Assignment on Inflammatory Bowel Disease

A practice school report submitted

In Partial Fulfillment of the Requirements of the Degree of

BACHELOR OF PHARMACY (PRACTICE)

By
Pankaj Yadav
221405001

Under Supervision of

Ms. Chetna Chouhan,

Assistant Professor,
SGT College of Pharmacy, Gurugram

SHREE GURU GOBIND SINGH TRICENTENARY UNIVESITY,

GURUGRAM, HARYANA, INDIA
JUNE 2023
 CERTIFICATE

This is certified that the Assignment/ project entitled “Inflammatory

Bowel Disease”, submitted by Pankaj Yadav (221405001) in partial fulfillment of
Practice School, course code- for the Degree of BACHELOR OF
PHARMACY (PRACTICE), session 2022-23 is his work carried out under our
supervision and guidance.

Ms. Chetna Chouhan,

Assistant Professor,
SGT College of Pharmacy,
Gurugram
 DECLARATION

I hereby declare that this submission is my own work and that, to the best
of my knowledge and belief, it contains no material which to a substantial extent
has been accepted for the award of any other degree or diploma of the
university or other institution of higher learning, except where due
acknowledgement has been made in the text.

Pankaj Yadav
221405001
B Pharmacy Practice 1st year
SGT College of Pharmacy
SGT University, Gurugram
 ACKNOWLEDGEMENT

I would like to express my gratitude and sincere thanks to my mentor Ms.

Chetna Chouhan, Assistant Professor, SGT College of Pharmacy, SGT University,
Gurugram for her support guidance, encouragement and cooperation during my
project work.
I deeply acknowledge the support and valuable guidance rendered to me
from time to again by Prof. (Dr.) Vijay Bhalla, Dean, SGT College of Pharmacy,
SGT University, Gurugram.
I further extend my sincere gratitude to all my teachers and friends for
their kind cooperation and support during my assignment/project work.

Pankaj Yadav
221405001
B Pharmacy Practice 1st year
SGT College of Pharmacy
SGT University, Gurugram
Table of Content:-

Sr. No. Content Page No.

1. Introduction

2. Objective of Study

3. Literature Review

4. Materials and Methods of Diagnosis

5. Results and Discussion

6. Conclusion
 Introduction

Inflammatory bowel disease is a chronic inflammatory process of the lining of

gastro-intestinal (GI) tract. If left untreated, it can result in the build-up of scar
tissue, and even potentially to lymphoma. The inflammation usually causes
diarrhoea and abdominal pain, it is classified as an autoimmune disease: i.e.
Body’s own immune system attacks the GI tract
Inflammatory bowel disease is used to describe two different conditions:
Ulcerative colitis and Crohn’s disease.
The GI tract is responsible for digestion of food, absorption of nutrients, and
elimination of waste.
Inflammation impairs the ability of affected GI organs to function properly,
leading to symptoms such as
Persistent diarrhoea, abdominal pain, rectal bleeding, weight loss and fatigue.
While ongoing inflammation
In the GI tract occurs in both Crohn’s disease and Ulcerative colitis, they present
different clinical features.
Inflammatory bowel disease (IBD) is a group of disorders that cause chronic
inflammation (pain and swelling) in the intestines. IBD includes Crohn’s disease
and ulcerative colitis. Both types affect the digestive system. Treatments can
help manage this lifelong condition.
Crohn’s Disease Crohn’s disease can affect any part of the GI tract, from the
mouth to the anus. It most commonly affects the end of the small intestine (the
ileum) where it joins the beginning of the colon.
Crohn’s disease may appear in “patches,” affecting some areas of the GI tract
while leaving other sections completely untouched. In Crohn’s disease, the
inflammation may extend through the entire thickness of the bowel wall.
Ulcerative Colitis Ulcerative colitis is limited to the large intestine (colon) and
the rectum. The inflammation occurs only in the innermost layer of the lining of
the intestine. It usually begins in the rectum and lower colon, but may also
spread continuously to involve the entire colon.
 Objective of Study
Both types of IBD can strike at any age but most patients first experience
problems between ages 10 and 30, with a smaller peak incidence between ages
50 and 60. Both diseases have familial tendency: 10% to 20% of patients with
IBD have at least one relative who also has IBD.

Historically, inflammatory bowel disease (IBD) was most common in

North America and Europe and more common with a north-south gradient. Over
the past century, there has been a marked increase in IBD in general and in
childhood IBD in particular and over the past 50 years IBD has spread into the
developing world. The greatest risk factor of developing IBD is an affected family
member. Most patients with IBD do not have an affected family member. IBD is
more common in urban than rural regions and is associated with “good
standards” of domestic hygiene during childhood. People who migrate from
areas with a low incidence to areas with a high incidence of IBD have an
increased risk of developing IBD and the younger they are when they migrate,
the greater their risk of developing IBD. Moreover, people who migrate from
regions with a high incidence to areas with a low incidence of IBD have a
decreased risk of developing IBD. Together, these findings strongly suggest
particular environmental exposures occurring early in life may trigger
inflammatory bowel disease in genetically susceptible individuals. The key is
figuring out what those exposures might be.

