II. Epidemiology

  1. Age: 10 to 40 years old
  2. First degree relative with Inflammatory Bowel Disease increases risk 10 fold

III. Differential Diagnosis

  1. Lower GI Bleeding
    1. Diverticulitis (most common cause)
    2. Angiodysplasia (Arteriovenous Malformation)
    3. Neoplasm
    4. Ulcerative Colitis (Blood Diarrhea distinguishes from Crohn's Disease)
    5. Ischemic Colitis (Older patients with sudden onset pain)
    6. Anorectal Disease
      1. Hemorrhoids
      2. Anal Fissures
  2. Diarrhea
    1. Non-Infectious Osmotic Diarrhea
    2. Non-Infectious Secretory Diarrhea
    3. Ulcerative Colitis (bloody Diarrhea)
    4. Crohn's Disease
    5. Irritable Bowel Syndrome (diagnosis of exclusion)
    6. Fecal Impaction (with leakage)
    7. Infectious Diarrhea (Sudden onset and often painful)
      1. Pseudomembranous colitis of Clostridium difficile (recent antibiotic use)
      2. Entamoeba histolytica
      3. Tuberculosis
      4. Cytomegalovirus
      5. Yersinia
      6. Strongyloides

IV. History

  1. Travel
  2. Contaminated intake
    1. Foodborne Illness
    2. Waterborne Illness
  3. Immunodeficiency risk
  4. High risk sexual behavior
  5. Family History of Gastrointestinal disease
  6. Medications in the last 6 months (e.g. antibiotics)

V. Symptoms

  1. Chronic Inflammatory Diarrhea
    1. Crohn Disease may also cause Secretory Diarrhea (Chronic Watery Diarrhea)
  2. Pain
    1. Ulcerative Colitis
      1. Lower abdominal cramps
      2. Relieved with Bowel Movement
    2. Crohn's Disease
      1. Constant pain often in right lower quadrant
      2. Not relieved with Bowel Movement
  3. Stool Blood
    1. Grossly bloody stool in Ulcerative Colitis

VI. Signs

  1. Abdominal Mass
    1. Ulcerative Colitis: No abdominal mass
    2. Crohn's Disease: Mass often at Right lower quadrant
  2. Gastrointestinal Tract Affected
    1. Ulcerative Colitis
      1. Affects only colon
      2. Continuous from Rectum
    2. Crohn's Disease
      1. Mouth to anus potentially affected
      2. Discontinuous, "Skip" lesions
  3. Bowel Tissue affected
    1. Ulcerative Colitis: Mucosal disease (no Granuloma)
    2. Crohn's Disease: Transmural disease (Granulomas)

VII. Labs: Stool Studies

  1. Fecal Calprotectin
    1. Newer test with high Test Sensitivity and Test Specificity for Inflammatory Bowel Disease
    2. Fecal Calprotectin <40 mcg/g and CRP <0.5 reduce Inflammatory Bowel Disease likelihood to<1%
      1. Menees (2015) Am J Gastroenterol 110(3):444-54 [PubMed]
  2. General Stool studies
    1. Stool Culture
    2. Stool for Ova and Parasites
    3. GiardiaAntigen
    4. Clostridium difficile Toxin and culture
    5. Fecal Leukocytes
  3. Additional Stool studies
    1. Yersinia enterocolitica culture
    2. Toxigenic Escherichia coli isolation
    3. Entamoeba histolytica serologic titers

IX. Labs: Underlying Nutrition and Disease Severity

X. Differential Diagnosis: Distinguishing Crohn's Disease from Ulcerative Colitis

  1. Location
    1. Crohn's Disease can involve any area of Gastrointestinal Tract
    2. Ulcerative Colitis is typically limited to colon, and has onset at the Rectum
  2. Thickness
    1. Crohn's Disease involves the entire bowel wall
    2. Ulcerative Colitis is limited to the mucosa and submucosa
  3. Colonoscopy
    1. Crohn's Disease demonstrates skip lesions, cobblestoning, ulcerations and strictures
    2. Ulcerative Colitis demonstrates pseudopolyps, continuous areas of inflammation
  4. Other discriminating factors
    1. Anemia is more common in Ulcerative Colitis
    2. Abdominal Pain is more common in Crohn's Disease
    3. Rectal Bleeding is more common in Ulcerative Colitis
    4. Colon Cancer is much more common in Ulcerative Colitis

