Inflammatory bowel disease

Question 1

Inflammatory bowel disease should be considered when?

Answer 1

A young person presents with:

bloody diarrhoea and mucus

colonic pain and fever

extra-abdominal manifestations such as:

• arthralgia
• low back pain (spondyloarthropathy)
• eye problems (iridocyclitis)

Question 2

Two important diseases are

Answer 2

ulcerative colitis

and

Crohn disease

Question 3

Incidence

Answer 3

have equal sex incidence

can occur at any age

onset peaks at 20–40 yrs

Question 4

The main symptom of

Answer 4

Ulcerative colitis is bloody diarrhoea

Crohn disease is colicky abdominal pain

Question 5

Management principles for both diseases

Answer 5

Treat under consultant supervision

Treatment of acute attacks depends on:

• severity of the attack and
• the extent of the disease:

–mild attacks: manage out of hospital

–severe attacks: hospital, to attend to fluid and electrolyte balance

Question 6

Pharmaceutical agents (the following can be considered):

Answer 6

–5-aminosalicylic acid derivatives (mainly UC)

• sulfasalazine (mainstay) 1–2 g (o) 2–4 times/d
• olsalazine; mesalazine

–corticosteroids

• oral
• parenteral
• topical (rectal foam, suppositories or enemas)

–immunosuppressive drugs e.g.

• azathioprine
• cyclosporin (acute UC)
• methotrexate and infliximab (Crohn)

Question 7

Surgical treatment:

Answer 7

reserve for complications only