Dr. Ajmal Hasan

Inflammatory bowel Disease

Inflammatory bowel disease is characterized by ulcerations in small or large intestine. Two common inflammatory bowel diseases are Ulcerative colitis and Crohn’s disease.

Ulcerative colitis
Ulcerative colitis is disease characterized by ulcerations in large intestine

Common symptoms are
  • Diarrhoea
  • Blood in stool
  • Urgency (patient has to rush to toilet)
  • Incontinence (passage of stool in cloths)
  • Pain abdomen
  • Weight loss


  • Diagnosis is confirmed by colonoscopy and biopsy
  • Treatment depends upon severity of disease
  • Mild disease is treated by Mesalamines
  • Moderated and severe disease is treated by Steroids, antimetabolites, and Infliximab
  • Severe cases may require surgery
Crohn's disease
Crohn’s disease is characterized by ulceration in small and large bowel.
Symptoms of Crohn’s disease are
  • Pain in umbilical region
  • Diarrhea
  • Blood in stool
  • Vomiting and upper abdominal pain
  • Weight loss
  • Fever
  • Abdominal lump

Following tests are required for the diagnosis and evaluation of extent of the disease

  • Colonoscopy and biopsy
  • CT enterography
  • Barium study
  • Double balloon enteroscopy
  • Capsule endoscopy
Treatment depends upon the severity and extent of disease
  • Mild disease is treated by mesalamine
  • Moderate disease is treated by oral steroids and antimetabolites
  • Severe disease activity may require steroids, antimetabolites and Infliximab
  • Surgery is reserved for severe but localized disease, and stricturing disease


Crohn's Disease Ulcerative colitis

Celiac disease

Celiac diseases is the disease of mucosa of small intestine.
It is characterized by small bowel dysfunction after ingestion of gluten in wheat.
Symptoms of celiac disease are
  • Diarrhea
  • Stunted growth
  • Bloating
  • Anemia
  • Amenorrhea, infertility and impotence
  • Serological testing
    • IgA anti tissue transglutaminase
    • IgA antiendomysial antibodies
    • Antigliadin antibodies
  • UGI endoscopy and small intestinal biopsy which reveals villous atrophy
Treatment of celiac disease
  • Withdrawal of wheat/oat/barley/rye containing food items from the diet
  • Dietary supplements
  • Steroids may be helpful in severely ill patients with crisis

Colonic Polyps and cancer

Colonic polyp
Polyp is discrete mass of the tissue, that protrude into the lumen of the bowel
Polyps are categorized as non neoplastic polyps and neoplastic polyps
Neoplastic polyps
  • Adenoma
Non neoplastic polyps
  • Hyperplastic polyps
  • Juvenile polyps
  • Peutz Jeghers polyps
  • Inflammatory polyps
Adenoma are benign neoplastic polyps, and are of two types, tubular and villous adenomas. Polyps which are larger than 2 cms and with villous morphology are more likely to have transformation to malignancy
Polyps less than 5 mm are called diminutive polyp, these polyps are highly unlikely to have malignant potential

Risk factors

  • Inherited susceptibility
  • Excessive dietary intake of fat and low fiber

Clinical features
  • Most of the polyps are clinically silent
  • Pain abdomen
  • Rectal bleeding
  • Diarrhea and constipation
  • Colonic obstruction
Detection of colonic polyps
  • Most of the polyps are diagnosed during colonoscopy.
  • Adenomas without deeper invasion can be taken out endoscopically, resected polyp should be submitted for histopathology to confirm the complete resection
  • Polyp with invasion of deeper layers should be taken out surgically
Colon cancer
Colon cancer is a major cause of morbidity and mortality
Risk factors
  • High fat low fiber diet
  • Smoking
  • Colorectal adenomas   polyposis syndromes
  • Family history of colorectal cancer
  • Ulcerative colitis and Crohn’s disease
  • Tumor on the right side of the colon, are larger in size and present with chronic bleed and there may be palpable mass also
  • Tumor on the left side of the colon present with change in bowel habits, pain abdomen, anemia and chronic bleed
  • Colonoscopy is done for confirmation of diagnosis, biopsy is taken from abnormal areas for histopathological confirmation
  • CECT abdomen and chest are done to r/o distant metastasis
  • Surgery is the treatment of choice for colon cancer
  • Patients with advanced disease (disease beyond serosa/lymph node positive cases patients with liver metastasis) should be offered chemotherapy

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is very common cause of abdominal discomfort.
Symptoms are
  • Abdominal pain eased after defecation
  • Looser stool at onset of pain
  • More frequent stool at onset of pain
  • Abdominal distension
  • Feeling of incomplete emptying
  • Mucus per rectum
Alarming features
Presence of these features are uncommon in IBS and suggest alternate pathology
  • Blood in stool
  • Family history of Inflammatory bowel disease/colon cancer
  • Fever
  • Onset after the age of 50
  • Weight loss
  • Chronic diarrhea
  • Progressive dysphagia
Presence of symptoms of IBS and absence of alarming symptoms are suggestive of diagnosis of IBS
  • Antispasmodics
  • Laxatives
  • Antidiarrhoeal
  • Antidepressants and anxiolytics
  • Antibiotics
  • Probiotics