II. Epidemiology
- Age: 10 to 40 years old
- First degree relative with Inflammatory Bowel Disease increases risk 10 fold
III. Differential Diagnosis
-
Lower GI Bleeding
- Diverticulitis (most common cause)
- Angiodysplasia (Arteriovenous Malformation)
- Neoplasm
- Ulcerative Colitis (Blood Diarrhea distinguishes from Crohn's Disease)
- Ischemic Colitis (Older patients with sudden onset pain)
- Anorectal Disease
-
Diarrhea
- Non-Infectious Osmotic Diarrhea
- Non-Infectious Secretory Diarrhea
- Ulcerative Colitis (bloody Diarrhea)
- Crohn's Disease
- Irritable Bowel Syndrome (diagnosis of exclusion)
- Fecal Impaction (with leakage)
- Infectious Diarrhea (Sudden onset and often painful)
IV. History
- Travel
- Contaminated intake
- Immunodeficiency risk
- High risk sexual behavior
- Family History of Gastrointestinal disease
- Medications in the last 6 months (e.g. antibiotics)
V. Symptoms
-
Chronic Inflammatory Diarrhea
- Crohn Disease may also cause Secretory Diarrhea (Chronic Watery Diarrhea)
- Pain
- Ulcerative Colitis
- Lower abdominal cramps
- Relieved with Bowel Movement
- Crohn's Disease
- Constant pain often in right lower quadrant
- Not relieved with Bowel Movement
- Ulcerative Colitis
-
Stool Blood
- Grossly bloody stool in Ulcerative Colitis
VI. Signs
- Abdominal Mass
- Ulcerative Colitis: No abdominal mass
- Crohn's Disease: Mass often at Right lower quadrant
-
Gastrointestinal Tract Affected
- Ulcerative Colitis
- Affects only colon
- Continuous from Rectum
- Crohn's Disease
- Mouth to anus potentially affected
- Discontinuous, "Skip" lesions
- Ulcerative Colitis
-
Bowel Tissue affected
- Ulcerative Colitis: Mucosal disease (no Granuloma)
- Crohn's Disease: Transmural disease (Granulomas)
VII. Labs: Stool Studies
-
Fecal Calprotectin
- Newer test with high Test Sensitivity and Test Specificity for Inflammatory Bowel Disease
- Fecal Calprotectin <40 mcg/g and CRP <0.5 reduce Inflammatory Bowel Disease likelihood to<1%
- General Stool studies
- Additional Stool studies
- Yersinia enterocolitica culture
- Toxigenic Escherichia coli isolation
- Entamoeba histolytica serologic titers
VIII. Labs: Immunocompromised Patient Evaluation
IX. Labs: Underlying Nutrition and Disease Severity
-
C-Reactive Protein or Erythrocyte Sedimentation Rate
- Correlates with severity
- Serum Protein level
- Hemoglobin
X. Differential Diagnosis: Distinguishing Crohn's Disease from Ulcerative Colitis
- Location
- Crohn's Disease can involve any area of Gastrointestinal Tract
- Ulcerative Colitis is typically limited to colon, and has onset at the Rectum
- Thickness
- Crohn's Disease involves the entire bowel wall
- Ulcerative Colitis is limited to the mucosa and submucosa
-
Colonoscopy
- Crohn's Disease demonstrates skip lesions, cobblestoning, ulcerations and strictures
- Ulcerative Colitis demonstrates pseudopolyps, continuous areas of inflammation
- Other discriminating factors
- Anemia is more common in Ulcerative Colitis
- Abdominal Pain is more common in Crohn's Disease
- Rectal Bleeding is more common in Ulcerative Colitis
- Colon Cancer is much more common in Ulcerative Colitis
XI. Diagnosis
- Colonoscopy with mucosal biopsy
XII. Imaging
- CT Abdomen and Pelvis (or MRI Abdomen)
- Abdominal XRay findings (if done for other reasons)
- Perforation signs (i.e. Free air in peritoneum)
- Toxic Megacolon
- Thumb-printing
- Pattern of multiple locations where bowel wall appears indented (as if by a thumbs)
XIII. Resources
- Crohn's and Colitis Foundation of America
- Cedars-Sinai Inflammatory Bowel Disease Center
Images: Related links to external sites (from Bing)
Related Studies
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 |
Russian | KISHECHNIKA VOSPALITEL'NYE BOLEZNI, КИШЕЧНИКА ВОСПАЛИТЕЛЬНЫЕ БОЛЕЗНИ |
Croatian | UPALNE BOLESTI CRIJEVA |
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 |