Inflammatory bowel disease is due to complex biological response of body tissues in colon and small intestine. Most common diseases are Crohn's disease, and Ulcerative colitis. The reason of IBD is unknown but Genetics and immune system problems are associated in formation.
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Inflammatory bowel disease (IBD) grouped as autoimmune disease arises due to inflammation of small and large intestine. Based on the target organ IBD is classified under Ulcerative colitis (UC; affects the colon) and Crohn’s disease (CD; affects whole intestinal wall but mainly to the ileum) . 1-1.6 million people are suffering from IBD in United States and the main target age group is between 15-30 yrs. The prevalence rate of 201/106 of CD and 238/106 of UC in adults attracts attention to the disease . Abdominal cramping, weight loss, fever, sweats, fatigue, growth retardation, diarrhoea, constipation and abnormal bowel movement are the major symptoms of IBD. It is clearly noticed that IBD is not limited to just inflammation of the digestive tract, but it can lead to other complications like arthritis, thromboembolism, cardiovascular-, pulmonary-&neurological disease affecting the quality of life of an individual. It is clearly seen that IBD runs in the family, and the family members of affected individuals are at the maximum risk of IBD.
Primary sclerosing cholangitis is a chronic cholestatic syndrome affecting both extrahepatic and intrahepatic bile ducts that is frequently progressive, leading to liver cirrhosis, portal hypertension, and eventually to end-stage liver disease. Primary sclerosing cholangitis is strongly associated with inflammatory bowel disease. The prevalence of inflammatory bowel disease (typically ulcerative colitis) among primary sclerosing cholangitis patients is approximately 70-80% while only 2-7.5% of patients with ulcerative colitis will develop primary sclerosing cholangitis. Primary sclerosing cholangitis is accompanied by an increased risk of liver failure, cholangiocarcinoma, and colorectal cancer. Cholangiography is considered the gold standard for the diagnosis of primary sclerosing cholangitis. It is noteworthy that medical, endoscopic, and surgical therapies do not convincingly alter disease progression in primary sclerosing cholangitis patients. Liver transplantation is currently the only available therapeutic modality for patients with end-stage primary sclerosing cholangitis.
Inflammatory bowel disease (IBD) includes Crohn's disease (CD) and ulcerative colitis (UC) and can be diagnosed in childhood and adolescence in 25% of cases. Children that contract IBD before 10 years of age almost always present with extensive colitis that cannot be classified as either UC or CD, and remain colitis not determined (IBD-U) until several years later. Data from the literature on the time of diagnosis vary considerably. A pediatric IBD study in Germany found that the average time for CD diagnosis was 5 months (2-10 months), for the UC was 3 months (1-6 months) and IBD-U was 4 months (2-11 months) and the growth deficit was the most common sign in cases with late diagnosis
The inflammatory disorders of bowel are very common in gastrointestinal clinics. These are characterized by intermittent relapsing and remitting course or chronic inflammatory course affecting the gastrointestinal tract and comprise of a spectrum of disorders as shown in Figure 1. In this chapter, the focus is on understanding idiopathic IBD, especially ulcerative colitis (UC) and crohn's disease (CD) from a surgeon's perspective with specific focus on life after surgery for this IBD.