IBD Diagnosis and Evaluation
The diagnosis and evaluation of ulcerative colitis and Crohn’s disease is critically important to provide appropriate patient care. Familiarity with modes of clinical presentation allows the clinician to promptly select the most efficient combination of t
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Key Concepts • Familiarity with modes of clinical presentation of ulcerative colitis and Crohn’s disease allows the clinician to promptly select the most efficient combination of tests. • Knowledge of histologic findings of ulcerative colitis and Crohn’s disease facilitates discussion with other physicians of the care team and tailors specific medical and surgical therapies. • Serologic tests such as ASCA, pANCA, and fecal markers such as calprotectin are increasingly becoming utilized for diagnosis and treatment effectiveness monitoring. • High definition images, chromoendoscopy, confocal laser endomicroscopy, and double balloon enteroscopy add to the ability to diagnose and treat ulcerative colitis and Crohn’s. • Capsule endoscopy, computerized tomography and computerized tomography enterography, magnetic resonance imaging, and magnetic resonance enterography provide previously unimagined ability to visualize disease and are revolutionizing the care of the IBD patient.
The consideration of ulcerative colitis and Crohn’s disease together as inflammatory bowel diseases is beautifully described in a historical review in the Mt. Sinai Journal of Medicine, “Although clinical descriptions of diarrhea with or without blood go back thousands of years, clear distinctions between enteritis and ulcerative colitis were possible only in the nineteenth century.” [1] The term “ulcerative colitis” was mentioned in 1888 by Dr. Hale-White in his paper, “On simple ulcerative colitis and other rare incidental ulcers” [2]. As described by Dr. Lockhart Mummery in 1905, the introduction of the electric sigmoidoscope made it possible to make proper diagnosis of ulcerative colitis and distinguish it from infective dysentery, membranous mucous or catarrhal colitis, and nervous diarrhea [3]. The entity now known as Crohn’s disease has a politicized origin. Drs. Ginzburg and Oppenheimer “in conjunction with Dr. Burrill B. Crohn” presented a definitive paper, “Non-specific Granulomata of the Intestine,” on May 2, 1932, to the American Gastro-Enterological Association and the paper “Regional Ileitis: A Pathologic and Chronic Entity,” under the authorship of Crohn, Ginzburg, and Oppenheimer,” was published later that year [4].
Inflammatory Bowel Disease: Diagnosis and Evaluation
Ulcerative Colitis
Historical Context The purpose of this chapter is to describe modalities and points of information that will aid the surgeon in the diagnosis and evaluation of the inflammatory bowel diseases. Crohn’s disease and ulcerative colitis are collectively referred to as inflammatory bowel diseases. Inflammation plays a significant role in each entity. Though largely different in the distribution of disease and the manner in which inflammation affects the gastrointestinal tract, occasionally the diseases overlap both in behavior and in their responses to similar treatments.
The classic presentation of ulcerative colitis is the new passage of bloody diarrhea. The work-up must include a careful history. The importance of rapidity of onset, fecal consisten
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