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Source: Hemstreet, BA. Inflammatory Bowel Disease. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th edition. http://accesspharmacy.com/content.aspx?aid=7978181. Accessed May 31, 2012.

  • Idiopathic inflammatory bowel disease (IBD) manifesting as transmural inflammation of gastrointestinal (GI) mucosa

  • Unknown, but major theories include combination of infectious, genetic, and immunologic causes (Table 1)

Table 1. Proposed Etiologies for Inflammatory Bowel Disease

  • Transmural inflammatory process most commonly seen in terminal ileum.
    • Colonic involvement in two-thirds of patients
      • 15–25% of patients have only colonic disease.
    • Discontinuous disease with normal bowel separating segments of diseased bowel
    • Comparison with ulcerative colitis (UC) in Table 2
  • Extensive bowel wall injury
  • Complications
    • May involve intestinal tract or organs unrelated to it.
      • Surgery may be required for small bowel stricture with subsequent obstruction.
      • Fistula formation common.
    • Systemic
      • Arthritis
      • Iritis
      • Skin lesions
      • Liver disease
    • Nutritional deficiencies
      • Weight loss
      • Iron deficiency anemia
      • Vitamin B12 deficiency
      • Folate deficiency
      • Hypoalbuminemia
      • Hypokalemia
      • Osteomalacia

Table 2. Comparison of Clinical and Pathologic Features of Crohn’s Disease and Ulcerative Colitis

  • Bimodal age distribution
    • Peak incidence in second or third decades with second peak between 60 and 80 years of age

  • Smoking associated with twofold increased frequency of CD
  • NSAIDs may trigger disease occurrence or flares
    • Use may be warranted in patients with arthritis symptoms if benefits outweigh risks

  • Highly variable
    • Single episode may not be followed by further episodes
    • May experience continuous, unremitting disease

Signs and Symptoms

  • Diarrhea
  • Abdominal pain
  • Perirectal or perianal lesion
  • Malaise and fever
  • Frequent bowel movements
  • Hematochezia
  • Fistula
  • Weight loss and malnutrition
  • Arthritis
  • Abdominal mass and tenderness

Laboratory Tests

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