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home - IBD - Epidemiology - Natural History of Inflammatory Bowel Disease Written by Dr Sebastian Zeki

Knows the science underlying the pathogenesis of IBD in particular
relating to genetic and environmental factors involved and
differences between UC and Crohn’s disease

Understands the natural history of UC and Crohn’s disease including
its variability and the impact of therapy on the natural history

Understands the mechanism of action (as far as it is understood) and
rationale for using different treatment types in IBD including

aminosalicylates immune suppressants and biologic therapies
Able to use knowledge of modifiable and non-modifiable risk factors
to underly management decisions and to stratify risk for patients and
their relative

Able to explain to patients and their families the concepts underlying
the disease and the factors that they can alter and the risks of
complications and disease su ptibility in relatives

Natural History of Inflammatory Bowel Disease

Acute Episode Remission Surgery For Acute UC 80% if not responding to steroids Maintenance of remission Pancolitis / severe disease at presenta-tion: chance of colectomy = 50% at 5 years Colectomy rate 25% at 10 years Colectomy rate 1% per year whatever the extent 90% working at 1 yearMortality same as general population except pancolitis within first two years UC Natural History Montreal classification Crohn’s Natural History ASYMPTO Hi activity Lo activity 50% 25% 25% 75% work 1 yr post dx Worse Prognosis if:Perianal diseaseYoung age at diagnosisImmediate need for steroids at diagnosis- of these 50% are in remission at 1 month and 25% at one year 50% recurrence after 10 years Relapses Predictors:Age<25.<1 year since last flare.Smoking.Raised ESR (>15) or CRP (>20). SurgeryAfter 15 years: 30% no op/ 30% 1 op/ 30% +2 opsMost common with ileocae-cal disease 15% can’t work after 5-10 yrs Patterns of disease:Static 50-60% remission at 2 years, <5% no symptoms at 15 years.Relapsing remitting: 90% intermittent symptoms.Proximal extension of distal disease in 15% at 5 years and 30% after 10 years.In distal disease 20% resolve spontaneously and only very rarely need surgery. 20% relapse/yr The probability of relapse during the first 3 years correlates well with that seen during the following years. Ileocolitis Ileitis Colitis Written by Dr Sebastian Zeki

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