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Inflammatory bowel disease: Treatment | Gastrointestinal system diseases | NCLEX-RN | Khan Academy

– [Voiceover] Inflammatory bowel disease is a chronic inflammatory
disease, as its name suggests. And both types of the
disease, both Crohn’s disease and ulcerative colitis, usually
last throughout one’s life after they’re diagnosed. And if they’re not properly
managed, they can result in many serious or potentially even life-threatening complications. So, let’s briefly talk
about the clinical course of inflammatory bowel
disease and how it relates to treating IBD. So let’s create a timeline of the severity of inflammatory bowel disease. So, on the X axis, we have time, so this is going to be over
a period of years to decades. And then, on the Y axis, we’ll
have the severity of disease. And we’ll classify the
severity kind of in three categories here, with
mild, moderate, and severe. So, you’ll notice that early
on in the disease process, it starts out fairly mild. In fact, during this period,
someone may not necessarily realize that they have
inflammatory bowel disease. But then, it’s going to spike. And these spikes are known
as relapses or IBD flares. And it’s during this first
inflammatory bowel disease flare typically when the disease is diagnosed. But then it’s treated, and
the severity goes back down, and it will go back down
close to, hopefully, close to their baseline severity. But what you’ll notice is,
over time, there’ll be more and more of these flares and relapses. And occasionally, when the
relapse resolves, the severity of the disease, the new
baseline, gets worse and worse over time. So, these peaks are known
as flares or relapses. And then these valleys,
these baseline periods, are known as remissions. So, this disease pattern is
known as relapsing-remitting. And it’s very characteristic of both types of inflammatory bowel disease. But how does this all
relate to the treatment of inflammatory bowel disease? Well, there are three
goals to the treatment of inflammatory bowel
disease, and they have to do with these relapses and remissions. So, the first goal is to induce remission. The second goal is to maintain remission, or you can think about it
as preventing relapses. And the last goal is to prevent
and treat complications. Now, to understand how we
can accomplish these goals, I think it’s helpful to
think about the mechanism of inflammatory bowel disease
as having three steps. And the first step is the immune response. And this is a drawing of
a macrophage, which is one of the main types of immune cells in inflammatory bowel disease
that causes the inflammation, which is the second step in the mechanism. Then, it’s the inflammation that results in the complications. Now, we can use these
three steps as a framework to develop a better understanding
of how the different medications used to treat
inflammatory bowel disease will achieve these three goals. Now, it is important to note
that many of these treatments are effective for both Crohn’s disease and ulcerative colitis. So I’m going to talk about them together. However, the efficacy of
some of the medications may vary depending on the condition, whether it’s ulcerative
colitis or Crohn’s disease, as well as it can vary from
individual to individual. Now, since inflammatory
bowel disease most frequently presents from a medical
evaluation during this first or second flare, let’s start
by discussing how to achieve this first goal of inducing remission. So, you can think of an
inflammatory bowel disease flare as this immune response kind
of getting out of control, and it results in a ton of inflammation. And it’s this inflammation
that’s causing all of the pain and discomfort for someone with inflammatory bowel disease. And because of this, the
primary mechanism by which we can induce remission
is to directly treat this inflammation with
anti-inflammatory medications. And the type of medication
that’s going to be used will likely depend on this severity here. So, for flares that are mild
to moderate in severity, the primary anti-inflammatory medication that’s going to be used to
induce remission is a group of medications known as aminosalicylates. Then, for moderate to severe
flares, the type of medication that’s primarily used is corticosteroids. Now, corticosteroids are
very effective and powerful anti-inflammatories, but
the reason they’re reserved for some of the more
moderate to severe cases of inflammatory bowel disease
is because they can have many different side effects,
and they shouldn’t be taken for long periods of time. So, they’re really only
used when necessary. And there are some other
drugs that can be used as anti-inflammatory medications over the aminosalicylates,
and corticosteroids are by far the most common anti-inflammatories. But this isn’t the only type of medication that can be used to treat an acute flare. The other group of medications are known as immunomodulators. So, this immune response
is largely mediated by these signaling
proteins that are released by inflammatory cells such as macrophages. And one of these signaling
proteins is a protein known as tumor necrosis factor
alpha, which is abbreviated TNF alpha, and it is one
of the signaling proteins that’s responsible for the inflammation. Fortunately, we have
medications that can target TNF alpha and prevent its effect. So, one of the most common
types of immunomodulators used to treat an acute flare
of inflammatory bowel disease are the TNF alpha inhibitors. Now, once an acute flare has been overcome and the medications for inducing remission have been successful, the
next step is to maintain that remission. Now, fortunately, the
medications used to maintain remission are a lot of the
same medications that are used to induce remission. However, in the induction,
the anti-inflammatories are the primary focus
because it’s the inflammation that’s causing all of
the pain and discomfort. During the maintenance phase,
it’s the immunomodulators that are a little bit more
stressed, but they’re still taken at slightly less doses often
than they would be taken during the induction of remission. Then, another treatment
category that’s important to mention during this
kind of remission phase is lifestyle modifications. And although the effect
of some of these lifestyle modifications can be kind of
small, they have been shown to decrease the rate of relapse. So, one of the lifestyle
modifications is smoking cessation. And this is especially
important in Crohn’s disease. And another one to mention is diet. Now, there’s no evidence that
certain diets actually cause inflammatory bowel disease. However, some foods may
aggravate the symptoms of inflammatory bowel
disease and should be limited or avoided as much as possible. And these include things
like dairy, high-fat foods, as well as high-fiber foods. And then, the last lifestyle modification is stress reduction, which can be achieved through meditation or routine exercise. All right. So, the last goal in treating
inflammatory bowel disease is preventing and treating complications. So, let’s start with the prevention. And there’s two main areas we focus on, and that is infection and cancer. So, someone with
inflammatory bowel disease during an acute flare is
much more likely to develop a severe abdominal infection. So, sometimes, during
these relapses or flares, prophylactic or preventative
antibiotics will be prescribed. And the other is cancer,
specifically colorectal cancer. So, inflammatory bowel disease
is associated with a much higher risk of developing
colorectal cancer. Now, it’s higher for both Crohn’s disease and ulcerative colitis, but
it’s significantly higher much more so in ulcerative colitis. So, anyone with ulcerative
colitis is recommended to start having a routine
colorectal screening with a colonoscopy
starting eight years after they’re diagnosed with ulcerative colitis or by the age of 40, whatever comes first. All right. So, we’ll start with abscesses. And what an abscess is is
it’s a localized walled-off pocket of infection. And on its own, an abscess
isn’t necessarily that bad of a complication, but it
has a risk of rupturing, and if it ruptures, it can
cause a life-threatening infection of the abdominal
cavity called peritonitis. To prevent an abscess from
rupturing and to treat it, what happens is the
individual will be starting on IV antibiotics and
then the abscess is going to be drained. And drainage most commonly is accomplished by having a needle inserted
through the abdominal wall into that pocket of inflammation,
and this is typically done under x-ray guidance
in order to make sure that the needle gets
right into the right spot. And then, the fluid is
aspirated out of the abscess, and then it tends to heal down on its own. The next complication
is known as a fistula. So, a fistula is kind
of like a tunnel between two structures that aren’t
supposed to be connected. So, imagine in this drawing
here, you have the bladder and it’s kind of right up next to a loop of the small bowel. Well, if that loop of the
small bowel becomes inflamed within inflammatory bowel disease lesions such as in Crohn’s disease,
and that’s right up next to the bladder, well,
unfortunately, over time, that inflammation can
extend through the wall of the bladder and form
this kind of tunnel into the bladder. So, the bladder is
usually a sterile space, and so now it’s exposed
to all the bacteria and inflammation of the small intestine, and you can get a pretty
bad bladder infection. So, fistulas are also
treated with antibiotics because of this infection
risk, and then also they typically will require surgery. Now, there are a number
of other complications that can occur with Crohn’s disease and ulcerative colitis. But the abscesses and the fistulas are two of the most common. Unfortunately, a lot of the complications do require surgery. So, about one-third of
individuals who have inflammatory bowel disease
will eventually need surgery for the treatment of
some sort of complication. And, unfortunately,
surgery is not curative. So, if you think once again
about this three-step mechanism of inflammatory bowel
disease, the surgery really only treats the complications. It doesn’t really affect the inflammation or this immune response. So, if you look at this
clinical course over time, unfortunately, surgery isn’t
going to affect it that much because it doesn’t focus on
the underlying mechanism. There is one exception
to this, and that is with ulcerative colitis. So, because ulcerative
colitis never extends outside of the colon, someone who has inflammation of the entire colon
known as total colitis, they can have a procedure known as a proctocolectomy
where their entire rectum and colon is removed. And this can actually be
curative of ulcerative colitis because there’s no longer
the large intestine to become inflamed. However, this is not something
that’s typically done unless it absolutely needs
to, because it is a very big surgery. So, if you can remember, the
inflammatory bowel disease is a relapsing, remitting disease. It’s caused by this
inappropriate immune response resulting in inflammation throughout the gastrointestinal tract. You can remember that you
can use anti-inflammatory medications or these
immunomodulators to treat inflammatory bowel disease.

