1 / 32

Extra GI Manifestations of IBD

Extra GI Manifestations of IBD. Dr. Matt W. Johnson BSc MBBS MRCP MD Consultant Gastroenterologist Luton & Dunstable FT Hospital. Luminology. To the ileum …and beyond. Extra GI Manifestations of IBD =40%. EGIM of IBD. Mouth. Glossitis - Angular Stomatitis Orofacial granulomatosis.

renata
Download Presentation

Extra GI Manifestations of IBD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Extra GI Manifestations of IBD Dr. Matt W. Johnson BSc MBBS MRCP MD Consultant Gastroenterologist Luton & Dunstable FT Hospital

  2. Luminology

  3. To the ileum …and beyond

  4. Extra GI Manifestations of IBD =40%

  5. EGIM of IBD

  6. Mouth Glossitis - Angular Stomatitis Orofacial granulomatosis

  7. Glossitis • B12 deficiency • Red “beefy” tongue • Fe deficiency • Atrophic smooth tongue Rx = Supplements

  8. Angular Stomatitis • Fe deficiency Rx = Supplements

  9. Orofacial Granulomatosis • Rare chronic inflammatory condition • Characterised by lip swelling • 64% have histological granulomas similar to CrD • Rx = Elemental or Cinnamon and benzoate free diet

  10. Eyes Episcleritis Iritis Uvietis Steroid Cataracts

  11. Episcleritis • Incidence = 5% • Superficial redness of the episclera and conjuctiva • Burning + itching due to dilated vessels • Mx = Self resolves +/- NSAIDS

  12. Scleritis • Deeper redness of sclera • Serious inflammatory condition • Ocular pain, photophobia, tearing, blindness • Rx = Treat the IBD + Systemic steroids, NSAIDS, antibiotics or immunosuppressant

  13. Iritis / Uveitis • Inflammation of the iris (anterior uveitis) • 0.5-3% • Acute self resolves within weeks • Chronic persists for months and needs Rx • Ocular pain, photophobia, blurry vision, synechia

  14. Iritis • Complications include; synechia, cataracts, glaucoma, blindness • Rx = Steroids (PO + drops, subconjuctival injections)

  15. Uveitis • Inflammation of middle/inner eye • 10% of blindness in USA • Mx = Urgent referral to ophthalmologist • Treat the IBD • Rx = Steroids (PO + drops, subconjuctival injections), dilators + pressure reducing drops (brimonidine tartrate) +/- MTX, IFX

  16. Skin Erythema Nodosum Pyoderma gangerenosum

  17. Erythema Nodosum • 8-15% of UC + CrD • Usually reflects active disease • Can precede the IBD diagnosis • Red hot nodules on extensor surfaces • Assoc with pauciarticular arthropathy • Rx the IBD and you Rx the EN

  18. Pyoderma Gangerenosum • 5% UC • 2% of CrD patients • 50% assoc with IBD activity • Starts with a red area + central pustules then develops into a painful necrotic ulcer • Steroids, IFX, Cyclosporin • Colectomy does not always help

  19. Airway inflammation UC > CrD Chronic cough and mucopurulent sputum Progressive airways narrowing leads to Chronic bronchitis + bronchiectasis + bronchiolitis obliterans CXRs frequently normal, needs HRCT Rx = Large airways - Inhaled steroids Small airways - Systemic steroids

  20. Thrombo-embolic disorders • TE events occur in 25% • 3 fold increase above general population • Recurrence risk is 10-15%

  21. Liver + Pancreas Abnormal LFTs = 30% eg. AZA Gallstones = 13-34% of sb Crohn’s PSC PBC AI Pancreatitis

  22. Primary Sclerosing Cholangitis • 5% of UC and 1-2% CrD • Can precede colitis by years • Symptoms = Pruritis, fatigue, RUQ pain, jaundice, cholangitis • Bedding and stricturing of IHDs • Associated with cholangiocarcinoma 6-20% • Increased risk of U+L GI cancer x6 and ampullary cancer • Colonoscopy every year, with OGD every 2 years • Survival if symptomatic = 15-18y

  23. Primary Biliary Cirrhosis • More commonly seen with UC • High cholesterol • Deficiencies in the fat soluble vitamins DEAK • Leads to cholestasis

  24. Bones Osteoporosis Sacroileitis Arthropathies (RhA, AnkSpond)

  25. Osteopenia / Osteoporosis Peak bone mass reached in our 20-30s Then 0.5-1% per year thereafter 15% BMD lost in first 5y post menopause Osteopenia occurs in 40-50% Osteoporosis occurs in 2-30% Lifetime risk of fractures in IBD = 41% CrD women have 2.5 fold increase fracture risk

  26. Osteoporosis Prevention • Weight bearing exercise • Stop smoking • Reduce weight • Moderate Xol intake • Ca intake (1000-1500mg/d) = 1 pint of semi skimmed is 700mg • Stop steroids ASAP • Bone loss starts rapidly • Occurs even with low doses • Fracture risk improves on cessation • Ca + Vit D = All patients on steroids • Bisphosphonates = steroids >3m, those >65y or low impact (fragility) fractures • HRT eg testosterone in steroid induced hypogonadism

  27. BSG Mx of Osteoporosis • Calcium + Vit D • PO Bisphosphonates (eg alendronate, residronate) • IV Bisphosphonates (eg. pamidronate) • In those with difficult side effects eg. oesophagitis • Poor mucosal absorption • Avoids the problems • HRT (in PMP women) - risk of clots / breast+gynae cancer • Raloxifene - modulator of OR, without increased of breast Ca

  28. Sacroilitis • Prevalence = 47% • Sacro-iliac pain • Hazziness of sacro-iliac joint • Can be one sided • Rx = COX II inhibitors • Try to avoid NSAIDS • Steroids / IFX • Mx = Treat the IBD

  29. IBD Arthropathy • 10-20% of IBD patients (esp in Colonic disease, EN, Eyes) • Not to be confused with arthralgia secondary to steroid withdrawal, AZA or steroid induced myopathy. • 1) Type 1 (Large Joint) Arthropathy = 5% •  6 joints, (typically 1 large joint eg. knee) • Attacks assoc with active inflammatory relapses, EN + Iritis • Usually self limiting, no role for NSAIDS • Treat the IBD = 5ASAs, Steroids, MTX, AZA, Colectomy • 2) Type 2 (Small Joint) Arthropathy = 3-4% • Affects >5 joints, (typically small joints of hands and feet) • No direct assoc with IBD activity or Rx

  30. Rx Algorithm for IBD Arthropathy

  31. EGIM of IBD

More Related