Last reviewed: 25 Jun 2021
Last updated: 27 Apr 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • rectal bleeding
  • diarrhoea
  • blood in stool

Other diagnostic factors

  • abdominal pain
  • arthritis and spondylitis
  • malnutrition
  • abdominal tenderness
  • fever
  • weight loss
  • constipation
  • skin rash
  • uveitis and episcleritis
  • pallor

Risk factors

  • family history of inflammatory bowel disease
  • HLA-B27
  • infection
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • not smoking or former smoker

Diagnostic investigations

1st investigations to order

  • stool studies for infective pathogens
  • faecal calprotectin
  • FBC
  • comprehensive metabolic panel (including LFTs)
  • erythrocyte sedimentation rate (ESR)
  • CRP
  • plain abdominal radiograph
  • flexible sigmoidoscopy
  • colonoscopy
  • biopsies

Treatment algorithm

Contributors

Authors

Ben Shandro, BMedSci, MBBS(Hons), MPH, MRCP

Research Fellow in Gastroenterology

St George's Hospital

London

UK

Disclosures

BS declares that he has no competing interests.

Hesam A. Nooredinvand, MBBS, MRCP, BSc (Hons)

Research Fellow in Gastroenterology

St George's Hospital

London

UK

Disclosures

HAN declares that he has no competing interests.

Andrew Poullis, BSc, MBBS, MD, FRCP

Consultant Gastroenterologist

Department of Gastroenterology

St George’s Hospital

London

UK

Disclosures

AP is an author of a reference cited in this topic.

Acknowledgements

Dr Ben Shandro, Dr Hesam A. Nooredinvand, and Dr Andrew Poullis would like to gratefully acknowledge Dr Anet Soubieres, Dr Rhys Hewett, Dr Willem J.S. de Villiers, and Dr Houssam Mardini, previous contributors to this topic.

Disclosures

AS, RH, WJSD, and HM declare that they have no competing interests.

Peer reviewers

Trevor Winter, MD, PhD

Associate Professor of Medicine

Division of Digestive Diseases and Nutrition

University of Kentucky

Lexington

KY

Disclosures

TW declares that he has no competing interests.

Sharon Stein, MD

Assistant Professor of Surgery

Division of Colon and Rectal Surgery

University Hospital Case Medical Center

Cleveland

OH

Disclosures

SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.

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