Inflammatory bowel disease (summary)
Updates to Article Attributes
This is a basic article for medical students and other non-radiologists
Inflammatory bowel disease is a generic term used to describe diseases of the GI tract that have an inflammatory cause. Crohn disease (CD) and ulcerative colitis (UC) are the commonest causes of inflammatory bowel disease.
Reference article
This is a summary article; read more in our article on inflammatory bowel disease.
Summary
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epidemiology
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young adults
CD: 15-25 years, M=F
UC: 15-40 years, M>F
-
-
presentation
chronic diarrhoea (may be bloody)
abdominal pain
Crohns may present with extra-intestinal features
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pathophysiology
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CD: any part of the bowel may be affected
skip lesions, fistulation
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USUC: only the colon is affected
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-
investigation
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treatment
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disease-modifying drugs
steroids
immunomodulation, e.g. azathioprine,
cyclosporineciclosporin, methotrexatebiological agents, e.g. infliximab
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surgical treatment
strictures, fistulae, abscess, perforation
non-responding bowel disease, e.g. colectomy
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Role of imaging
Radiology can be useful for diagnosis and follow-up.
identify abnormal bowel
determine response to therapy
identify complications
Radiographic features
Ultrasound
Bowel ultrasound allows assessment of the whole bowel. It is a relatively simple technique but requires a practitioner who has appropriate experience. It requires patient preparation and cooperationco-operation and may take up to 30 minutes.
bowel wall thickening
loss of normal bowel wall architecture
increased vascularity
Ultrasound may also detect complications:
localised perforation
interloop abscess
fistulation
Ultrasound is used in the assessment of rectal disease (endorectal ultrasound) and of liver disease (abdominal ultrasound).
CT
CT with both IV and luminal contrast can be used to assess small and large bowel.
bowel wall thickening
ulceration
strictures
fistulae (CD)
abscess formation and perforation
MRI
MRI is particularly useful in Crohn disease:
assessment of small bowel disease
assessment of perianal fistulae
-<h6>This is a basic article for medical students and other non-radiologists</h6><p><strong>Inflammatory bowel disease</strong> is a generic term used to describe diseases of the GI tract that have an inflammatory cause. Crohn disease (CD) and ulcerative colitis (UC<a title="Ulcerative colitis (UC)" href="/articles/ulcerative-colitis">)</a> are the commonest causes of inflammatory bowel disease.</p><h4>Reference article</h4><p>This is a <a href="/articles/summary-article">summary article</a>; read more in our article on <a title="Inflammatory bowel disease" href="/articles/inflammatory-bowel-disease">inflammatory bowel disease</a>.</p><h4>Summary</h4><ul>- +<h6>This is a basic article for medical students and other non-radiologists</h6><p><strong>Inflammatory bowel disease</strong> is a generic term used to describe diseases of the GI tract that have an inflammatory cause. Crohn disease (CD) and ulcerative colitis (UC<a href="/articles/ulcerative-colitis" title="Ulcerative colitis (UC)">)</a> are the commonest causes of inflammatory bowel disease.</p><h4>Reference article</h4><p>This is a <a href="/articles/summary-article">summary article</a>; read more in our article on <a href="/articles/inflammatory-bowel-disease" title="Inflammatory bowel disease">inflammatory bowel disease</a>.</p><h4>Summary</h4><ul>
-<strong>epidemiology</strong><ul><li>young adults<ul>-<li>CD: 15-25 years, M=F</li>-<li>UC: 15-40 years, M>F</li>- +<p><strong>epidemiology</strong></p>
- +<ul><li>
- +<p>young adults</p>
- +<ul>
- +<li><p>CD: 15-25 years, M=F</p></li>
- +<li><p>UC: 15-40 years, M>F</p></li>
