Summary
Definition
History and exam
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
- human leukocyte antigen-B27
- infection
- use of non-steroidal anti-inflammatory drugs (NSAIDs)
- not smoking or former smoker
Diagnostic investigations
1st investigations to order
- stool studies for infective pathogens
- faecal calprotectin (FC)
- FBC
- comprehensive metabolic panel (including LFTs)
- erythrocyte sedimentation rate (ESR)
- CRP
- plain abdominal radiograph
- flexible sigmoidoscopy
- colonoscopy
- biopsies
Treatment algorithm
Contributors
Authors
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.
Sailish Honap,
Consultant Gastroenterologist
Department of Gastroenterology
St George’s Hospital
London
UK
Disclosures
SH has received honoraria from Pfizer (speaker, consultant, advisory board member, and received travel grants), Janssen (speaker fees, travel grants), AbbVie (speaker fees, consultant, travel grants), Takeda (speaker fees), Ferring (travel grants), Pharmacosmos (travel grants), Galapagos (travel grants).
Kamal Patel,
Disclosures
all disclosures
Aaron Bhakta, BMedSci (Hons), BMBS, MSc, MRCP
Clinical Fellow in Gastroenterology
Department of Gastroenterology
St George’s Hospital
London
UK
Disclosures
AB declares that he has no competing interests.
Acknowledgements
Dr Hesam A. Nooredinvand, and Dr Andrew Poullis would like to gratefully acknowledge Dr Ben Shandro, Dr Anet Soubieres, Dr Rhys Hewett, Dr Willem J.S. de Villiers, and Dr Houssam Mardini, previous contributors to this topic.
Disclosures
BS, 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.
References
Key articles
World Gastroenterology Organisation. Global guidelines: inflammatory bowel disease. Aug 2015 [internet publication].Full text
Rubin DT, Ananthakrishnan AN, Siegel CA, et al. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019 Mar;114(3):384-413. Abstract
Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020 Apr;158(5):1450-61.Full text Abstract
Harbord M, Eliakim R, Bettenworth D, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis. 2017 Jul 1;11(7):769-84.Full text Abstract
National Institute for Health and Care Excellence (UK). Ulcerative colitis: management. May 2019 [internet publication].Full text
National Institute for Health and Care Excellence. Colorectal cancer prevention: colonoscopic surveillance in adults with ulcerative colitis, Crohn's disease or adenomas. Sep 2022 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available here.
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