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A systematic search of the medical literature was performed on January 9, 2008. The databases used to conduct the search were PubMed, UpToDate®, SUMSearch, PIER, and the National Guideline Clearinghouse. The search was limited to human subjects and journals in the English language. The references of articles obtained through the search were reviewed for additional relevant materials. Medical position statements regarding inflammatory bowel disease are available at

Inflammatory bowel disease (IBD) is a gastrointestinal (GI) disorder that includes both ulcerative colitis (UC) and Crohn’s disease (CD). UC is characterized by diffused inflammation that is limited to the mucosa of the colon and rectum. CD describes a chronic inflammatory process that is manifested by focal, discontinuous, transmural lesions that may occur anywhere in GI tract from the mouth to the anus.

Patients with IBD are often embarrassed by the symptoms of the disease. The impact of the disease on social functioning and psychological health can be tremendous. Although some patients will experience an exacerbation that requires hospitalization, many will be treated in the community. Primary care providers will likely encounter patients with IBD, and should be prepared to meet the medical, psychological, and social needs of these patients.

IBD affects approximately 1 million individuals in the United States.1 The incidences of UC and CD in the United States are approximately 11 per 100000 and 7 per 100000 persons, respectively.2 The incidence of UC has remained stable over several years, whereas the incidence of CD appears to be increasing over the last few decades. UC and CD have a bimodal distribution, with peak incidence occurring in the mid-teens to early thirties and then a second peak in individuals who are 50 years or older. UC is more common among some ethnic groups than others, for instance, Ashkenazi Jews are at higher risk for developing UC whereas blacks and Asians are less likely to develop it. Additionally, IBD is more common in urban areas and is more prevalent in higher socioeconomic classes.2

Cigarette smoking has differential effects on UC and CD. For smokers, the risk for developing UC is 40% that of nonsmokers. In contrast, the risk for CD in smokers is twice that of nonsmokers. Interestingly, oral contraceptive use increases the relative risk for CD by 1.9 times.2

Like many other chronic illnesses, the clinical courses of UC and CD are characterized by disease relapse and remission. Health care providers should educate patients about the chronic nature of IBD. Symptoms are variable and often related to the extent of the disease.

Ulcerative Colitis

UC is classified as mild, moderate, or severe based on presenting symptoms (Table 12-1).3 The disease is further categorized based on the location of involvement in the colon and/or rectum (Fig. 12-1). The most common sites of involvement are the ...

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