10 thoughts on “Inflammatory bowel disease: Treatment | Gastrointestinal system diseases | NCLEX-RN | Khan Academy

  1. —————————————————————————————————————————————————————-
    Would Allah still punish us for RIBAH/interest/usury even though the whole world is engulfed in it?
    Islam and Money
    Written by Imran Nazar Hosein, Graduate of Graduate Institute of International Relations in Switzerland.

    Allah will hold you to account for that Riba which you can avoid even if you had to flee to the mountains sides where rain falls and take with you some sheep and goats.

    Imran Hosein – THE PROHIBITION of RIBA (Interest) [FULL VIDEO]

    This shaykh has deep understanding of the harm of RIBA. After listening to his lecture I understood why Allah SWT has declared war on people who deal with RIBA in society, because these people give power to control money to money landers/bankers who in turn put people in slavery and hardship and also can finance a war just by printing unlimited amount of paper money and kills those who oppose them. And the blood of those innocent people are also on the hands of those who give them RIBA/interest on loan money.
    Those who are willingly cooperate with them for a small worldly gain will be with Abu Lahab and Abu Jahal in hellfire for ever because they also financed war against believers.
    Allah SWT is not only very merciful but also stern punisher

  2. Many thanks, I've been looking for "relief from ibs pain" for a while now, and I think this has helped. You ever tried – Mackorny Defeat IBS Blueprint – ( search on google ) ? Ive heard some extraordinary things about it and my m8 got cool results with it

  3. Omg this is the BEST explanation of the treatments for inflammatory bowel disease! I am doing a diploma in paediatrics this year and am thus refreshing my general medical knowledge.. wish I watched this back in med school!

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