Crohn disease and ulcerative colitis

Symptoms Crohn disease Ulcerative colitis

 Mediated by dysfunctional IL-23-
Pathophysiology  Mediated by Th2 cells
Th17 signaling

 Greatly increased 
 Increased 
Frequency/type  Bloody diarrhea with mucus
 Typically nonbloody, watery diarrhea
of defecation  Tenesmus
 May be bloody in more severe cases
 Urgency

 Mostly normal, but weight loss and malnutrition may occur in

Nutritional
 Poor or malnourished severe disease 
status
 [18]

 Painful defecation, pain located in LLQ
 Mostly constant pain in RLQ 
Physical  Abdominal cramps and tenderness
 Palpable abdominal mass
examination  Tachycardia
 Low-grade fever
 Orthostatic hypotension

 Nephrolithiasis (e.g., calcium oxalate)

 Primary sclerosing cholangitis
 Cholelithiasis

 Skin
o Pyoderma gangrenosum
o Erythema nodosum
Extraintestinal
 Eyes
manifestations
o Uveitis
o Episcleritis
 Mouth: aphthous stomatitis
 Joints
o Peripheral arthritis
o Spondylitis
Crohn disease and ulcerative colitis

Symptoms Crohn disease Ulcerative colitis

 Common (to skin, bladder, or in between
loops)
Fistulas  Rare
 May cause pneumaturia and/or recurrent
UTIs

 Abscess  Fulminant colitis

Other
 Strictures (obstructions)  Toxic megacolon
complications
 Perianal fissures  Perforation

 Increased due to underlying pathology

 Increased secondary to immunosuppression
Cancer risk
 Small intestine  Cholangiocarcinoma 
 Colon  Colorectal cancer 
 Non-Hodgkin lymphoma  [19]

Antibodies  ASCA  p-ANCA

Endoscopy and imaging

 Typical
location: terminal ileum and colon with rectal
Location  Colon (exception: backwash ileitis) 
sparing
 May affect the entire GI tract

Pattern
 Discontinuous (skip lesions)  Continuous
of inflammation

Typical  Cobblestone sign  Friable mucosa

diagnostic  Pinpoint lesions  Mucosal ulcerations can be deep or superficial
findings  Snail trails  Crypt abscesses
 Creeping fat  Loss of haustra (lead pipe sign)
Crohn disease and ulcerative colitis

Symptoms Crohn disease Ulcerative colitis

 String sign

 Transmural inflammation
 Noncaseating granulomas  Confined to mucosa and submucosa
 Giant cells  No granulomas
Histology
 Lymphoid aggregates

 Neutrophilic inflammation of the crypts

Treatment

 Corticosteroids
 Thiopurine analogs (azathioprine, 6-
mercaptopurine)
 5-aminosalicylic acid (e.g., mesalamine)
 Anti-p40 antibodies (e.g., ustekinumab)
 6-mercaptopurine
 Alpha 4 integrase inhibitors (e.g., natalizumab,
Medication  Calcineurin inhibitors (e.g., cyclosporine, tacrolimus)
vedolizumab)
 Possibly antibiotics outside of an acute
episode (e.g., ciprofloxacin, metronidazole)

 Biologics (e.g., infliximab, adalimumab)

 Noncurative surgery may become necessary

Surgery  Curative surgery possible (proctocolectomy)
to alleviate symptoms