Inflammatory bowel disease: Ulcerative Colitis (UC) vs. Crohn’s disease
Ulcerative colitis Crohn’s disease
Age 30’s, F > M Age 20’s, F > M
Epidemiolog
Aetiology Concordance 10%, smoking protective, Th2-mediated Aetiology Concordance 70%, smoking increases risk
y
Th1/Th17 mediated
Rectum +/-colon +/- backwash Mouth anus
ileus Especially terminal ileum
Location Location
Never spreads beyond ileo-
Macroscopic
caecal valve Macroscopic
Distribution Continuous Distribution Skip lesions
Strictures No Yes
Strictures
Pathology Inflammation Mucosal- crypt abscesses
Shallow, broad Inflammation Transmural
Ulceration
Ulceration Deep thin ‘cobblestone’ mucosa
Microscopic Fibrosis None Fibrosis Marked
Microscopic
Granulomas None Granulomas Present
Pseudopolyps Marked Pseudopolyps Minimal
Fistulae No Fistulae Yes
Fever, anorexia, weight loss in Fever, anorexia, weight loss in active
Systemic Systemic
active disease disease
Diarrhoea (bloody), blood +/- Diarrhoea (usually non-bloody),
Abdominal mucus PR, abdominal discomfort Abdominal abdominal pain (Mass in RIF), weight
(LIF), tenesmus, faecal urgency loss
Symptoms Skin clubbing, erythema Symptoms Joints arthritis, sacroilitis, ankylosing
Presentation nodosum, pyoderma spondylitis
gangrenosum Hepatobiliary primary sclerosing
Extra-abdominal Extra-abdominal
Eyes iritis, Episcleritis, cholangitis, gallstones, fatty liver
conjunctivitis Other oxalate renal stones,
amyloidosis
Fever, tender, distended abdomen Apthous ulcers, glossitis, abdominal tenderness, RIF mass,
Signs Signs
perianal abscess, fistulae, tags
Barium enema loss of haustra Small bowel enema high sensitivity @ terminal ileum
Radiology
Superficial ulcerations, ‘pseudopolyps’, ‘drainpipe colon’ ‘Kantor’s string’ sign
Mild < 4 stools /day only a small amount of blood Reduce/stop smoking
Moderate 4-6 stools/day, varying amount of blood, no systemic upset Inducing remission glucocorticoids (oral, topical, IV) 5-ASA drugs
Severe > 6 blood stools/day + systemic upset Isolated perianal disease: Metronidazole
Managemen
Induce remission rectal aminosalicylates/steroids oral aminosalicylates oral
t Maintaining remission Azathioprine/Mercaptopurine Methotrexate
prednisolone
Maintaining remission oral aminosalicylates e.g. Mesalazine
Azathioprine/Mercaptopurine
Ulcerative colitis Crohn’s disease
Age 30’s, F > M Age 20’s, F > M
Epidemiolog
Aetiology Concordance 10%, smoking protective, Th2-mediated Aetiology Concordance 70%, smoking increases risk
y
Th1/Th17 mediated
Rectum +/-colon +/- backwash Mouth anus
ileus Especially terminal ileum
Location Location
Never spreads beyond ileo-
Macroscopic
caecal valve Macroscopic
Distribution Continuous Distribution Skip lesions
Strictures No Yes
Strictures
Pathology Inflammation Mucosal- crypt abscesses
Shallow, broad Inflammation Transmural
Ulceration
Ulceration Deep thin ‘cobblestone’ mucosa
Microscopic Fibrosis None Fibrosis Marked
Microscopic
Granulomas None Granulomas Present
Pseudopolyps Marked Pseudopolyps Minimal
Fistulae No Fistulae Yes
Fever, anorexia, weight loss in Fever, anorexia, weight loss in active
Systemic Systemic
active disease disease
Diarrhoea (bloody), blood +/- Diarrhoea (usually non-bloody),
Abdominal mucus PR, abdominal discomfort Abdominal abdominal pain (Mass in RIF), weight
(LIF), tenesmus, faecal urgency loss
Symptoms Skin clubbing, erythema Symptoms Joints arthritis, sacroilitis, ankylosing
Presentation nodosum, pyoderma spondylitis
gangrenosum Hepatobiliary primary sclerosing
Extra-abdominal Extra-abdominal
Eyes iritis, Episcleritis, cholangitis, gallstones, fatty liver
conjunctivitis Other oxalate renal stones,
amyloidosis
Fever, tender, distended abdomen Apthous ulcers, glossitis, abdominal tenderness, RIF mass,
Signs Signs
perianal abscess, fistulae, tags
Barium enema loss of haustra Small bowel enema high sensitivity @ terminal ileum
Radiology
Superficial ulcerations, ‘pseudopolyps’, ‘drainpipe colon’ ‘Kantor’s string’ sign
Mild < 4 stools /day only a small amount of blood Reduce/stop smoking
Moderate 4-6 stools/day, varying amount of blood, no systemic upset Inducing remission glucocorticoids (oral, topical, IV) 5-ASA drugs
Severe > 6 blood stools/day + systemic upset Isolated perianal disease: Metronidazole
Managemen
Induce remission rectal aminosalicylates/steroids oral aminosalicylates oral
t Maintaining remission Azathioprine/Mercaptopurine Methotrexate
prednisolone
Maintaining remission oral aminosalicylates e.g. Mesalazine
Azathioprine/Mercaptopurine
