Figure 2&3) (Baumgart & Carding, 2007).
Figure 2. Inflammation of the GI tract seen in Crohn`s Disease (Ratini,
2018)
Figure 3. Inflammation in the GI tract seen in ulcerative colitis (Ratini,
2018)

5. Introduction into Inflammatory Bowel Disease
Definition:
IBDs are described by the inappropriate reaction of the mucosal immune system
against the microflora of the gastrointestinal (GI) tract.This is through the means of
the innate and adaptive immune systems, which compromise the functional
integrity of the intestinal barrier (Baumgart & Carding, 2007).
Genetic Link:
It has been showed that IBDs are polygenic conditions, caused by a variable
network of genes - over 100 loci (specific site of genes on a chromosome) being
discovered to trigger the activation of IBDs (Ananthakrishnan, Xavier & Podolsky,
2017).

6. Introduction into Inflammatory Bowel Diseases
Treatment of IBDs is under continuous improvement,
since the traditional medications used today are known to
induce different adverse reactions.
The risk of development is increased both by genetic and
environmental factors (Figure 4), such as:
• Smoking
• Antibiotic exposure
• Environmental hygiene
• Low vitamin D
• Hormones etc. (Ananthakrishnan,Xavier & Podolsky,
2017)
Figure 4. Causal factors of IBD (Ananthakrishnan, Xavier &
Podolsky, 2017)

7. Epidemiology
• In 2017, there were 6.8 million cases of IBD globally.
The highest amount of cases were found in North
America and the lowest amount in the Caribbean.
• You can develop IBD at any age, however it is usually
diagnosed between the ages of 15 and 40.
• IBD is more prevalent in Caucasians compared to
African Americans,Asians and Hispanics.
• There was no significant difference between the
number of cases depending on whether you liked in
the Northern or Southern hemisphere.
• IBD is genetic condition and can run in most families.
Figure 5. global map of inflammatory bowel disease; red refers to the highest
numbers of recorded IBD compared green which shows the lowest numbers of
recorded IBD, no color means data is unknown (Cosnes, Gower-Rousseau, Seksik &
Cortot. 2011)

8. Epidemiology
• IBD is more prevalent in women
compared to men.
Figure 6. a graph to show incidence rates (per 100,00) comparing males
and females (Victoria,Sussak & Nunes. 2009)
• IBD is more common with
increasing age.
Figure 7. age specific incidence rate of men and women on a global
level (Johnston & Logan, 2008)

9. The genetics and pathogenesis behind IBD
• Inflammatory bowel disease (IBD) is a complex, multi-genetic disorder
• Genome wide association studies have identified and confirmed 136 susceptible
loci
• Genetic analysis identified two autophagy related genes- IRGM
and ATG16l1
• Nucleotide-binding oligomerization domain 2 (NOD2) was the
gene found partly susceptible for Crohn’s disease
• Trans-ethnic studies identified 38 new IBD susceptible loci
Figure 8. Shows the complex pathogenesis of IBD (Loddo & Romano,
2015)
Figure 9. Shows the structure of the human HOD2 gene and the 3-
common mutation with Crohn’s disease (Yamamoto & Ma, 2009)

10. The genetics and pathogenesis behind IBD
Monozygotic twin concordance is significantly higher than dizygotic concordance
rate for both subtypes of IBD:
• Crohn’s disease- 20%-50%Vs 0%-7%
• Ulcerative Colitis- 14%-19%Vs 0%-5%
Identified genetic factors and susceptibility only
account for a small proportion of disease variance
and genetic risk
Figure 10. showing monozygotic and dizygotic twin shareability of
genes (Osaka University,Twin study)

11. Signs and symptoms of IBD
Common symptoms related to Inflammatory Bowel disease are:
• Weight loss
• Extreme tiredness
• Recurring/blood in diarrhoea
• Pain, cramps or swelling in the stomach
Less frequent signs include: Arthritis, uveitis, erythema and jaundice
Symptoms between patients vary- Not all will experience these. Some may have
additional symptoms e.g. vomiting, anaemia and a high temperature (NHS)

12. Signs and symptoms of IBD
1) Symptoms of Ulcerative Colitis
Is a ‘long-term condition where the colon and rectum become inflamed’- which can
result in small ulcers on the lining of the colon.These may produce pus or bleed.
The major symptoms of Ulcerative Colitis are: stomach pain, frequent need to
empty bowels and recurring diarrhoea. For some individuals, the condition has a
massive impact on their daily life.
There can also be periods of flare-ups where the symptoms
deteriorate, developing more problems.There appears to be
no trigger identified for these flare-ups, apart from
occasionally the cause is an infection in the gut (NHS)
Figure 11- An image of the colon, comparing a healthy area and an
affected area because of colitis (Get healthy stay healthy website)

13. Signs and symptoms of IBD
2) Symptoms of Crohn’s disease
Crohn's disease is a ‘lifelong condition where parts of the digestive system become
inflamed’, impacting upon people of all ages with symptoms usually beginning in
childhood or early adulthood.
The main symptoms include diarrhoea, blood located in faeces, fatigue , weight loss
or stomach aches/cramps. (NHS)
Symptoms may be constant or come and go,
these include unpredictable flare-ups that
may disrupt daily life.There is plenty of
support available for patients (Crohn’s and colitis
website)
Figure 12- A comparison of a normal intestine and an individual’s intestine
affected byCrohn’s disease. (Harvard Health)

