Inflammatory Bowel Disease


Inflammatory bowel disease is inflammation of all or part of the gastrointestinal tract. The majority of cases are caused by Crohn’s disease or Ulcerative colitis.





Young, pale, cachectic patient

TPN line may be visible

Finger clubbing

Skin signs – which include erythema nodosum, pyoderma gangrenosum (especially common around stoma site)



Abdominal scars – (laparotomy, previous stoma sites, healed enterocutaneous fistulae)

Abdominal masses e.g. RIF mass

Abdominal tenderness

Stoma – comment on contents and surrounding stoma skin

Bowel sounds


Signs related to immunosuppression e.g. steroids, ciclosporin, azathioprine


Extraintestinal signs:

Aphthous ulcers in the mouth

Enteropathic arthropathy

Conjunctivitis/episcleritis/anterior uveitis




Abdominal pain

PR bleeding and bloody stools

Weight loss


Malaise and lethargy



Genetic and environmental factors are thought to play a part in the development of IBD such as smoking and infections



Stool MC+S and C Diff toxin

FBC/U+E/LFT/inflammatory markers/albumin (marker of severity)

Abdominal imaging – AXR, CT abdo pelvis

Flexible sigmoidoscopy/colonoscopy with biopsy are recommended for a histological diagnosis

Other imaging techniques for IBD include barium follow through and capsule endoscopy



Crohns: – as per NICE 2012 guideline. Treatment is complex with new drugs being developed

Remission: Steroid either PO or IV

In younger people enteral nutrition can be used to induce remission if there are concerns regarding steroid use

Drugs such as azathioprine/mercaptopurine/methotrexate can be added in to help induce remission

Maintenance: azathioprine/mercaptopurine/methotrexate are the most common drugs used

Biologic agents including infliximab/adalimumab for ongoing active disease

Surgery should be considered in limited disease (such as distal ileum), refractory disease, life threatening acute flare

Nutritional support is very important

Patients are managed with MDT support including physicians, surgeons, specialist nurses, dieticians and psychologists


UC – as UC often causes more localised disease rectal treatments are frequently used such as mesalazine enemas

Oral Mesalazine is often the treatment of choice for induction of remission and maintenance therapy

Steroids PO/IV are also often used to induce remission

Other maintenance medications include azathioprine and mercaptopurine

IV ciclosporin can be used for severe refractory colitis but has a considerable side-effect profile and can be poorly tolerated

Surgery is a potentially curative treatment and should be considered for disease refractory to medical treatment, life-threatening acute flares or for treatment of complications such as colorectal carcinoma



Top tips:

To complete make sure you state you would like to assess for perianal disease. Also say you want to do a thorough search for any extra-intestinal complications as well as complications of treatment such as anaemia and infection.


Extra-intestinal complications include:

Arthropathy – this is often an asymmetrical oligoarthritis with a predilection for large joints or sacroiliac joints

Eye involvement including– conjunctivitis, anterior uveitis, episcleritis


Aphthous Ulcers

Skin changes such as – pyoderma gangrenosum and erythema nodosum

Primary Sclerosing Cholangitis is associated with UC

Cholangiocarcinoma – particularly associated with UC

Renal stones – particularly associated with Crohns



Written by Jo Corrado

Resources used to write this document are listed in the references section of this webpage