The inflammation is based on a cell-mediated immune response in the mucosa of the GIT. The exact etiology is unknown. However, there are findings which indicate that the normal intestinal flora in patients with multifactorial genetic predisposition an unnatural immune reaction is (possibly play a disturbed epithelial tissue barrier and pathological defenses of the mucosa a role). Specific toxicants from the environment or from food or infections have not yet been identified cause. The immune response set in motion leads to the release of inflammatory mediators, incl. Cytokines, interleukins and TNF.

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis are, are associated with remissions and relapses chronic inflammation in various parts of the GIT leading to diarrhea and abdominal pain. The inflammation is based on a cell-mediated immune response in the mucosa of the GIT. The exact etiology is unknown. However, there are findings which indicate that the normal intestinal flora in patients with multifactorial genetic predisposition an unnatural immune reaction is (possibly play a disturbed epithelial tissue barrier and pathological defenses of the mucosa a role). Specific toxicants from the environment or from food or infections have not yet been identified cause. The immune response set in motion leads to the release of inflammatory mediators, incl. Cytokines, interleukins and TNF. Although there are a number of similarities between Crohn’s disease and ulcerative colitis, it can be distinguished clearly but in most cases (see table: differentiation between Crohn’s disease and ulcerative colitis). Approximately 10% of ulcerative cases are initially indistinguishable and are not classified; when a surgical pathological sample can not be classified, it is referred to as indeterminate colitis. The term colitis refers only to the inflammation of the colon (z. B. ulcerative, granulomatous, ischemic, radiation-induced and infectious colitis). The term “spastic colitis” is a misnomer, with sometimes a functional disease, the so-called. Irritable bowel syndrome, is called. Differentiation between Crohn’s disease and ulcerative colitis Crohn’s disease ulcerative colitis small bowel involvement in 80% of cases. Disease limited to the colon. The rectosigmoid is often omitted in Kolonbefall the right side is usually affected. The rectosigmoid is always infested the Kolonbefall mostly on the left side. Large rectal bleeding are rare, except in 75-85% of cases of Crohn’s colitis. It always comes to larger rectal bleeding. The development of fistulas, tissue masses and abscesses is widespread. Fistulas do not occur. Pronounced perianal lesions occur in 25-35% of cases. Pronounced perianal lesions do not occur. In the X-ray examination, the intestinal wall is asymmetric and segmental infested with “skip areas” between the affected segments. The intestine wall is symmetric infested and continuously from the rectum proximally. Endoscopically, a stain-shaped image with discrete segments ulceration and normal-appearing mucosa shows. Inflammation is uniform and diffuse. Under the microscope, a transmural inflammation and fissuring shows the distribution of the lesions is often pronounced focal. Inflammation is limited with the exception of severe cases to the mucosa. Epithelioid (sarkoid√§hnliche) granulomas are seen in the intestinal wall or lymph nodes in 25-50% of cases (pathognomonic). Typical epithelioid granulomas do not occur. Epidemiology Inflammatory bowel diseases occur at any age, but usually begin before age 30 with a peak between 14 and 24 years of age. IBD can have a second smaller peak age between the ages of 50 and 70 years of age. However, this late peak age may include some cases of ischemic colitis. Inflammatory bowel diseases are most common in northern Europe and the Anglo-Saxon countries, and are four times more likely than non-Jewish whites from the same geographical area under Ashkenazi Jews 2- to. The incidence is lower in Central and Southern Europe and even lower in South America, Asia and Africa. However, the incidence increases in black Africans and South Americans who live in North America, too. Both sexes are equally affected. First-degree relatives of patients with inflammatory bowel diseases have a 4- to 20-fold increased risk, their absolute risk may be up to 7%. A familial occurrence is more common in Crohn’s disease than in ulcerative colitis. Meanwhile, a number of specific gene mutations that have a high risk for Crohn’s disease (and some possibly for ulcerative colitis) carry identified. Cigarette smoking seems exacerbations of Crohn’s disease to favor, but reduces the risk of ulcerative colitis. A previous history of appendectomy for the treatment of appendicitis also appears to reduce the risk of colitis colitis. NSAIDs may exacerbate inflammatory bowel diseases. Oral contraceptives increase the risk of Crohn’s disease. Some data suggest that perinatal conditions and the use of antibiotics in childhood are associated with an increased risk of IBD. For unclear reasons have people who have a higher socioeconomic status, an increased risk of Crohn’s disease. Tips and risks cigarette smoking reduces the risk of ulcerative colitis. Extra-intestinal manifestations Both Crohn’s disease and ulcerative colitis are in addition to the bowel affected other organs. The majority of the extra-intestinal manifestations occur in ulcerative colitis and Crohn’s colitis, in a less exclusive small-bowel involvement of Crohn’s disease. Extra-intestinal manifestations of inflammatory bowel disease are classified according to three criteria: 1.Erkrankungen that are usually associated with inflammatory episodes of IBD (ie come and go..): These include peripheral arthritis, episcleritis, aphthous stomatitis, erythema nodosum and pyoderma gangrenosum. The Arthritis preferred affects large joints, moves and is temporary. At least one or more of these parallel diseases develop in more than one third of hospitalized patients with IBD. 2.Krankheiten that are clearly associated with IBD, but occur independently of IBD flare-ups: These include ankylosing spondylitis, sacroiliitis, uveitis, and primary sclerosing cholangitis ? ?. The ankylosing spondylitis is more common in IBD patients with HLA-B27 antigen. Most patients with spinal or sacroiliac involvement have uveitis and vice versa. The primary sclerosing cholangitis, which is a risk factor for the development of bile duct carcinoma is clearly associated with ulcerative colitis and Crohn’s colitis. Cholangitis may occur before or simultaneously with the bowel disease or even 20 years after colectomy. A liver disease (eg. B. fatty liver disease, autoimmune hepatitis, pericholangitis, cirrhosis) occurs in 3-5% of patients, although slight variations of the liver values ??are seen often. Some of these diseases (eg. As primary sclerosing cholangitis) can be preceded by years of IBD and should, as soon as they are diagnosed, add to the investigation of IBD occasion. 3.Krankheiten that occur in the sequence of disturbed intestinal physiology: This risk in particular in a severe Crohn’s disease of the small intestine. Malabsorption as a result of extensive ileal resection leads to deficiency of fat-soluble vitamins, vitamin B12 and minerals, resulting in anemia, hypocalcemia, hypomagnesemia, coagulation disorders and bone demineralization. In children malabsorption growth and development delays. Other diseases are kidney stones due to a marked Oxalataufnahme with the food Hydroureter and hydronephrosis, caused by compression of a ureter by an adjacent inflammatory bowel process, gallstones due to the decreased reabsorption of bile salts in the ileum and amyloidosis as a result of prolonged inflammatory and ulcerous processes. Furthermore, thromboembolic disorders as a result of multiple factors from all three categories of extra-intestinal manifestations may occur. Treatment Supportive treatment 5-aminosalicylic acid, corticosteroids Immunomodulatory drugs Biologicals (Antizytokine) Occasionally, antibiotics (eg. As metronidazole, ciprofloxacin) and probiotics in the treatment of IBD are used different drug classes. Details of their selection are discussed in the individual disease. Supportive treatment, many patients and their families are interested in special diets, and in a stress treatment. Although there are anecdotal reports of clinical improvements in certain diets, incl. A diet with severe carbohydrate restriction, controlled studies have failed to show a consistent advantage. A special stress management can be helpful.

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