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INTRODUCTION

Key Clinical Questions

  • image When should you suspect inflammatory bowel disease (IBD) as the cause of a newly admitted patient with abdominal pain and diarrhea?

  • image How do differences between ulcerative colitis (UC) and Crohn disease (CD) impact hospital management?

  • image What is the gastroenterologist’s approach to induce and maintain remission?

  • image What are the indications for surgical consultation?

  • image What should be the hospitalist’s approach while co-managing these patients?

  • image How can clinicians minimize adverse events related to IBD, its medications, and related surgeries?

Inflammatory bowel disease is a chronic inflammatory bowel condition that includes both ulcerative colitis (UC) and Crohn disease (CD). The underlying pathophysiology of disease remains unclear. The mainstay of therapy for both conditions is pharmacologic management. Ulcerative colitis is cured with surgical resection of the colon, while CD recurs even after surgical resection. This chapter will review the epidemiology of disease, diagnosis and workup of patients hospitalized with IBD, management of the hospitalized patient with IBD, and discharge planning.

EPIDEMIOLOGY

The peak age of onset of CD and UC is between 15 and 40 years old with a second possible peak between 50 and 80 years old. The disease is more common among Jewish ethnic groups, but is seen in other ethnic groups.

Only 10% to 25% of patients with IBD have a first degree relative with the disease. Genetic testing is not sufficient at this time to make a diagnosis or predict the likelihood of developing IBD.

Epidemiologic studies have identified multiple potential risk factors for developing IBD, including changes in the gut microbiome and/or disruption of the intestinal mucosa from gastrointestinal infections, antibiotics or medications such as nonsteroidal anti-inflammatory drugs. Other risk factors may include hormone replacement therapy and oral contraceptives. Tobacco usage is a risk factor for CD while protective against UC. Other factors that may be protective against IBD include increased physical activity, breast fed infants, and appendectomy (UC only).

UC

The overall incidence rate for UC in North America ranges from 2.2 to 19.2 cases per 100,000 person-years. In Europe the incidence rate varies with highs of 10 to 16.8 in Iceland, Denmark, United ­Kingdom, Netherlands, and Hungry, while ranging lower in ­Romania (0.97), Czech Republic (1.5), Estonia (1.7), and Poland (1.8). The overall incidence rates for Central and South America, Caribbean, Middle East, and Asia range from 0.74 to 6.02 cases per 100,000 patient years.

CD

Overall CD appears to have a higher incidence in industrialized countries and higher rates in the West compared to the East geographically. Crohn disease is more common in the North compared to the South in individual countries and in degrees latitude. In North America, it ranges from 6.3 to 13.4 cases per 100,000 person-years. In contrast, the incidence in Europe ranges from 0.1 in Poland to 10.1 in Denmark. Similar ranges are seen ...

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