Gastro Flash Vol-3, No-3, 2017

Biliary tract disease is a common occurrence in developed countries among which cholecystitis and biliary colic are most common. Both biliary colic and acute cholecystitis are most frequent complications of gall bladder stone disease or cholelithiasis. Biliary colic is defined as acute biliary pain which occurs when the gallbladder contracts against any stone obstructing the cystic duct. Patients with biliary colic usually presents with sharp, intermittent, right upper abdominal pain, nausea and vomiting. Besides, acute cholecystitis is an acute inflammation of the gall bladder due to its cystic obstruction. This obstruction leads to gall bladder distention, serosal edema, mucosal sloughing, venous and lymphatic congestion and subsequently ischemia. Symptoms of acute cholecystitis resembles to that of the biliary colic since patients with acute cholecystitis may have a history of attacks of biliary colic.2 Acute cholecystitis account for 3-10% of all patients with abdominal pain and 20% of patients admitted to hospital for biliary tract disease. It is 3 times more common in women than in men up to the age of 50 years and is 1.5 times more common in them thereafter. The complications of acute cholecystitis include perforation of the gall bladder, pericholecystic abscess, and fistula caused by gall bladder wall ischemia and infection. The overall mortality from an untreated complication is about 20%.

Inflammatory bowel disease (IBD) consist of two types of chronic intestinal disorders namely Crohn’s disease and ulcerative colitis.1 Crohn’s disease is a transmural inflammation affecting any part of the gastrointestinal tract, most commonly terminal ileum and the perianal region. It is frequently associated with complications including abscesses, fistulas and strictures. On the contrary, ulcerative colitis is characterized by mucosal inflammation and is restricted to the colon (Table 1). The incidences of ulcerative colitis and Crohn’s disease are highest in the West with annual rates of 24.3 per 100,000 and 29.3 per 100,000 persons, respectively. However, with rapid urbanization their incidence is also rising in parallel in the Asian countries. Nevertheless, all the developed countries in Asia do not share a similar incidence. India leads the Southeast Asian countries with an escalating incidence and prevalence of IBD. Near about 25% of patients with IBD are diagnosed in the first 2 decades of their life, among which majority of them are diagnosed in their childhood with an increased incidence in the early second decade of life. Furthermore, various studies have also demonstrated an increased incidence of IBD; particularly in adolescents. The exact etiology of IBD is unknown; however, the environmental factors, genetic factors and immune responses have been considered to be involved and functionally integrated in the pathogenesis.