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Management of Inflammatory Bowel Disease

Dr Swapnil Pawar November 18, 2020 664

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    Management of Inflammatory Bowel Disease
    Dr Swapnil Pawar

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

– Erythema Nodosum
– Pyoderma Gangrenosum

– Episcleritis
– Scleritis
– Iritis
– Conjunctivits
– Uveitis

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

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

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

– Bronchiectasis
– Interstitial lung disease
– Bronchiolitis obliterans
– Sarcoidosis

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

– 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



Peppercorn, M.A., Kane, S.V. (2020). Clinical manifestations, diagnosis and prognosis of Crohn Disease in adults. UpToDate. Retrieved November 8, 2020, from

Peppercorn, M.A., Kane, S.V. (2020). Clinical manifestations, diagnosis and prognosis of ulcerative colitis in adults. UpToDate. Retrieved November 8, 2020, from


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