-<strong>presentation</strong><ul>-<li>chronic diarrhoea (may be bloody)</li>-<li>abdominal pain</li>-<li>Crohns may present with extra-intestinal features</li>- +<p><strong>presentation</strong></p>
- +<ul>
- +<li><p>chronic diarrhoea (may be bloody)</p></li>
- +<li><p>abdominal pain</p></li>
- +<li><p>Crohns may present with extra-intestinal features</p></li>
-<strong>pathophysiology</strong><ul>-<li>CD: any part of the bowel may be affected<ul><li>skip lesions, fistulation</li></ul>- +<p><strong>pathophysiology</strong></p>
- +<ul>
- +<li>
- +<p>CD: any part of the bowel may be affected</p>
- +<ul><li><p>skip lesions, fistulation</p></li></ul>
-<li>US: only the colon is affected</li>- +<li><p>UC: only the colon is affected</p></li>
-<strong>investigation</strong><ul>-<li>blood tests: raised inflammatory markers, e.g. <a title="CRP" href="/articles/c-reactive-protein-1">CRP</a>, <a title="ESR (pathology)" href="/articles/erythrocyte-sedimentation-rate">ESR</a>-</li>-<li>colonoscopy: visualise abnormal areas and allow biopsy</li>-<li>ultrasound: thickened bowel wall</li>-<li>CT: used in the acutely unwell patient to identify complications</li>-<li>MRI: assessment of small bowel or perianal fistula (Crohn)</li>- +<p><strong>investigation</strong></p>
- +<ul>
- +<li><p>blood tests: raised inflammatory markers, e.g. <a href="/articles/c-reactive-protein-1" title="CRP">CRP</a>, <a href="/articles/erythrocyte-sedimentation-rate" title="ESR (pathology)">ESR</a></p></li>
- +<li><p>colonoscopy: visualise abnormal areas and allow biopsy</p></li>
- +<li><p>ultrasound: thickened bowel wall</p></li>
- +<li><p>CT: used in the acutely unwell patient to identify complications</p></li>
- +<li><p>MRI: assessment of small bowel or perianal fistula (Crohn)</p></li>
-<strong>treatment</strong><ul>-<li>disease-modifying drugs<ul>-<li>steroids</li>-<li>immunomodulation, e.g. azathioprine, cyclosporine, methotrexate</li>-<li>biological agents, e.g. infliximab</li>- +<p><strong>treatment</strong></p>
- +<ul>
- +<li>
- +<p>disease-modifying drugs</p>
- +<ul>
- +<li><p>steroids</p></li>
- +<li><p>immunomodulation, e.g. azathioprine, ciclosporin, methotrexate</p></li>
- +<li><p>biological agents, e.g. infliximab</p></li>
-<li>surgical treatment<ul>-<li>strictures, fistulae, abscess, perforation</li>-<li>non-responding bowel disease, e.g. colectomy</li>- +<li>
- +<p>surgical treatment</p>
- +<ul>
- +<li><p>strictures, fistulae, abscess, perforation</p></li>
- +<li><p>non-responding bowel disease, e.g. colectomy</p></li>
-<li>identify abnormal bowel</li>-<li>determine response to therapy</li>-<li>identify complications</li>-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Bowel ultrasound allows assessment of the whole bowel. It is a relatively simple technique but requires a practitioner who has appropriate experience. It requires patient preparation and cooperation and may take up to 30 minutes.</p><ul>-<li>bowel wall thickening</li>-<li>loss of normal bowel wall architecture</li>-<li>increased vascularity</li>- +<li><p>identify abnormal bowel</p></li>
- +<li><p>determine response to therapy</p></li>
- +<li><p>identify complications</p></li>
- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Bowel ultrasound allows assessment of the whole bowel. It is a relatively simple technique but requires a practitioner who has appropriate experience. It requires patient preparation and co-operation and may take up to 30 minutes.</p><ul>
- +<li><p>bowel wall thickening</p></li>
- +<li><p>loss of normal bowel wall architecture</p></li>
- +<li><p>increased vascularity</p></li>
-<li>localised perforation</li>-<li>interloop abscess</li>-<li>fistulation</li>- +<li><p>localised perforation</p></li>
- +<li><p>interloop abscess</p></li>
- +<li><p>fistulation</p></li>
-<li>bowel wall thickening</li>-<li>ulceration</li>-<li>strictures</li>-<li>fistulae (CD)</li>-<li>abscess formation and perforation</li>- +<li><p>bowel wall thickening</p></li>
- +<li><p>ulceration</p></li>
- +<li><p>strictures</p></li>
- +<li><p>fistulae (CD)</p></li>
- +<li><p>abscess formation and perforation</p></li>
-<li>assessment of small bowel disease</li>-<li>assessment of perianal fistulae</li>- +<li><p>assessment of small bowel disease</p></li>
- +<li><p>assessment of perianal fistulae</p></li>
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