From the Guidelines
Inflammatory Bowel Disease (IBD) typically presents with chronic diarrhea, abdominal pain, weight loss, and fatigue, and its management aims to achieve induction of remission, followed by maintenance therapy to prevent recurrent disease flares, as outlined in the WSES-AAST guidelines 1.
Key Features of IBD
- Crohn's disease can affect any part of the gastrointestinal tract and presents with transmural inflammation, skip lesions, and potential complications like strictures, fistulas, and abscesses.
- Ulcerative colitis primarily affects the colon and rectum with continuous mucosal inflammation.
- Patients may also experience extraintestinal manifestations including arthritis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis, and uveitis.
Diagnosis and Treatment
- Diagnosis requires a combination of clinical evaluation, laboratory tests (including inflammatory markers like CRP and fecal calprotectin), endoscopy with biopsies, and imaging studies such as CT or MRI enterography.
- Treatment depends on disease severity and type, ranging from 5-ASA compounds for mild ulcerative colitis to immunomodulators and biologics for moderate to severe disease, as recommended by the WSES-AAST guidelines 1.
- A stepwise approach to rule-out ongoing inflammatory activity should be followed in IBD patients with persistent GI symptoms, including measurement of fecal calprotectin, endoscopy with biopsy, and cross-sectional imaging, as suggested by the AGA clinical practice update 1.
Management and Monitoring
- Corticosteroids like prednisone are used for acute flares but not for maintenance therapy due to side effects.
- Surgical intervention may be necessary for complications or treatment-refractory disease.
- Regular monitoring of disease activity, medication side effects, and cancer surveillance is essential for optimal management, as emphasized in the WSES-AAST guidelines 1.
From the Research
IBD Presentation
- Inflammatory bowel disease (IBD) presentation is complex and requires a full understanding to ensure appropriate treatment 2.
- The initial presenting symptoms of patients with IBD can vary, with common symptoms including tiredness/fatigue, abdominal pain, passage of blood with bowel movements, and loose/watery bowel movements 3.
- The most common presenting symptoms in Crohn's disease (CD) are tiredness/fatigue and abdominal pain, while in ulcerative colitis (UC), the most common symptoms are passage of blood with bowel movements and loose/watery bowel movements 3.
Symptom Profiles
- Principal component analysis (PCA) has identified distinct symptom profiles in CD and UC patients, with four symptom components solution for both CD and UC 3.
- The symptom profiles can be used to classify patients by symptom phenotype at the time of diagnosis, which may help guide treatment decisions 3.
Treatment and Management
- Mesalamine is considered a first-line therapy for ulcerative colitis, with clinical trials confirming its efficacy and safety in patients with mild to moderate disease 4, 5.
- The goal of therapy is to induce and maintain remission, which can be achieved with conventional therapies such as mesalamine, steroids, azathioprine/mercaptopurine, cyclosporine, or infliximab 4, 5.
- Pharmacogenetics may play a role in the treatment of IBD, with variants in genes influencing the efficacy or toxicity of common drugs used in treatment 6.