Last reviewed:September 2019
Last updated:August  2019

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
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • infection
  • not smoking or former smoker

Diagnostic investigations

1st investigations to order

  • stool studies
  • FBC
  • comprehensive metabolic panel (including LFTs)
  • erythrocyte sedimentation rate (ESR)
  • CRP
  • plain abdominal radiograph
  • flexible sigmoidoscopy
  • colonoscopy
  • biopsies
Full details

Investigations to consider

  • serological markers: perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-Saccharomyces cerevisiae antibody (ASCA)
  • double-contrast barium enema
  • CT scan
  • radionuclide studies
Full details

Treatment algorithm

Contributors

Research Fellow in Gastroenterology

St George's Hospital

London

UK

Disclosures

BS declares that he has no competing interests.

Consultant Gastroenterologist

Department of Gastroenterology

St George’s Hospital

London

UK

Disclosures

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

Dr Ben Shandro 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.

Peer reviewersVIEW ALL

Associate Professor of Medicine

Division of Digestive Diseases and Nutrition

University of Kentucky

Lexington

KY

Disclosures

TW declares that he has no competing interests.

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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