Inflammatory Bowel Disease

Abstract

7.1

Chronic relapsing idiopathic inflammation of the rectum and variable length of the adjoining colon.

7.2

• Crohn’s disease is a chronic inflammation which initially was believed to be located to the terminal ileum. However, it is now well known that it may involve any part of the gastrointestinal tract from mouth to anus.

• Characteristic is its segmental distribution, often with rectal sparing but frequently with anorectal disease.

• The onset is common in young people and the burden to the healthcare system as well as the community is substantial.

• Until now there is no cure for Crohn’s disease and both the medical and surgical treatment aims at reducing the symptom load.

• Many patients can live a fairly normal life but 20–30% have more or less severe restrictions of their working ability.

• The cumulative mortality has been increased, approximately twofold.

• Sepsis, liver failure and thromboembolism are the main causes of death in patients with severe chronic disease.

7.3

The term “indeterminate colitis” was first introduced by Ashley Price, a pathologist at St. Mark’s Hospital in London, UK. He used it to describe colectomy specimens where a definite diagnosis of ulcerative colitis or Crohn’s disease could not be established due to overlapping features. At the time it was felt that indeterminate colitis was likely to represent a temporary state in the evolution of inflammatory bowel disease, which in due course would declare itself as either ulcerative colitis or Crohn’s disease.

7.4

Colorectal diverticular disease and its complications are highly prevalent conditions in daily practice in Western countries. Different etiological factors have been involved, although none of them can explain by itself the development of colonic diverticular disease. Diverticular disease of the colon is usually an asymptomatic disease. In symptomatic patients, treatment with new drugs may reduce abdominal symptoms and even the incidence of diverticulitis. Diverticulitis is the most frequent complication of colonic diverticular disease. Clinical manifestations, diagnostic procedures, complications and treatment strategies are described. The efficacy of mesalazine in improving the severity of symptoms and in preventing symptomatic recurrence of diverticulitis is emphasized. Elective surgical treatment of diverticular disease is usually considered when a fistula or symptomatic stenosis has developed. However, after a first episode of complicated diverticulitis with an abscess successfully resolved by percutaneous drainage, surgical treatment is controversial. Elective surgical procedures should only rarely be offered to patients who have presented two episodes of uncomplicated diverticulitis. Basic principles of the surgical technique are described. The management of diverticular disease in young patients has changed in recent years but this issue continue to be a matter of debate.

7.5

Necrotising enterocolitis (NEC) represents a significant clinical problem. Ischaemic and necrotic alterations in the intestinal wall more frequently refer to the terminal ileum than to the caecum and ascending colon. The necrosis begins in the mucous layer and then may involve the full thickness of the bowel wall resulting in perforation.