Inflammatory bowel disease (IBD) is a term for two conditions (Crohn’s disease and ulcerative colitis) that are characterized by chronic inflammation of the gastrointestinal (GI) tract.
Pathophysiology
Mucosal barrier in Crohn’s disease, and in ulcerative colitis. | Stange E. (ed.): Entzündliche Darmerkrankungen, Stuttgart: Schattauer 2015; 26, 27, with the kind permisison of Schattauer Verlag.
Differential diagnosis of UC & Crohn’s disease | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072
Presentation
Crohn’s disease (CD):
Transmural inflammatory disease of the mucosa with episodic progression.
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Ulcerative colitis (UC):
Nontransmural inflammatory disease with episodic progression that is restricted to the colon.
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Extraintestinal manifestations:
Common extra-intestinal manifestations & associated autoimmune disesases | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072
MRI of the pelvis: severe erosions of the sacroiliac joint in sacroiliitis as an extra-intestinal manifestation (axial arthropathy) in a patient with Crohn’s disease | Baumgart D. C. (2009). The diagnosis and treatment of Crohn’s disease and ulcerative colitis. Deutsches Arzteblatt international, 106(8), 123–133. https://doi.org/10.3238/arztebl.2009.0123Pyoderma gangrenosum as an extraintestinal manifestation in a patient with ulcerative colitis | Baumgart D. C. (2009). The diagnosis and treatment of Crohn’s disease and ulcerative colitis. Deutsches Arzteblatt international, 106(8), 123–133. https://doi.org/10.3238/arztebl.2009.0123
Diagnosis
Basic diagnostic evaluation for patients with suspected ulcerative colitis or Crohn’s disease | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072
Full ileocolonoscopy with biopsies
M/C, GOLD STANDARD
Typical endoscopic and tomographic findings in chronic inflammatory bowel disease: (a) Mild ulcerative colitis: edema and erythema, with broken light reflexes from the granulated colonic mucosa. (b) Terminal ileitis in Crohn’s disease: partly aphthous (8 o’clock), partly confluent ulcerations (2 and 4 o’clock) of the small bowel mucosa. (c) Contrast-enhanced computerized tomography (CT): massively dilated cecum with coprostasis and thickening of the wall of the ascending and transverse colon with loss of haustration in an acute, severe relapse of longstanding ulcerative colitis (kindly provided by PD Dr. C. Schraml, Department of Diagnostic and Interventional Radiology [Director, Prof. Dr. K. Nikolaou], Universitätsklinikum Tübingen). (d) Contrast-enhanced magnetic resonance enteroclysis: Crohn’s disease, mixed inflammatory and fibrotic-stenotic changes in the terminal ileum (acknowledgement as above). | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072
Management
Treatment pyramid for ulcerative colitis (UC) and Crohn disease (CD) in children. TPN=total parenteral nutrition, TNF-α=tumor necrosis factor-alpha, 6-MP=6-mercaptopurine, 5-ASA=5-aminosalicylates, IV=intravenous | Glick, S. R. and Carvalho, R. S. (2010) ‘Inflammatory Bowel Disease’, Pediatrics in Review, 32(1), p. 14 LP-25. Available at: http://pedsinreview.aappublications.org/content/32/1/14.abstract.
Medical management:
Treatment algorithm for Crohn’s disease, developed by K.H. and E.F.S. | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072Treatment algorithm for ulcerative colitis, developed by K.H. and E.F.S. | Wehkamp, J., Götz, M., Herrlinger, K., Steurer, W., & Stange, E. F. (2016). Inflammatory Bowel Disease. Deutsches Arzteblatt International, 113(5), 72–82. https://doi.org/10.3238/arztebl.2016.0072
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