Non Idiopathic Inflammatory (IBD) colitis

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Diagnosing IBD colitis is a degree exclusion diagnosis of colitis causes.
As the treatment of IBD is more complex and the early initiation of treatment may change their natural course, it is important to identify the other colitis mimic IBD.
Reflection is more intense in certain clinical scenarios such as the elderly, young children, immunocompromised and if diagnosed IBD complicated by the presence of another – usually infectious – colitis.
As possible causes of colitis are many recommended diagnostic approach to adapt to each clinical scenario for the purpose of targeted use tests such as endoscopy and histology. It is therefore necessary clinical history to examine specific epidemiological characteristics (origin and travel), eating habits, medications and comorbidities.

First we must recognize the patient with colitis, as opposed to the disease of the small intestine showing diarrhea with small volume, tenesmus and especially blood admixture.

Common diagnostic problem is the differential diagnosis of IBD emerging infectious acute self-limited colitis. There are differences and overlap in clinical and endoscopic characteristics such as histological examination to be more useful.
Specifically suggested search chronicity indicative of IBD data on patient biopsies colitis: disordered architecture of the crypts and the stronger and deeper the presence of lymphocytes and plasma cells.
Interestingly finding granulomas advocacy for Crohn’s disease is rare and nonspecific. Repeat endoscopy and biopsy can help in doubts.

In infectious colitis causes find the usual suspects: viruses, bacteria, fungi and parasites. The colitis virus usually subside quickly and easily as there is no specific therapy rarely trouble. An exception is intestinal infestation CMV complicating the treatment of known IBD colitis.

The most common bacteria is Shigella, the Salmonella, the Campylobacter, Yersinia and the 0157 E.Coli. The Yersinia successfully mimics eileokoliki Crohn’s and 0157 E.Coli ischemic colitis. Increased in recent years the frequency and severity of infection by Clostridium Difficile with significant early diagnosis and treatment.

Mycobacterium tuberculosis can also cause confusion with eileokoliki disease Crohn’s. Differences in clinical and endoscopy turn to the right diagnostic research.

Fungi and parasites usually associated with immunosuppression and specific epidemiology. Suspicion of sexually transmitted colitis-orthitides usually enters the appropriate clinical context (HIV, anal intercourse). Search generally virion faeces (crops) or biopsy material is usually crucial.

Microscopic colitis (collagenous or lymphocytic) is not related to IBD. The diagnosed by histological examination macroscopically normal mucosa. Usually they are women who develop watery diarrhea. There is medication history (usually NSAIDs) and autoimmunity.

Colitis on disuse (diversion) is encountered in surgically isolated from the flow of fecal portions of the colon. No specific histological or endoscopic features. Restore to restore bowel continuity.

In elderly differential diagnostic problem posed by ischemic colitis, especially chronic forms thereof. often coexisting cardiovascular comorbidity and medication without mostly prominent vascular occlusion executives.

When diverticula exist will have to think and segmental colitis associated with diverticula. Usually do not concern the clinician or because typical endoscopic distribution (around sigmoid diverticulum, without affecting the rectum), or because of mild clinical picture.

There colitis associated with specific physical factors such as radiation therapy to the pelvis and medicines. In the category of colitis by drugs other than known from old (NSAIDs, 5-fluorouracil) are continuously added new example immunotherapies such as ipilimumab, which require awareness and vigilance.

Many systemic diseases, mainly vasculitis, affecting among others the digestive system. Because this can occur in the absence of systemic manifestations generated diagnostic problems with typical case of Crohn’s disease by mimicking or Behcet sarcoidosis.

At very young ages-children are gene specified diseases with IBD phenotype, but completely different therapeutic handling. All that originally required is clinical suspicion.

In recent years, constantly expanding the category of immunocompromised patients.

In recent years, constantly expanding the category of immunocompromised patients. They may develop IBD colitis, colitis from opportunistic infections and colitis of the treatments they receive.

Finally it should be noted the importance of the coexistence of other causes of colitis in patients with IBD. There for several reasons colonization of the intestine with infectious agents, with their prominent C Difficile and CMV. Many times it is difficult to see whether they are «innocent coexistence» or clinically significant disease that must be treated.

In conclusion, while IBD colitis now the most frequently diagnosed patient with colitis, there are others which can mimic them. As not all special features to handle a challenge for the clinical gastroenterologist. Prerequisites for the successful diagnosis and treatment of other colitis is their knowledge and good clinical judgment with judicious use of diagnostic technologies and partnerships, particularly with the pathologist.

 

SUGGESTED READING

  1. Louis E. When it is not inflammatory bowel disease: differential diagnosis. Current Opinion in Gastroenterology 2015, 31: 283-9
  2. Chachu K et al. How to diagnose and treat Inflammatory Bowel Disease Mimics in the refractory IBD patient who does not have IBD. Inflammatory Bowel Disease 2012, 22: 1262-1280
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