14. Diagnosis
Your doctor will only diagnose someone with IBS if all other
possibilities for his/her symptoms have been ruled out.They will
use a combination of different tests and procedures to help with
the diagnosis of IBD.
There are 3 different ways for testing to see if a person has the disease.These are
laboratory tests, endoscopic procedures and imaging procedures:
1. Lab tests for IBS include: A stool study,A blood test for anaemia or infection
2. Endoscopic procedures include: A colonoscopy, flexible sigmoidoscopy, upper
endoscopy, capsule endoscopy, and balloon assisted enteroscopy.
3. Imaging procedures include: An X-ray, computerised tomography scan (CT) and
magnetic resonance imaging (MRI)
Figure 13. showing how a colonoscopy is
performed, one way of diagnosing Crohn’s
disease or UlcerativeColitis (Mayo Clinic)

15. Treatments for the disease
There is currently no cure for inflammatory bowel disease, however
there are treatments aimed to relieve and prevent symptoms.
Figure 14. Hierarchy showing treatment options
available to help control and manage the
disease (IBD clinic website)
1. Anti-inflammatory drugs: such as corticosteroids, amino salicylates, reduce inflammation in the gut and which
anti-inflammatory drug the patient takes depending on what area of the colon is affected.
2. Immune suppressants: are another treatment, these include steroids and azathioprine.These suppress the bodies
immune systems activity of releasing inflammation-causing chemicals which can damage the digestive tract.
3. Biological medicines and the newer biosimilars: work in a very similar way, they are needed if the previous
medicine was not strong enough.These are antibody-based treatments that are administered by injection, these
medicines work by targeting the part of the immune system that releases the inflammatory-causing chemicals.

16. Treatments for the disease…
4 . Antibiotics: can be used if the patient is thought to have risk of
infection, these can be used as an addition to the medicine the patient
is already taking. Examples of antibiotics used for Crohn’s disease is
ciprofloxacin and metronidazole.
5. Dietary support: IBD can cause malnutrition and severe weight loss,
this can be combated with seeing a professional dietitian. Or in serious
cases doctors can administer feeding tubes (enteral nutrition) or
nutrients injected into the blood stream directly (parenteral nutrition).
6. Surgery: is the last call when it comes to treatment of IBD, this
surgery consists of removing inflamed parts of large bowel. 1 in 5
people who have ulcerative colitis need surgery and around 60 to 75%
of people with Crohn’s will need surgery
Figure 15. Surgery is a finally resort option
where the patient either has partial or whole
removal of the bowel (You and IBD website)

17. Conclusion
In summary, inflammatory bowel disease includes both Crohn’s disease and
Ulcerative Colitis. Both conditions are commonly characterized by chronic
inflammation in many different sites of the gastrointestinal tract, leading to many
symptoms such as blood in diarrhea, pain or cramps in the stomach and weight loss.
The inflammation is the result of a self-mediated immune response in the
gastrointestinal mucosa.The immune response involves the release of cytokines
and interleukins and tumor necrosis factors, all of which can cause inflammation. In
order to be diagnosed with either condition, your doctor can conduct many
different types of tests including lab tests and imaging procedures. Once diagnosed
the disease can be treated with anti-inflammatory drugs, immune suppressants and
surgery.

18. References
• Baumgart C. Daniel & Carding R. Simon (2007) Inflammatory bowel disease: cause and immunobiology, The Lancet,
volume 369, Issue 9573, DOI: 10.1016/s0140-6736(07)60750-8
• Ananthakrishnan N. Ashwin, Xavier J. Ramnik & Podolsky K. Daniel (2017) Inflammatory Bowel Diseases. A Clinician`s
Guide, Wiley Blackwell
• Overview of Ulcerative Colitis (2020) Crohn`s & Colitis Foundation, ://www.crohnscolitisfoundation.org/what-is-
ulcerative-colitis/overview
• Ratini Melinda (2018) A visual guide to IBD, WebMD, https://www.webmd.com/ibd-crohns-disease/ss/slideshow-
inflammatory-bowel-overview
• Cosnes, Jacques; Gower-Rousseau, Corinne; Seksik, Philippe & Cortot, Antoine (2011). Gastroenterology-”epidemiology
and natural history of inflammatory bowel disease”, https://www.gastrojournal.org/article/S0016-5085(11)00164-8/pdf
• Victoria, C.Roberto; Sussak, L.Yukie & Nunes, H.Rubens de Carvalho (2009). “Incidence and prevalence rates of
inflammatory bowel disease in Midwestern Soa Paulo state, Brazil”. Vol.46.
https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032009000100009&lng=en
• Johnston, Richard.D; Logan, Richard.F (2008). “What is the peak age for the onset of IBD”.
https://www.researchgate.net/publication/23282751_What_Is_the_peak_age_for_onset_of_IBD

19. References
• Loddo, Italia & Romano, Claudio (2015) “Inflammatory bowel disease:Genetics, epigenetics and
pathogenesis”, https://www.frontiersin.org/articles/10.3389/fimmu.2015.00551/full
• Yamamoto, Soichiro & Ma, Xiaojing (2009). “Role of NOD2 gene in development in Crohn’s disease”,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924159/
• Cho, Judy.H (2008). “Inflammatory bowel disease: genetics and epidemiologic considerations”,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679123/
• https://www2.med.osaka-u.ac.jp/twin/en/twin_research/twins/
• https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/diagnosis-treatment/drc-
20353320
• http://www.ibdclinic.ca/treatment/
• http://www.youandibd.com/en-ibd/view/m301-s8-small-bowel-and-large-bowel-surgery-for-ibd-slide-
show
• https://www.nhs.uk/conditions/inflammatory-bowel-disease/
• https://www.gethealthystayhealthy.com/articles/living-with-ulcerative-colitis.
• https://www.nhs.uk/conditions/ulcerative-colitis/
• https://www.nhs.uk/conditions/crohns-disease/
• https://www.health.harvard.edu/a_to_z/crohns-disease-a-to-z
• https://www.crohnsandcolitis.org.uk/