when to suspect

• peak incidence 20-40yo

• 10-20% have 1 or more other family member affected with IBD

• diarrhoea

  • most present wiht diarrhoea blood or mucous

  • may be solid if rectal disease only (UC)

• Other bowel symptoms

  • pain

  • urcency/incontinence

  • tenesmus

  • mouth ulcers

  • bowel stricture/obstruction

  • fistulae

  • abscness

• Non bowel

  • malaise

  • fever

  • weight loss

  • children with failure to thrive

associated

• Joint disease - arthritis, sacroilitis, ank spond

• Eye disease - conjunctivitis, episcleritis, uveitis

• skiin disease - erythema nodosum, pyodrema gangrenosum

• liver disease - autoimmune hepatitis, gall stones, sclerosing cholangitis

• urinary - stones, ureteric obstruction, fistulae

• other; aneamia, vte, osteoporosis, amyloidosis

DDx

• infectious diarrhoea

• diverticulitis

• coeliac disease

• IBS

• colon caner

Investigations

• CBC

• crp

• electrolytes

• lfts

• stool culture

• iga TTG

Urgent referral

• complciatiosn

  • infection

  • malabsorption

  • strictures

  • obstruction

  • abscesses

  • fistulae

  • bleeding

  • erforation

  • toxic megacolon

• consider acute referral

  • severe abdomina lpain = especially if associated with tenderness

  • severe diarrhoea (>8/day)

  • dramatic weight loss

  • fever or severe systemic illenss

Management

Aminosalicylates

• at risk of blood dyscrasia

• sulphasalazine, mesalazine

Corticosteroids

• reduce dose over 8wk once remission

• rapid withdrawal increase risk of relapse

• cortociosteroids not indicated for maintenance treatment in IBD

Immunosuppressives

• at risk of blood dyscrasia

• suppression of bone marrow

• methotrexate, azathioprine, cyclosporin, mercaptopurine

Anti-TNF

• generalised effect on immune system

• infection risk ins increased

• increase risk of lymphoma

  • Crohn’s disease associated increase risk

Crohn’s disease

5/100 000

• weight loss is characteristic

• physical exam may show perianal soreness or discoloration together with tendersnss in abdmoin

-

• elevated CRP/esr

• anaemia

• relapsing remitting

• more variable

• less favourable

• 4yr period

  • 1/4 remain in remission

  • 1/3 frequent flarea

  • 1/2 fluctuating between periods of remission and periods of flares

• one yr

  • 75% able to work

Ulcerative colitis

• replapsing remitting course

• 50% change of a flare in any year

• 10% may remain in remisison up to 25yrs

• one year 90% able to work

• extra - colonic

  • erythema nodosum

  • pyodrema gangrenosum

  • uveitis

  • scleritis

  • episcleritis

  • primary sclerosing cholangitis

    • high risk for development of cholangiocarcinoma (1 in 10)