复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）消化系统_Inflammatory Bowel Disease

o nflammatory Bowel disease SUN JANYONG DEPARTMENT OF GASTROENTEROLOGY ZHONGSHAN HOSPITAL FUDAN UNIVERSITY

Inflammatory Bowel Disease SUN JIANYONG DEPARTMENT OF GASTROENTEROLOGY, ZHONGSHAN HOSPITAL, FUDAN UNIVERSITY

Inflammatory Bowel Disease (BD) HCrohn's Disease(CD) Ulcerative Colitis(UC) Uncertain colitis

Inflammatory Bowel Disease (IBD) Crohn’s Disease (CD) Ulcerative Colitis (UC) Uncertain Colitis

Epidemiology Rate higher in northern climates and the developed world a Equal incidence between men and women ■ Peak incidence CD 15-35 years by far the commonest UC usually diagnosed prior to 30 years Aggregation in families 25%of patients with CD 20 %of patients with UC a Smoking reduces risk of Uc but increases risk of cd

Epidemiology  Rate higher in northern climates and the developed world  Equal incidence between men and women  Peak incidence CD 15-35 years by far the commonest UC usually diagnosed prior to 30 years  Aggregation in families 25 % of patients with CD 20 % of patients with UC  Smoking reduces risk of UC but increases risk of CD

Etiology and Pathogenesis

Etiology and Pathogenesis

Etiology and Pathogenesis Environmental factors Genetic easy to infect Fungus in intestines Immune and non-immune system of intestines Immunological reaction and inflammation

Etiology and Pathogenesis Genetic easy to infect Environmental factors Fungus in intestines Immune and non-immune system of intestines Immunological reaction and inflammation

Environmenta/ factors /BD is more prevalent in developed countries and more common in white-collar workers 口 Risk of uc Negative: Breast feeding, appendectomy, smoking Positive. "Western diet left-handedness depression Risk of cd Smoking, second-hand smoke

Environmental factors IBD is more prevalent in developed countries and more common in white-collar workers Risk of UC Negative: Breast feeding, appendectomy, smoking Positive: “Western diet” , left-handedness, depression Risk of CD Smoking, second-hand smoke

Genetic factors High Family incidence, but low with spouse Concordance for CD in twins Mutations of Gene -Polygene disease and heterogenetical disease

Genetic factors High Family incidence, but low with spouse Concordance for CD in twins Mutations of Gene Polygene disease and heterogenetical disease

Infected factors Mycobacterium paratuberculosis Paramyxovirus Measles virus ■ Helicobacter species

Infected factors  Mycobacterium paratuberculosis  Paramyxovirus  Measles virus  Helicobacter species

Immune factors Abnormal immune response to auto-intestinal normal fungus Abnormal function of cells CD Typical T-helper 1(Th1)(ce/l-mediated) reaction UC Atypical T-helper 2(Th2)(humoral) reaction Non-immunological cells. epithelia/ cel, vascular endothelia/ce∥ -Immune cytokines and medium ROMS. NO

Immune factors Abnormal immune response to auto-intestinal normal fungus Abnormal function of T cells CD Typical T-helper 1 (Th1) (cell-mediated) reaction UC Atypical T-helper 2 (Th2) (humoral) reaction Non-immunological cells: epithelial cell, vascular endothelial cell Immune cytokines and medium ROMs, NO

Definitions Ulcerative colitis is a continuous inflammation and ulceration of the colon and rectum and typically involves only the innermost lining or mucosa, with no segments of normal tissue Crohn's disease is a chronic, relapsing, focal asymmetric, transmural inflammation of the gut anywhere between the mouth and the anus but is predominantly seen in the terminal ileum and/or colon

Ulcerative colitis is a continuous inflammation and ulceration of the colon and rectum and typically involves only the innermost lining or mucosa, with no segments of normal tissue. Crohn’s disease is a chronic, relapsing, focal, asymmetric, transmural inflammation of the gut anywhere between the mouth and the anus, but is predominantly seen in the terminal ileum and/or colon. Definitions