Inflammatory bowel disease

From IDWiki
Ulcerative colitis Crohn disease
Location Pancolitis (30%)
Proctosigmoiditis (50%)
Includes PSC (5%)
Terminal ileum (80%)
Ileocolonic (50%)
Isolated ileal (30%)
Isolated colonic (20%)
Distribution Continuous from rectum Skip lesions, often rectum-sparing
Histology Mucosal inflammation without granulomas Transmural inflammation, granulomas, cobblestone
Serology p-ANCA Anti-Saccharomyces cervisiae IgG
Complications Toxic megacolon
Colorectal cancer
Intraabdominal abscess, perforation, fistulae, strictures, perianal disease, obstruction, colorectal cancer

Extraintestinal Manifestations

Arthritis

Type 1: Pauciarticular

  • <5 joints
  • Large joints
  • Short duration
  • Correlates with disease activity

Type 2: Polyarticular

  • >5 joints
  • Small joints
  • Months to years
  • Independent of disease activity

Differential Diagnosis

  • Infectious mimics (see below)
  • Radiation colitis
  • Diversion colitis
  • Solitary rectal ulcer syndrome
  • Graft versus host disease
  • Diverticular colitis
  • Medication-induced colitis, including NSAIDs, retinoic acid, checkpoint inhibitors, mycophenolate, and gold
  • CVID

Colitis or Ileitis

Proctitis