SURGICAL INTERVENTION IN INFLAMMATORY BOWEL DISEASE

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 but the ulcerative affect the colon only. The highest rates of IBD are assumed to be in developed countries, and the lowest are considered to be in developing regions; colder-climate regions and urban areas have a greater rate of IBD than those of warmer climates and rural areas. The combination and interaction of genetics (permissive, but they are not causative), environmental influences, and immunologic abnormalities may play the most important role. Population-based studies provided compelling evidence that genetic susceptibility plays an essential role in the pathogenesis of IBD. The manifestations of inflammatory bowel disease (IBD) generally depend on the area of the intestinal tract involved. The commonly experienced symptoms of crohn's disease include recurrent abdominal pain and diarrhea. Sometimes, the diagnosis may be delayed by several months to a few years, as these symptoms are not specific for IBD. Patients with IBD have irritable bowel syndrome. Systemic symptoms are common in IBD and include weight loss, fever, sweats, malaise, and arthralgias. A low-grade fever may be the first warning sign of a flare. Patients are commonly fatigued. Children may present with growth retardation and delayed or failed sexual maturation. In 10-20% of cases, patients present with extraintestinal manifestations, including arthritis, uveitis, or liver disease. However, in a small percentage of patients, the initial presentation can be of a fulminant nature. There is no single test to confidently confirm or exclude the diagnosis of inflammatory bowel disease. IBD is initially diagnosed on the basis of a combination of clinical, laboratory, histologic, and radiologic findings. Laboratory study results are generally non specific but may be helpful in supporting the diagnosis. Serologic studies have been proposed to help diagnose IBD and to differentiate crohn's disease from ulcerative colitis, but such studies are not recommended for routine diagnosis of crohn's disease or ulcerative colitis. Gastrointestinal endoscopy and biopsy is the gold standard for the diagnosis of IBD. Endoscopy is a crucial tool in the management of inflammatory bowel disease. There is a spectrum of situations when an endoscopy may be of value in IBD, extending from initial diagnosis to differentiating between crohn's disease and ulcerative colitis to long term management of both conditions. Gadolinium MRI (GMRI) confirmed the diagnosis of either crohn's disease or ulcerative colitis, with a sensitivity and specificity of 96% and 92%.