Inflammatory Bowel Disease
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- Idiopathic, chronic inflammatory diseases of intestines, which can involve extraintestinal sites as well.
- Differentiation between ulcerative colitis (UC) and Crohn's is not always clear; intermediate forms of inflammatory bowel disease (IBD) exist.
- May present as initial onset of disease or exacerbation of existing disease.
- Maintain high index of suspicion owing to frequent, subtle presentation of Crohn's disease.
- Pediatric considerations:
- Can occur in 1st few years of life.
- Extraintestinal manifestations may predominate.
- Differences between Crohn's and UC:
- Rectum almost always involved in UC with continuous inflammation proximally.
- Small intestine is not involved in UC.
- Crohn's can occur anywhere from mouth to anus, often with normal GI tract segments between affected areas.
- Crohn's involves transmural inflammation, whereas UC is confined to submucosa.
- Similarities between Crohn's and UC:
- Higher rate of colon cancer with disease >10 yr.
- Bimodal age distribution, with early peak between teens and early 30s and 2nd peak about age 60 yr.
- Crohn's disease clinical pattern:
- Ileocecal: ∼40%
- Small bowel: ∼30%
- Colon: ∼25%
- Other: ∼5%
- UC clinical pattern on presentation:
- Pancolitis: 30%:
- Most severe clinical course
- Pancolitis: 30%:
- Proctitis or proctosigmoiditis: 30%:
- Relatively mild clinical course
- Left-sided colitis (up to splenic flexure): 40%:
- Moderate clinical course
- Crohn's disease and UC are separate entities with common genetic predisposition.
- A positive family history is very common.
- Multifactorial origin involving interplay among the following factors:
- Gut wall becomes unable to downregulate its immune responses, ultimately resulting in chronic inflammation.
- There is no definitive evidence for the etiologic role of infectious agents.
- Psychogenic factors may play a role in some symptomatic exacerbations.