Chronic relapsing-remitting GI inflammation: Crohn's (transmural, skip lesions, anywhere) or UC (continuous mucosal, colon).
Clinical features
- • UC: bloody diarrhoea, urgency, tenesmus
- • Crohn's: abdominal pain, diarrhoea, weight loss, perianal disease
- • Extra-intestinal: arthritis, uveitis, erythema nodosum, PSC
Investigations
- • FBC, CRP, ferritin, B12, folate, U&E, LFT
- • Faecal calprotectin
- • Stool culture + C. difficile
- • Colonoscopy + biopsy
- • MRI small bowel (Crohn's)
Management
- • UC mild: topical/oral 5-ASA
- • UC moderate-severe: oral steroid → biologics (anti-TNF, vedolizumab, ustekinumab, JAK)
- • Crohn's: induction steroids; maintenance thiopurines or biologics
- • Surgery for stricture, fistula, refractory disease
Complications
- • Toxic megacolon (UC)
- • Stricture, fistula, abscess (Crohn's)
- • Colorectal cancer (surveillance)
- • Malnutrition, osteoporosis
Clinical pearls
- • Faecal calprotectin distinguishes IBD from IBS
- • Severe UC: Truelove-Witts; rescue therapy day 3
Educational — verify locally.
