Chapter 163. Inflammatory Bowel Disease

1. What factors predispose to the development of IBD?

2. Which patients with IBD require hospital admission?

3. How can clinicians induce and maintain remission quickly and safely to prevent progression of disease and surgical intervention in hospitalized patients with inflammatory bowel disease (IBD)?

4. How can clinicians minimize adverse events related to IBD, its medications, and related surgery?

Significant heterogeneity in the geographic distribution of inflammatory bowel disease (IBD) exists, but a north-south gradient has been confirmed in multiple studies. Both conditions, ulcerative colitis (UC) and Crohn disease (CD), are more common in commercially insured and individuals of the upper middle class than those covered by Medicaid. A total of approximately 1.5 million Americans are affected by UC and CD. In adults, the prevalence of UC and CD was 238 and 201 per 100,000 people, respectively. The incidences for UC and CD range from 7.6–8.8 and 6.9–7.9 per 100,000 people, respectively. In developed countries, incidence rates have been increasing for CD, but are stable for UC. Further, in comparison to the general population, patients with IBD are more likely to visit the emergency room, be admitted for medical management of their disease, and be admitted for surgery during the first five years following diagnosis.

Presentation

UC and CD are chronically remitting inflammatory conditions. Both diseases are extremely variable in their presentation and course, and both have bimodal age distributions (average age of presentation 28 years with a second peak at age 50 years). The clinical presentation is more variable in CD due to the transmural nature of the condition, variability in the extent of inflammation, and extraintestinal manifestations of the disease.

Symptoms Common in UC and CD

Presentation of IBD varies considerably and can be subtle. The most common presentation for both diseases includes increase in stool frequency and decrease in consistency. The second most common presenting symptom is abdominal pain. In UC, this pain is cramping, located in the left lower quadrant, and improves with bowel movement, whereas in CD pain is felt in the right lower quadrant and worsens with food intake. The third most common symptom is weight loss, which is more prevalent in CD than UC, and the presenting symptom in 87% of patients with CD. Both CD and UC may exhibit extraintestinal manifestations as well (Table 163-1).

Up to one-third of patients with IBD suffer from extraintestinal manifestations that can be divided into three groups. Patients with either UC or CD involving the ...