Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a term for chronic inflammation of the bowel that includes ulcerative colitis and Crohn disease. Possible causes and risks for IBD are gene susceptibility, environmental, epithelial cell barrier function alteration, and altered immune response to intestinal microflora (Huether & McCance, 2017). The mucosal epithelium loses its ability to discern normal intestinal antigens from harmful ones and cell-mediated immunity is activated. Dendritic cells are activated, T cells differentiate, and proinflammatory cytokines and chemokines are produced (Huether & McCance, 2017). The result of the altered immune response is chronic inflammation (Centers for Disease Control and Prevention, 2018; Huether & McCance, 2017). Ulcerative colitis and Crohn disease are slightly different with location and cellular appearance. With ulcerative colitis, the cellular inflammation and destruction can lead to frequent bowel movements, pain, fever, bloody stools, fissures, and abscess. Those with Crohn disease may experience diarrhea, pain, fistulae, and obstruction (Huether & McCance, 2017).
According to the Crohn’s and Colitis Foundation of America (2014), the onset of IBD can occur at any age, but is most common between the ages of 15 and 35. When it comes to age, Herzog et al. (2018) found that disease onset results in no change of IBD behavior or progression. Similarly, a metanalysis found that age of diagnosis does not impact mortality (Duricova, Burisch, Jess, Gower-Rousseau, & Lakatos, 2014). However, pediatric diagnosis of IBD is found to have higher rates of anemia, and stomatitis, and lower rates of arthralgia and osteopenia (Herzog et al., 2018).
Psoriasis
Psoriasis is a chronic and relapsing condition of the skin, scalp, and nails. Psoriasis appears to be T cell driven. Dendritic cells react to a trigger and secrete cytokines (Fischer, 2017). Interleukins are secreted, impacting keratinocyte proliferation, cytokine secretion, and more activation of T cells (Fischer, 2017). Psoriasis is marked by a thickening of the dermis and epidermis because of cellular hyperproliferation, altered keratinocyte differentiation, and expanded dermal vasculature, causing scales and thickened red plaques (Huether & McCance, 2017). Psoriasis can occur at any age, although generally happens by the age of 35. There is not a lot of information on the factor of age. Gulliver, Parfre, Gulliver, Randell, and Connors (2016) state that psoriasis is associated with excess cardiovascular-related deaths and decreased longevity of 20 years. The authors state there are no predictive factors for at risk patients (Gulliver et al., 2016).
Comparison of IBD and Psoriasis
IBD and psoriasis seem to be the result of altered innate and cell-mediated response. Both have a cellular-mediated immune response that result in a chronic inflammatory response. In both conditions, dendritic cells are activated, T cells are mobilized, and eventually inflammatory mediators are released. Patients who suffer experience both periods of remission and exacerbation or flares. However, their locations and clinical manifestations are very different. Psoriasis causes the over-proliferation of the dermis and epidermis. IBD is marked by damage and inflammation to the mucosa and submucosa.
References
Centers for Disease Control and Prevention. (2018). What is inflammatory bowel disease (IBD)?
Retrieved from https://www.cdc.gov/ibd/what-is-IBD.htm
Crohn’s and Colitis Foundation of America (2014). The facts about inflammatory bowel
diseases. Retrieved from https://www.crohnscolitisfoundation.org/assets/pdfs/updatedibdfactbook.pdf
Duricova, D., Burisch, J., Jess, T., Gower-Rousseau, G., & Lakatos, P. (2014). Age-related
differences in presentation and course of inflammatory bowel disease: An update on the
population-based literature. Journal of Crohn’s and Colitis, 8(11), 1351-1361. doi:
Fischer, S. (2017). 2017 update: Etiology and pathogenesis of psoriasis. Retrieved from
Gulliver, W., Parfre, B., Gulliver, S., Randell, S., & Connors, S. (2016). Early age of onset of
psoriasis (<25 years of age) may be a predictor for cardiovascular disease in patients with
severe psoriasis. Journal of the American Academy of Dermatology, 74(5), AB244. doi:
Herzog, D., Fournier, N., Buehr, P., Rueter, V., Koller, R., Helyand, K., Nydegger, A.,
Spalinger, J., Schibli, S., Petit, L., & Braegger, C. (2018). Age at disease onset of inflammatory bowel disease is associated with later extraintestinal manifestations and complications. European Journal of Gastroenterology & Hepatology, 30(6), 598-607. doi: 10.1097/MEG.0000000000001072
Huether, S.E., & McCance, K.L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
MO: Mosby.
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