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Inflammatory Bowel Disease

Inflammatory Bowel Disease is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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
  • Proctitis or proctosigmoiditis: 30%:
    • Relatively mild clinical course
  • Left-sided colitis (up to splenic flexure): 40%:
    • Moderate clinical course

Etiology

  • Unknown
  • 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:
    • Genetic
    • Environmental
    • Immune
  • Pathogenesis:
    • 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.

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Citation

Rosen, Peter, et al., editors. "Inflammatory Bowel Disease." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307024/all/Inflammatory_Bowel_Disease.
Inflammatory Bowel Disease. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307024/all/Inflammatory_Bowel_Disease. Accessed April 26, 2019.
Inflammatory Bowel Disease. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307024/all/Inflammatory_Bowel_Disease
Inflammatory Bowel Disease [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307024/all/Inflammatory_Bowel_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Inflammatory Bowel Disease ID - 307024 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307024/all/Inflammatory_Bowel_Disease PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -