inflammatory%20bowel%20disease
INFLAMMATORY BOWEL DISEASE
Inflammatory bowel disease consists of ulcerative colitis and Crohn's disease.
Ulcerative colitis is a diffuse mucosal inflammation limited to the colon while Crohn's disease is a patchy, transmural inflammation that occurs in any part of the gastrointestinal tract.
The ileum and colon are the most frequently affected sites.

Colorectal Cancer Surveillance

  • Patients with UC and CD have increased risk of colorectal cancer, but there is much more known data about the risk in UC than in CD
    • The risk for IBD is related to both the duration and extent of the disease, and to the degree of histologic inflammation over time
  • Patients with UC who have family history of colorectal cancer have a 5-fold risk of developing colorectal cancer
  • Pancolonic dye spraying with targeted biopsy of abnormal areas is recommended
  • If a dysplastic polyp is detected within an area of inflammation and can be removed, colectomy is not routinely recommended
  • Several major societies have different recommendations on optimal surveillance strategies for colon cancer in patients with IBD

Society

Ulcerative Colitis

Crohn’s Disease

American Gastroenterological Association
  • Surveillance colonoscopy after 8 years in pancolitis
  • Surveillance colonoscopy after 15 years in left-sided colitis
  • Repeat colonoscopy every 1-2 years
  • Same guideline for UC also applies to CD
American College of Gastroenterology
  • Yearly surveillance colonoscopy after 8-10 years in patients who are surgical candidates
  • Multiple biopsies at regular intervals
  • Repeat surveillance colonoscopy at a shorter interval for patients with indefinite dysplasia
  • No guideline for surveillance due to insufficient evidence
American Society for Gastrointestinal Endoscopy
  • Surveillance colonoscopy after 8 years in pancolitis
  • 4 biopsies every 10 cm from cecum to rectum. Any suspicious lesions or masses should be biopsied
  • Repeat colonoscopy every 1-3 years
  • Surveillance colonoscopy after 15 years for left-sided colitis
  • Surveillance is not warranted in ulcerative proctitis
  • Patients with longstanding Crohn colitis should be offered surveillance colonoscopy and biopsy for dysplasia but data to guide the surveillance/screening intervals as well as procedure for biopsies are limited
British Society of Gastroenterology
  • Surveillance colonoscopy should be performed during remission
  • Surveillance colonoscopy in all patients after 10 years of symptom onset
  • Surveillance colonoscopy every 5 years for patients at low risk, every 3 years for intermediate risk, every year for high risk
  • 2-4 random biopsies every 10 cm from entire colon if chemoendoscopy is not used. Any suspicious area should be biopsied
  • Surveillance flexible sigmoidoscopy of pouch/rectal mucosa every year for postcolectomy patients at high risk; if without risk factors every 5 years
  • Same guideline for UC also applies to CD

Monitoring

Patient Monitoring for Ulcerative Colitis
  • Assessment of body mass index (BMI) and nutritional status should occur at diagnosis
  • For children, monitor height and weight; for adults, monitor the weight
Hospitalized Patient Monitoring for Severe Ulcerative Colitis
  • Physical exam daily to evaluate abdominal tenderness and rebound tenderness
  • Stool chart to record number and character of bowel movements
  • Daily abdominal radiography if colonic dilatation is detected at presentation
  • Immediate surgical referral if there is evidence of toxic megacolon
  • Objective re-evaluation on the 3rd day of intensive treatment
    • Consideration of colectomy or treatment with IV Ciclosporin or Infliximab
Patient Monitoring for Crohn's Disease
  • Assessment of BMI and nutritional status should occur at diagnosis
  • For children, monitor height and weight in children; for adults, monitor the weight
  • Vit B12 status should be monitored especially if there is ileal resection

Prevention

Vaccination for Ulcerative Colitis
  • May consider administration of the following vaccines prior to therapy of immunosuppressants: Influenza, pneumococcal, tetanus, hepatitis B, and meningococcal
  • Once immunosuppressants are initiated, avoid vaccinations with live vaccines
Vaccinations for Crohn's Disease
  • May consider administration of the following vaccines prior to therapy of immunosuppressants: Influenza, pneumococcal and hepatitis B
  • Once immunosuppressants are initiated, avoid vaccinations with live vaccines
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
01 May 2014

New drug applications approved by US FDA as of 15-30 May which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.

28 Apr 2017
Silymarin does not appear to be significantly better than placebo in reducing disease activity by 30 percent or more in patients with nonalcoholic steatohepatitis (NASH), according to the results of a trial.
08 May 2017
Transabdominal bowel wall ultrasonography shows utility in monitoring disease activity in patients with active Crohn’s disease (CD), according to a study. The imaging technique is ideal for evaluating early transmural changes in disease activity, in response to medical treatment.