Inflammatory Bowel

Disease (IBD)

Anisyah Achmad, S.Si., Apt., Sp.FRS

Clinical Pharmacy, Major of Pharmacy,
Medical Faculty - Universitas Brawijaya
 Definition
• Infl ammatory bowel disease (IBD) is an
idiopathic and chronic inflammatory condition
of the gastrointestinal tract consisting of
Ulcerative Colitis ( UC )
Crohn’s disease (CD )
 Etiology
• a. Viral infection , L-form-bacteria,
Mycobacteria , Clamidya,
L.monocytogenes, M. paratuberculosis
b. Genetic
• c. Diet (Alkohol, Smoking, NSAID)
• d. Environment
e. Defect system imun (imbalance between
pro- and anti-inflammatory cytokines in
gut lumen)
• f. Psycologic
 Ulcerative Colitis

Inflamation from Colon to Rectum

Crohn’s Disease
All of the Gut (mouth to rectum)
and mucosal transmural
 Epidemiology
• The peak age of onset of UC and CD is between 15
and 30 years.
• A second peak occurs between the ages of 60 and
80.
• The male to female ratio for UC is 1:1 and for CD is
1.1–1.8:1.
 Epidemiology

• Urban areas have a higher prevalence of IBD

than rural areas
• high socioeconomic classes have a higher
prevalence than lower socioeconomic classes.
 Epidemiology
• The risk of UC in smokers is 40% that of nonsmokers
•
• In contrast, smoking is associated with a twofold
increased risk of CD.

• Oral contraceptives are also linked to CD; the odds

ratio of CD for oral contraceptive users is about 1.4.

• Appendectomy is protective against UC but

increases the risk of CD.
Clinical Symtomps
 Clinical Symtomps

Pada ulceratif colitis : kramp abdomen , diare

,panas , hipoalbuminemia , lekositosis ,
dehidrasi, takikardia , hipotensi

Pada penyakit Crohn manifestasi bervariasi

intermittent atau berulang terus , lesi
rectal/anal
 Ulcerative Colitis
• Superficial mucosal inflammation of colon
only
• Begins at rectum and spreads continuously
• 30% proctitis, 40% L sided colitis, 30%
pancolitis
• Sxs: bloody diarrhea, fecal urgency, tenesmus,
abdominal cramping
• Mild colitis produces redness and swelling of the
mucosa, resulting in a loss of the normal vascular
pattern, an overall granular appearance, and
friability (fragility with ease of bleeding).
 Crohn’s Disease
• Transmural inflammation of any part of GI tract,
presence of “skip” lesions and noncaseating
granulomas
• Rectum often spared
• 30% small bowel (usually terminal ileum), 40%
ileum/colon, 25% colon, 5% stomach/duodenum
• Sxs: non-bloody diarrhea, weight loss, fever, perianal
disease with abscess and/or fistulas
 UC vs. CD
• Continuous/superficial • “Skip”/Deep
• Colon only w/ rectum • Mouth to anus+rectum
• ++Rectal bleeding • +Rectal bleeding
• Rare fistulas/strictures • ++fistulas/strictures
• Surgery curative • Surgery palliative (high
rate of recurrence,
>50%)
Clinical Condition
 Laboratory testing
• CBC (high rate of anemia, due to chronic
inflamm., blood loss, B12 malabsorption)
• ESR, CRP often elevated
• Albumin (often low due to chronic inflamm.,
blood loss, malabsorption)
• Stool studies to rule out infection
• Noncaseating granulomas on biopsy suggest CD
 SEROLOGI TEST
pANCA (perinuclear antineutrophil cytoplasmic
antibody) : ULCERATIVE COLITIS

anti-saccharomyces cerevisiae antibody(ASCA)