Around 25 percent of patients with IBD are diagnosed in the first 2

decades of their life. Of them, most are diagnosed in childhood (about 13-18
years) and its incidence is increasing in the early second decade of life.
Moreover, studies from a variety of countries demonstrate that the incidence of
IBD in increasing, especially in adolescence.
 Literature Review

Inflammatory bowel disease (IBD) is a group of disorders that cause

chronic inflammation (pain and swelling) in the intestines. Inflammatory bowel
disease (IBD) is a group of inflammatory conditions of the colon and small
intestine, Crohn's disease and ulcerative colitis (UC) being the principal
types. Crohn's disease affects the small intestine and large intestine, as well as
the mouth, oesophagus, stomach and the anus, whereas ulcerative colitis
primarily affects the colon and the rectum. The term inflammatory bowel
disease (IBD) describes a group of disorders in which the intestines become
inflamed. It has often been thought of as an autoimmune disease, but research
suggests that the chronic inflammation may not be due to the immune system
attacking the body itself. Instead, it is a result of the immune system attacking a
harmless virus, bacteria, or food in the gut, causing inflammation that leads to
bowel injury.

Difference between inflammatory bowel disease (IBD) and irritable bowel

syndrome (IBS)-

IBD is a disease; IBS is a syndrome, or group of symptoms. The causes and

treatments are different.

IBS is a type of functional gastrointestinal disease. It affects how the

bowels function, causing them to contract more (or sometimes less) often than
usual. IBS is also known as spastic colon or nervous stomach.

IBS doesn’t inflame or damage the intestines like IBD, so imaging scans
can’t detect it and it doesn’t increase the risk of colon cancer. People with IBS
rarely need hospitalization or surgery.

Crohn’s disease and ulcerative colitis are the main types of IBD. Types
include:

1. Crohn’s disease causes pain and swelling in the digestive tract. It can
affect any part from the mouth to the anus. It most commonly affects
the small intestine and upper part of the large intestine.

2. Ulcerative colitis causes swelling and sores (ulcers) in the large

intestine (colon and rectum).

1. Ulcerative colitis :
This involves inflammation of the large intestine — but only in the
digestive tract. It can lead to other non-digestive issues. Always involves the
rectum and inflammation can extends continuously throughout the colon to an
extent. It only affects the colon and only affects the mucosa of the gut wall and
is common in young adults15-25 and second peak in 6th decade.
Chronic inflammation results in ulceration with loss of goblet cells and the
formation of abscesses.
 Image Ulcerative colitis
Symptoms of Ulcerative colitis:
 Bloody diarrhoea.
 Fever.
 Passage of mucus.
 Episodic cramps.
 Anorexia.
 Nausea.
 Abdominal pain.

2. Crohn’s disease:
This involves Chronic transmural inflammation – i.e. involves all layers of
the gut wall and is Highly heterogeneous and may progress from
inflammation to abdominal abscesses. It is Not region specific i.e. can affect
any region of the GI tract (Small intestine involvement – most cases 80%,
Colitis alone - 15-20%).
It Causes loss of tolerance to intestinal microflora and results in damage to
the gut wall.
It can result in abscesses, strictures, fissures and fistula which can require
surgery.
Symptoms of Crohn’s Disease:
 Colonic involvement.
 Recurrent mild diarrhoea.
 Cramps and fevers lasting for days or weeks.
 Fatigue.
 Small intestine involvement.
Etiology:

The exact cause of IBD is unknown, several factors may be responsible for
the IBD. The following Etiological factors may increase the risk of IBD:
1) Autoimmune Disorder.
2) Genetics.
3) Poor Hygiene.
4) Bacterial and Viral Infections.
5) Environmental Factors like smoking, alcohol drinking, oral
contraceptive etc.

Pathogenesis:

Due to etiological factors

Irritation of cells

Inflammation of cell

Ulceration

Inflammatory Bowel Disease

Common symptoms of IBD: As with other chronic diseases, a person with IBD
will generally go through periods in which the disease flares up and causes
symptoms, followed by periods in which symptoms decrease or disappear and
good health returns. Symptoms range from mild to severe and generally depend
upon what part of the intestinal tract is involved. They include:
 Abdominal cramps and pain
 Diarrhoea that may be bloody
 Severe urgency to have a bowel movement
 Fever
  Weight loss
 Loss of appetite
 Iron deficiency anaemia due to blood loss

Materials and Methods of Diagnosis

The doctor makes the diagnosis of inflammatory bowel disease based on the
patient’s symptoms and various exams and tests:

1. Stool exam: The Patient will be asked for a stool sample that will be sent
to a laboratory to rule out the possibility of bacterial, viral, or parasitic
causes of diarrhea. In addition, the stool will be examined for traces of
blood that cannot be seen with the naked eye.