XI. Diagnosis

  1. Colonoscopy with mucosal biopsy

XII. Imaging

  1. CT Abdomen and Pelvis (or MRI Abdomen)
  2. Abdominal XRay findings (if done for other reasons)
    1. Perforation signs (i.e. Free air in peritoneum)
    2. Toxic Megacolon
    3. Thumb-printing
      1. Pattern of multiple locations where bowel wall appears indented (as if by a thumbs)

XIII. Resources

  1. Crohn's and Colitis Foundation of America
    1. http://www.ccfa.org
  2. Cedars-Sinai Inflammatory Bowel Disease Center
    1. http://www.csmc.edu/ibd

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Inflammatory Bowel Diseases (C0021390)

Definition (NCI) A spectrum of small and large bowel inflammatory diseases of unknown etiology. It includes Crohn's disease, ulcerative colitis, and colitis of indeterminate type.
Definition (NCI_NCI-GLOSS) A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease.
Definition (MSH) Chronic, non-specific inflammation of the GASTROINTESTINAL TRACT. Etiology may be genetic or environmental. This term includes CROHN DISEASE and ULCERATIVE COLITIS.
Definition (CSP) chronic, non-specific inflammation of the gastrointestinal tract; etiology may be genetic or environmental.
Concepts Disease or Syndrome (T047)
MSH D015212
SnomedCT 155759008, 196974002, 266516008, 24526004
LNC LP36210-0, LA15162-3
English Bowel Diseases, Inflammatory, Inflammatory Bowel Diseases, IBD, IBD - Inflam bowel disease, BOWEL DIS INFLAMM, INFLAMM BOWEL DIS, Inflammatory bowel disease NOS, Inflammatory Bowel Diseases [Disease/Finding], Disease;inflammatory bowel, bowel disease inflammatory, disease inflammatory bowel, inflammatory bowel diseases, bowel diseases inflammatory, inflammatory bowel disease, Autoimmune Bowel Disorder, Inflammatory bowel diseases, inflammatory bowel disease (diagnosis), Inflammatory bowel disease, IBD - Inflammatory bowel disease, Inflammatory bowel disease (disorder), Inflammatory bowel disease, NOS, Inflammatory Bowel Disease
Italian Malattia infiammatoria intestinale, Malattia infiammatoria intestinale NAS, Malattie infiammatorie dell'intestino
Dutch inflammatoire darmziekte NAO, inflammatoire darmziekte, Darmziekte, inflammatoire, Darmziekten, inflammatoire, Inflammatoire darmziekte, Inflammatoire darmziekten, Ziekte, inflammatoire darm-, Ziekten, darm-, inflammatoire
French Maladie inflammatoire intestinale SAI, Syndrome de l'intestin irritable (SII), Maladie entérique inflammatoire, Maladies inflammatoires intestinales, Maladies inflammatoires de l'intestin, MICI, Maladies inflammatoires chroniques de l'intestin, Maladies inflammatoires des intestins
German IBD, entzuendliche Darmerkrankung NNB, entzuendliche Darmerkrankung, Entzündliche Darmkrankheiten
Portuguese Doença intestinal inflamatória, Doença intestinal inflamatória NE, Doenças Inflamatórias Intestinais, Doenças Intestinais Inflamatórias, Enteropatias Inflamatórias, Doenças Inflamatórias do Intestino, Doença entérica inflamatória
Spanish EII, Enfermedad intestinal inflamatoria NEOM, Enfermedades Inflamatorias Intestinales, Enfermedades Intestinales Inflamatorias, enfermedad inflamatoria intestinal (trastorno), enfermedad inflamatoria intestinal, Enfermedad intestinal inflamatoria, Enfermedades Inflamatorias del Intestino
Japanese 炎症性腸疾患NOS, エンショウセイチョウシッカン, エンショウセイチョウシッカンNOS, 炎症性腸疾患, 腸疾患-炎症性
Swedish Inflammatoriska tarmsjukdomar
Czech záněty střev nespecifické, Zánětlivé střevní onemocnění, Zánětlivé střevní onemocnění NOS, idiopatické střevní záněty, střeva - nemoci zánětlivé, nespecifické střevní záněty, IBD
Finnish Tulehdukselliset suolistosairaudet
Polish Choroby jelit zapalne, Zapalenie jelit nieswoiste
Hungarian Gyulladásos bélbetegség, Gyulladásos bél betegség k.m.n., IBD
Norwegian Inflammatorisk tarmsykdom, Tarmsykdom, inflammatorisk

Ontology: IBD5 gene (C1415836)

Concepts Gene or Genome (T028)
English IBD5, inflammatory bowel disease 5, IBD5 gene