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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
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
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