Management of Inflammatory Bowel Disease

Written by – Dr Andrew Lam

Crohn’s Disease vs. Ulcerative Colitis

	Crohn’s	Ulcerative Colitis
Location	Anywhere in the GIT including the mouth, resulting in oral ulcers. Skip lesions possible	Only affects the large colon up to the ileocaecal valve (may involve distal ileum if backwash ileitis present). Progression is continuous, beginning in the rectum and moving retrograde.
Layer Involvement	Transmural inflammation affecting all layers	Only affects mucosa and submucosal layers
Clinical Presentation	More likely to present with mucousy diarrhea with crampy abdominal pain. Worsened by smoking	More likely to present with bloody diarrhea. Smoking is protective and helps prevent disease
Macroscopic Pathology	Pseudopolyps due to regenerating mucosa popping out of areas of ulceration	Cobblestone appearance due to the formation of linear ulcers with normal/inflamed tissue between forming “cobblestones”
Microscopic Pathology	Non-caseating granulomas. Goblet cells present with few crypt abscesses	Crypt abscesses with loss of mucin and loss of goblet cells

 

Extra-Intestinal Manifestations

Dermatological
– Erythema Nodosum
– Pyoderma Gangrenosum

Ocular
– Episcleritis
– Scleritis
– Iritis
– Conjunctivits
– Uveitis

Rheumtological
– Enteropathic Arthritis (Asymmetrical Oligo-arthritis)
– Ankylosing Spondylitis

Gastrointestinal
– Primary sclerosing cholangitis
– Autoimmune hepatitis
– Cholesterol stones (Decreased bile resorption resulting in precipitation of cholesterol)

Renal
– Renal calculi (uric acid and calcium oxalate stones from dehydration, steatorrhea and    diarrhea)
– Renal amyloidosis

Pulmonary
– Bronchiectasis
– Interstitial lung disease
– Bronchiolitis obliterans
– Sarcoidosis

Musculoskeletal
– Osteopenia/Osteoporosis (Can be secondary to steroid use or Calcium/Vit D deficiency)

Haematological
– Anaemia (Secondary to Folate/B12 deficiency, iron deficiency, anaemia of chronic disease)

 

Complications of Inflammatory Bowel Disease

• Malabsorption/Malnutrition

• Iron Deficiency

• Vitamin B Deficiency

• Vitamin D Deficiency

• Calcium Deficiency

• Fistulas

• Entero-enteric

• Entero-vesical

• Entero-uterine

• Enterocutaneous

• Abscess formation

• Toxic Megacolon

• Colonic Adenocarcinoma

• More common in UC than in Crohn’s

• Perforation 

• More common in Crohn’s disease given presence of transmural inflammation

 

References: 

Peppercorn, M.A., Kane, S.V. (2020). Clinical manifestations, diagnosis and prognosis of Crohn Disease in adults. UpToDate. Retrieved November 8, 2020, from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-diagnosis-and-prognosis-of-crohn-disease-in-adults

Peppercorn, M.A., Kane, S.V. (2020). Clinical manifestations, diagnosis and prognosis of ulcerative colitis in adults. UpToDate. Retrieved November 8, 2020, from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-diagnosis-and-prognosis-of-ulcerative-colitis-in-adults