: CROHN DISEASE
COMPLICATION
 Extraintestinal Manifestations
• Derm: erythema nodosum, pyoderma
gangrenosum
 Extraintestinal Manifestations
• Ocular: episcleritis, anterior
uveitis
• MSK: arthritis, ankylosing
spondylitis, sacroiliitis
• Hepatobiliary: steatosis,
cholelithiasis, primary sclerosing
cholangitis
 Extraintestinal Manifestations
• Derm: erythema nodosum, pyoderma
gangrenosum
 Toxic Megacolon
• Occurs in 1-3% of pt.s w/ IBD
• Colonic dilatation >6cm and signs of toxicity
(fever, hypotension, tachycardia, leukocytosis)
• High risk of perforation
• Medical management w/ broad-spectrum
antibx, urgent surgical consultation if no
response
 Colon Cancer
• Risk for colon cancer UC=CD
• Risk factors: disease duration, disease extent,
dysplasia on bx, presence of PSC
• 1-2% risk per year if IBD >10 years
• Colon cancer not preceded by adenomatous
polyps
• Colonoscopy with surveillance biopsies
recommended q1-2 years after disease for 10
years
 Treatment options
1. Aminosalicylates
2. Corticosteroids
3. Thiopurines
4. Ciclosporin
5. Methotrexate
6. Infliximab
7. Surgery
 ALGORITMA TERAPETIK UC

Kelompok Studi Infl ammatory Bowel Disease Indonesia. Konsensus nasional penatalaksanaan
infl ammatory bowel disease (IBD) di Indonesia. Jakarta: Perkumpulan Gastroenterologi
Indonesia 2011.
 ALGORITMA TERAPETIK CD

Kelompok Studi Infl ammatory Bowel Disease Indonesia. Konsensus nasional penatalaksanaan
infl ammatory bowel disease (IBD) di Indonesia. Jakarta: Perkumpulan Gastroenterologi
Indonesia 2011.
TERAPI UC
TERAPI CD
 Sulfasalazine
• Sulfasalazine is used to treat a certain type of
bowel disease called ulcerative colitis. This
medication does not cure this condition, but it
helps decrease symptoms such as fever,
stomach pain, diarrhea, and rectal bleeding.
Side Effects
• Stomach upset, nausea, vomiting, loss of
appetite, headache, dizziness, or unusual
tiredness.
• This medication may cause your skin and urine
to turn orange-yellow. This effect is harmless
and will disappear when the medication is
stopped.
Dose
• Usual Adult Dose for Ulcerative Colitis
Active
3 to 4 g/day orally in evenly divided doses
Maintenance
2 g/day orally in evenly divided doses

Comments:
-To reduce possible GI intolerance, a lower starting
dose (e.g., 1 to 2 g/day) may be considered.
 Corticosteroids
• MOA: enter cells and bind to and activate specific
cytoplasmic receptors
• Steroid-receptor dimers enter cell nucleus
• Activate steroid-responsive elements in DNA
• Gene repression or induction  anti-inflammatory
effects
• Anti-inflammatory effects take several hours
 Corticosteroids
• Prednisolone oral/ enema
• Hydrocortisone iv
• Budesonide (poorly absorbed – used for
iliocaecal CD/ UC)
 Indications
• Moderate to severe relapse UC & CD
• No role in maintenance therapy
• Combination oral and rectal
• No added benefit over 40mg /day
• <15mg ineffective
• Rapid reduction a/w relapse
 Effect

•  inflammation
•  healing
• Na retention/ K loss / Ca loss
•  gluconeogenesis – diabetogenic
•  catabolism
• Redistribution of fat – Cushingoid appearance
• Reduced endogenous steroids – withdrawal a/w
acute adrenal insufficiency
Downloaded from: StudentConsult (on 24 October 2005 02:39 PM)
 Methotrexate
• Inducing remission/preventing relapse in CD
(Unlicensed indication)
• Refractory to or intolerant of Azathioprine
• MOA: inhibitor of dihyrofolate reductase; anti-
inflammatory
• S/E: myelosupression*;mucositis;GI; hepatotoxicity;
pneumonitis
• Co-administration of folinic acid reduces
myelosupression;mucositis
 PUSTAKA
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THANK YOU