Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview

Abstract

This article is an overview of guidelines for the clinical diagnosis and surgical treatment of predominantly colonic inflammatory bowel diseases (IBD). This overview describes the systematically and comprehensively multidisciplinary recommendations based on the updated principles of evidence-based literature to promote the adoption of best surgical practices and research as well as patient and specialized healthcare provider education. Colonic IBD represents idiopathic, chronic, inflammatory disorders encompassing Crohn’s colitis (CC) and ulcerative colitis (UC), the two unsolved medical subtypes of this condition, which present similarity in their clinical and histopathological characteristics. The standard state-of-the-art classification diagnostic steps are disease evaluation and assessment according to the Montreal classification to enable explicit communication with professionals. The signs and symptoms on first presentation are mainly connected with the anatomical localization and severity of the disease and less with the resulting diagnosis “CC” or “UC”. This can clinically and histologically be non-definitive to interpret to establish criteria and is classified as indeterminate colitis (IC). Conservative surgical intervention varies depending on the disease phenotype and accessible avenues. The World Gastroenterology Organizations has, for this reason, recommended guidelines for clinical diagnosis and management. Surgical intervention is indicated when conservative treatment is ineffective (refractory), during intractable gastrointestinal hemorrhage, in obstructive gastrointestinal luminal stenosis (due to fibrotic scar tissue), or in the case of abscesses, peritonitis, or complicated fistula formation. The risk of colitis-associated colorectal cancer is realizable in IBD patients before and after restorative proctocolectomy with ileal pouch-anal anastomosis. Therefore, endoscopic surveillance strategies, aimed at the early detection of dysplasia, are recommended. During the COVID-19 pandemic, IBD patients continued to be admitted for IBD-related surgical interventions. Virtual and phone call follow-ups reinforcing the continuity of care are recommended. There is a need for special guidelines that explore solutions to the groundwork gap in terms of access limitations to IBD care in developing countries, and the irregular representation of socioeconomic stratification needs a strategic plan for how to address this serious emerging challenge in the global pandemic.

Role of CD34 in inflammatory bowel disease

“…The immune response plays an important role in the course of IBD. The prevailing view is that IBD is caused by the dysbiosis of the intestinal microbiota in the gut, which leads to the impairment of the intestinal barrier function and induces abnormal immune responses in the intestinal site (Ramos and Papadakis, 2019;M'Koma, 2022). The dysbiosis caused by the increased proportion of intestinal pathogenic bacteria leads to the production of toxic factors and other metabolites by the pathogenic bacteria, which stimulate the intestine to release a large amount of inflammatory cytokines and chemokines (Stzepourginski et al, 2017) and induce abnormal immune responses in the body (Hills et al, 2019).…”

“…However, the specific mechanism regulating the connection with other adhesion molecules needs to be further investigated. homeostasis IBD is characterized by an impaired intestinal homeostasis, often leading to a decreased function of the intestinal immune barrier and an abnormal immune response (M'Koma, 2022;Ramos and Papadakis, 2019). The decrease in the above function and abnormal response is mostly caused by the decrease in the diversity of the intestinal microbiota and the increase pathogenic bacteria in the site of inflammation (Aldars-García et al, 2021), which is manifested by the direct or indirect contact and function of intestinal microbiota with immune cells.…”

“…Ulcerative colitis is more commonly affecting the rectum and colon mucosa, leading to inflammation and ulcers (Conrad et al, 2014). Crohn's disease affects the entire digestive system from the mouth to the anus, often leading to inflammation of the entire intestinal layer (transmural and skip lesions), even further affecting the physiological functions of other organs through fistulas (M'Koma, 2022;Nosti et al, 2013). However, the pathogenesis and etiology of IBD are still unclear.…”

A Review of Ophthalmic Complications in Inflammatory Bowel Diseases

“…IBD include Crohn s disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC). For several decades, an increasing incidence of IBD in both adults and children has been observed, especially in the Western world but also in developing countries [1][2][3]. The etiology of IBD is complex and not fully understood.…”

Bamboo Shoot and Artemisia capillaris Extract Mixture Ameliorates Dextran Sodium Sulfate-Induced Colitis

“…Furthermore, infection, loss of blood supply, and invasion of the colon wall with collagen or lymphocytic cells are the causes of colonic inflammation [ 4 ]. Although the pathogenesis of IBD has not been fully clarified yet, it is generally accepted that the cause of IBD is multifactorial, including genetic predisposition, gastrointestinal microbiota disorders, and altered dysregulated immune responses [ 5 , 6 , 7 ]. This study aimed to investigate a therapeutic approach to IBD prevention and therapeutics, which could soften patient outcomes and be efficacious, less toxic, and cost-effective.…”