2. Complete blood count: A nurse or lab technician will draw blood, which
will then be tested in the lab. An increase in the white blood cell count
suggests the presence of inflammation. And if the patient have severe
bleeding, the red blood cell count and hemoglobin level may decrease.

3. Other blood tests: Electrolytes (sodium, potassium), protein, and markers

of inflammation, such as erythrocyte sedimentation rate (ESR) and C-
reactive protein (CRP), may be drawn to look at how serious the disease
is.

4. Other radiologic tests: Computed tomography (CT scan), magnetic

resonance imaging (MRI), and ultrasound have also been used in the
diagnosis of Crohn's disease and ulcerative colitis.

5. Sigmoidoscopy: In this procedure, a doctor uses a sigmoidoscope, a

narrow, flexible tube with a camera and light, to visually examine the last
one-third of your large intestine, which includes the rectum and the
sigmoid colon. The sigmoidoscope is inserted through the anus and the
intestinal wall is visually examined for ulcers, inflammation, and bleeding.
The doctor may also take samples, called biopsies, of the intestinal lining
with an instrument inserted through the tube. These will then be
examined in a laboratory under a microscope.
6. Colonoscopy: A colonoscopy is similar to a sigmoidoscopy, except that the
doctor will use a colonoscope, a longer flexible tube, to examine the entire
colon. This procedure gives you a look at the extent of disease in the
colon.

7. Upper endoscopy. If the patient have upper GI symptoms such as nausea

and vomiting, a doctor will use an endoscope, a narrow, flexible tube with
a camera and light that will be inserted through the mouth -- to examine
oesophagus, stomach, and duodenum, which is the first part of small
intestine. Ulceration occurs in the stomach and duodenum in up to one
out of every 10 people with Crohn's disease.

8. Capsule endoscopy. This test may be helpful to diagnose disease in the

small intestine, such as in Crohn's disease. The Patient swallow a small
capsule that has a camera in it. Pictures are taken of the esophagus,
stomach and small bowel and then sent to a receiver patient wear on a
belt. At the end of the procedure, the pictures are downloaded from the
receiver onto a computer. The camera is passed through body into the
toilet.
 Results and Discussion

The doctor will diagnose IBD based on the patient’s signs and symptoms,
medical and family histories, and test results.

IBD complications:
Complications may include:
IBD can lead to several serious complications in the intestines, including:
 Profuse intestinal bleeding from the ulcers.
 Perforation, or rupture of the bowel.
 Narrowing -- called a stricture -- and obstruction of the bowel; found in
Crohn's.
 Fistulae (abnormal passages) and perianal disease, disease in the tissue
around the anus. These conditions are more common in Crohn's than in
ulcerative colitis.
 Toxic megacolon, which is an extreme dilation of the colon that is life-
threatening. This is associated more with ulcerative colitis than Crohn's.
 Malnutrition.
 IBD, particularly ulcerative colitis, also increases the risk of colon cancer.
 IBD can also affect other organs. For example, someone with IBD may
have arthritis, skin conditions, inflammation of the eye, liver and kidney
disorders, or bone loss. Of all the complications outside the intestines,
arthritis is the most common. Joint, eye, and skin complications often
happen together.
 Conclusion

Prevention and Non Pharmacological Management:

Although no specific diet has been shown to prevent or treat IBD, dietary
changes may be helpful in managing your symptoms. It's important to talk with
your doctor about ways to modify your diet while making sure you get the
nutrients you need. For instance, depending on your symptoms, the doctor may
suggest that you reduce the amount of fibre or dairy products that you consume.
Also, small, frequent meals may be better tolerated. In general, there is no need
to avoid certain foods unless they cause or worsen your symptoms.

One dietary intervention your doctor may recommend is a low-residue

diet, a very restricted diet that reduces the amount of fiber and other
undigested material that pass through your colon. Doing so can help relieve
symptoms of diarrhea and abdominal pain. If you do go on a low-residue diet,
be sure you understand how long you should stay on the diet because a low-
residue diet doesn't provide all the nutrients you need. Your doctor may
recommend that you take vitamin supplements.

Another important aspect of self-care is to learn how to manage stress,

which may worsen your symptoms. One thing you might want to do is to make
a list of things that causes you stress and then consider which ones you can
eliminate from your daily routine. Also, when you feel stress coming on, it can
help to take several deep breaths and release them slowly. Learning to meditate,
creating time for yourself, and regular exercise are all important tools for
reducing the amount of stress in your life.

Participating in a support group puts you in contact with others who know
exactly the effect IBD has on your day-to-day life because they are going through
the same things you are. They can offer support and tips on how to deal with
symptoms and the effect they have on you.
 Treatment of IBD:

Doctors treat symptoms of IBD with a few different medications. Some

are taken by mouth, while others are available as injections.

Medicines, such as

1. Antibiotics.

2. Anti-inflammatory

3. Immune suppressive drugs

4. Corticosteroids

5. Analgesics

6. Anti – Diarrheal Drugs.