الفهرس 
PathophysiologyOnly 14 pages are availabe for public view
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Abstract
The term ‘inflammatory bowel disease’ (IBD) encompasses two major forms of chronic intestinal inflammations: Crohn’s disease and ulcerative colitis. Diagnosis and management of IBD is often not straightforward and requires specialist input. Crohn’s disease is an inflammatory disease that may affect any part of the gastrointestinal tract from mouth to anus causing a wide variety of symptoms.
The worldwide distributions of Crohn’s disease is most prevalent in North America, North-western Europe, especially Scandinavia, and the UK. Countries in Southern Europe, South Africa and Australia have somewhat lower incidence rates. IBD is rare in Asia, Africa and South America.
The pathogenesis of Crohn’s disease is presently unknown. Current theories speculate a multifactorial aetiology encompassing genetic pre-disposition, environmental influences and immune system disorders. Genetic factors are well recognized.
The disease classified according to the most affected areas ; Ileocolic Crohn’s, Crohn’s ileitis Crohn’s colitis.
There are three categories of disease presentation in Crohn’s disease: structuring, penetrating, and inflammatory.
Crohn’s disease in children is more likely to be extensive than Crohn’s disease in adults, most commonly involving both the ileum and colon. Lesions are focal and asymmetrical. The inflammation is focal and patchy, both in location and severity.
The constellation of abdominal pain, diarrhea, poor appetite, and weight loss constitutes the classic presentation of Crohn’s disease in any age group. This symptom complex (with and without extraintestinal manifestations of IBD) comprises the mode of presentation in nearly 80% of children and adolescents.
There is no single test to confidently confirm or exclude the diagnosis of IBD. The gold standard for the diagnosis of IBD remains endoscopic evaluation with tissue histology. However, less invasive modalities, such as serological biomarkers, video capsule endoscopy, and advanced imaging, are being developed with improving sensitivity and specificity.
The goal of treatment of IBD is not only to induce remission of the active disease but also to prevent relapse. An individual treatment plan, based on type, severity and location of inflammation, age and psychological factors, is devised for each patient. Treatment may consist of one, or a combination of, nutritional treatment (or supplementation), drug therapy, biological therapy and possibly surgery.
Treatment of Crohn’s disease involves first treating the acute symptoms of the disease, then maintaining remission. Treatment initially involves the use of medications to eliminate infections, generally antibiotics, and reduce inflammation.
The rate of surgery in IBD has been decreasing, probably due to recent improvements in nutritional and medical treatment of the conditions.
Surgery is usually avoided in Crohn’s disease as it is not curative. However, there are certain specific clinical situations where it is indicated.
It therefore only tends to be advised when there is a failure of medical management or when the side-effects of medical management become unacceptable.
Operative management cannot be expected to solve every problem related to Crohn’s disease. Overall, careful use of medical therapy, appropriately combined with surgical therapy, provides the best treatment of Crohn’s disease.
Stricture resection or stricturoplasty is used to treat symptomatic strictures. Resection of an isolated, limited area of active inflammation. A defunctioning colostomy can provide both symptomatic relief and clinical improvement in severe perianal disease. Now all these methods can be done laparoscopically.
Surgery for Crohn’s disease is undertaken for failure of medical management or complications of the disease or from therapy.
Once patients come to operation, there is a wider choice of surgical procedures, Laparoscope has been used as a treatment modality in various forms of the disease.
Patients who would not have been referred for permanent ileostomy are now being referred for IPAA (Ileal Pouch-Anal Anastomosis), thus achieving a better function and quality of life.
The guiding principle behind the use of stricturoplasty was that obstructive symptoms resulting from Crohn’s disease could be ameliorated without resection, thus reducing the risk of short-gut syndrome.
More than half of Crohn’s disease sufferers have tried complementary or alternative therapy. These include Acupuncture , diets, probiotics, fish oil and other herbal and nutritional supplements. The benefit of these medications is uncertain.
Many clinical trials have been recently completed or are ongoing for new therapies for Crohn’s disease. They include the following: Helminthic therapy, Certolizumab, Sargramostim & Autologous stem cell transplants are also still under evaluation.