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
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
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 ...