浙江大学医学院：Inflammatory Bowel Disease：Ulcerative Colitis & Crohn’s Disease（PPT讲稿）

Inflammatory bowel Disease Ulcerative Colitis Crohn's Disease 浙江大学医学院附属邵逸夫医院 曹倩

Inflammatory Bowel Disease: Ulcerative Colitis & Crohn’s Disease 浙江大学医学院附属邵逸夫医院 曹 倩

学习目标 掌握IBD的发病机制 掌握IBD临床表现和治疗 掌握溃疡性结肠炎和克罗恩病的鉴别

学习目标 •掌握IBD的发病机制 • 掌握IBD临床表现和治疗 • 掌握溃疡性结肠炎和克罗恩 病的鉴别

炎症性肠病 Inflammatory bowel Disease (IBD) chronic, relapsing, immunologically-mediated inflammatory condition of the gi tract Presentation varies widely Characterized by exacerbations remissions Affects males and females equally

炎症性肠病 Inflammatory Bowel Disease (IBD) • chronic, relapsing, immunologically-mediated inflammatory condition of the GI tract • Presentation varies widely • Characterized by exacerbations & remissions • Affects males and females equally

Spectrum of Disease Ulcerative colitis Crohn's disease Limited to colon+rectum “ Mouth to anus” Continuous Transmural mucosal Skip lesions In determinate Colitis/granulomas 5-10 IBD1 BD4 Severe Mild Disease Disease

Ulcerative Colitis Crohn’s Disease Limited to colon+rectum Continuous mucosal “Mouth to anus” Transmural Skip lesions granulomas Indeterminate Colitis 5-10% Spectrum of Disease IBD1 IBD2 IBD3 IBD4 Severe Disease Mild Disease

Inflammatory Bowel Disease (IBD) ssure thickened wa haustra distortion cobblestone 图正常结肠〔左列) Crohn病〔中列),溃疡性结肠炎〔右列〕大体形态〔上行〕肠粘膜病理解剖(中行 镜下所见〔下行)的比较图

Inflammatory Bowel Disease (IBD)

BD Incidence 10 Ulcerative colitis Incidence 6 per 10 Crohn's disease ( olmstead County, MN) 194019501960197019801993 Loftus EWJet al. Gastroenterology 1998; 114: 1161 Loftus evj et al. Gut 2000: 46: 336

Etiologic Theories in Inflammatory bowel Disease Mucosal Immune Genetic System Predisposition BD(Immuno-regulatory Defect Environmental Triggers (Lumenal Bacteria, Infection)

Etiologic Theories in Inflammatory Bowel Disease Mucosal Immune System (Immuno-regulatory Defect) Environmental Triggers (Lumenal Bacteria, Infection) Genetic Predisposition IBD

BD- Environmental risk Factors UC D Smoking ↓↓个个个 Appendectomy ↓ 0 High sanitation level 个个 in childhood High intake refined carbohydrates Perinatal infection Breast feeding ↓? w oral contraceptives

Genetic Susceptibility Concordance in twins. CD UC Monozygotic 44-50 5-14% Dizygotic 8% 0% Tysk et al. Gut 1988; 29: 990 Ornholm M et al. Scand J. Gastroenterology 2000; 35: 1075

炎症性肠病是怎么发生的? 」orri Acute injury cvironnental Tolerance Complete t门!e了 healing LupiNal bacteria Tolerance Acute scepsis controlled inflammation inflammation Chronic Inflammation

炎症性肠病是怎么发生的？