Inflammatory Bowel Disease
Contents
Foreword: Inflammatory Bowel Disease xi
Ronald F. Martin
Preface: Inflammatory Bowel Disease xiii
Kerry L. Hammond
Inflammatory Bowel Disease: Historical Perspective, Epidemiology, and Risk
Factors 1105
Talha A. Malik
Inflammatory bowel disease (IBD) describes a group of closely related yet
heterogeneous predominantly intestinal disease processes that are a
result of an uncontrolled immune mediated inflammatory response. It is
estimated that approximately one and a half million persons in North Amer-
ica have IBD. Pathogenesis of IBD involves an uncontrolled immune medi-
ated inflammatory response in genetically predisposed individuals to a still
unknown environmental trigger that interacts with the intestinal flora. There
continues to be an enormous amount of information emanating from
epidemiological studies providing expanded insight into the occurrence,
distribution, determinants, and mechanisms of inflammatory bowel
disease.
Diagnostic Modalities for Inflammatory Bowel Disease: Serologic Markers and
Endoscopy 1123
Clarence Clark and Jacquelyn Turner
The evaluation, diagnosis, and monitoring of inflammatory bowel disease
(IBD) has improved significantly over the past few decades. However, dif-
ferentiation and management of the subtypes of IBD (Crohn’s disease,
ulcerative colitis, and indeterminate colitis) can still be challenging. The
evolution of serologic markers has improved our understanding of the
pathogenesis and natural history of IBD. In addition, advancements in
endoscopy and endoscopic scoring systems have improved the accuracy
of diagnosis and the efficacy of surveillance of IBD patients. This article
reviews the recent literature on serologic markers, endoscopy, and endos-
copy scoring systems.
Imaging for Inflammatory Bowel Disease 1143
Melanie S. Morris and Daniel I. Chu
Multiple imaging modalities exist for inflammatory bowel disease. This
article explores the use of plain radiographs, contrast radiologic imaging,
computed tomography, MRI, ultrasound, and capsule endoscopy. History,
technique, indications for use, limitations, and future directions are
discussed for each modality.
vi Contents
Medical Therapy for Inflammatory Bowel Disease 1159
Panayiotis Grevenitis, Arul Thomas, and Nilesh Lodhia
Surgeons often care for patients with inflammatory bowel disease (IBD)
who are receiving therapies that can include 5-ASA compounds, steroids,
immunomodulators, and biologics. The goal of these agents is to suppress
intestinal inflammation, ultimately improving the quality of life in patients
afflicted with IBD. Traditionally, an acceptable therapeutic endpoint was
the resolution of symptoms, defined as clinical remission. However, as a
result of recent advances in therapy, clinicians can now strive to achieve
more stringent endpoints, such as endoscopic or histologic remission.
Many different classes of agents can be used, individually or in combina-
tion, to achieve mucosal healing.
Crohn’s Disease of the Foregut 1183
Kurt G. Davis
Crohn’s disease of the foregut is more common than previously recog-
nized, with up to 40% of patients with Crohn’s disease in the distal intes-
tine also having evidence of foregut disease. Esophageal disease is best
managed medically with proton pump inhibition, steroids, thiopurines,
methotrexate, and anti–tumor necrosis factor-a biologic medications.
Esophageal strictures are dealt with using endoscopic dilation. Surgery
is generally reserved of resistant strictures or esophageal fistulas. Patients
with gastroduodenal disease more commonly come to surgery. The most
commonly performed operations for gastroduodenal Crohn’s disease are
intestinal bypass or strictureplasty. The concomitant use of vagotomy
remains controversial.
Crohn’s Disease of the Colon, Rectum, and Anus 1195
William J. Harb
There is no cure for Crohn’s disease. Newer treatments, such as biological
therapy, have led to an improved quality of life. This article focuses on the
surgical management of Crohn’s disease of the colon, rectum, and anus.
Restorative and nonrestorative surgical options for colonic Crohn’s dis-
ease are discussed. Treatment options for perianal Crohn’s disease are
also reviewed.
Indications and Options for Surgery in Ulcerative Colitis 1211
Jaime L. Bohl and Kathryn Sobba
Ulcerative colitis affects differing lengths of the colon and rectum.
Surgical treatment is considered curative when the entire colon and
rectum is removed. However, surgical treatment of ulcerative colitis
should only be pursued for additional complicating factors of the dis-
ease. In addition, the current physiologic status as well as the patient’s
desire to retain intestinal continuity should be considered. This article
outlines the current indications for surgical treatment in patients with ul-
cerative colitis, the various surgical options, and the techniques used to
accomplish these goals.
Contents vii
Challenges in the Medical and Surgical Management of Chronic Inflammatory
Bowel Disease 1233
Ellen H. Bailey and Sean C. Glasgow
Inflammatory bowel disease patients will likely come to the surgeon’s
attention at some point in their course of disease, and they present several
unique anatomic, metabolic, and physiologic challenges. Specific and
well-recognized complications of chronic Crohn’s disease and ulcerative
colitis are presented as well as an organized and evidence-based
approach to the medical and surgical management of such disease
sequelae. Topics addressed in this article include intestinal fistula and
short bowel syndrome, pouch complications, and deep venous throm-
bosis with emphasis placed on optimization of the patient’s physiologic
state for best outcomes.
Extraintestinal Manifestations Associated with Inflammatory Bowel Disease 1245
Shaun R. Brown and Lisa C. Coviello
Inflammatory bowel disease (IBD) affects multiple organ systems outside
of the gastrointestinal tract. The clinician treating patients with IBD should
be acutely aware of the diagnosis and treatment of extraintestinal manifes-
tations in order to decrease morbidity. The management can be difficult
and often times requires a multidisciplinary approach. Future research
investigating the pathophysiology, diagnosis, and treatment is needed to
further the care of these patients.
Colorectal Neoplasia and Inflammatory Bowel Disease 1261
Jamie Cannon
Inflammatory bowel disease is associated with an increased risk of gastro-
intestinal neoplasia. Ulcerative colitis increases the risk of colorectal can-
cer, and patients with this condition should undergo routine colonoscopic
surveillance to detect neoplasia. Crohn’s disease increases the risk of ma-
lignancy in inflamed segments of bowel, which may include small bowel,
colon, rectum, and anus.
Nutritional Support of Patient with Inflammatory Bowel Disease 1271
Stephanie C. Montgomery, Cayla M. Williams, and Pinkney J. Maxwell IV
Ideally, surgical patients should be nutritionally optimized, as better nutri-
tional status correlates with favorable outcomes during the perioperative
period. As inflammatory bowel disease often leads to overall malnutrition,
special consideration should be given to this patient population by sur-
geons. In this article, we review methods for nutritional assessment and
provide nutritional recommendations for this special surgical population.
Psychosocial Support of the Inflammatory Bowel Disease Patient 1281
Abdul Alarhayem, Ebele Achebe, and Alicia J. Logue
Inflammatory bowel disease (IBD) is a chronic, debilitating disease whose
effects spread far beyond the gut. IBD does not generally result in excess
mortality; health care providers should thus focus their efforts on
viii Contents
improving health-related quality of life and minimizing associated
morbidity. A bidirectional relationship exists between IBD and psychiatric
conditions; chronic inflammation can produce neuromodulatory effects
with resultant mood disorders, and the course of IBD is worse in patients
with anxiety and depression. Screening for the early signs of depression or
anxiety and initiating appropriate treatment can lead to improved
functioning and positively impact disease course.
Index 1295
