Inflammatory bowel disease diagnosis

Advancement in autoimmune and inflammatory disease treatment and diagnosis represents a critical worldwide need ranking in importance only behind management of cardiovascular disease and cancer to the medical practitioner. The list of related diseases is long major classes include rheumatoid arthritis, asthma, diabetes type 1, multiple sclerosis, and inflammatory bowel disease. 

Mpofu C and Ireland A (2006) Inflammatory bowel disease - the disease and its diagnosis. Hospital Pharmacist 13 153-158. 

Bemklev T, Jalinsen J, Schulz T, Sauar J, Fygren I, Hemdksen M, Sti ay N, Kjellevold O, AAdland E, Vain M, Moun B (2005) Course of disease, drug treatment and health related quality of life in patients witli inflammatory bowel disease 5 years after initial diagnosis. Eui J Gastroentrol Hepatol 10 1037—1045. 

The causal connection between NSAIDs and large bowel inflammation needs to be confirmed by appropriate epidemiological studies. Many publications have associated NSAID and colonic inflammation (SEDA-10, 77) (SEDA-15, 95), but the differential diagnosis between colonic inflammation arising de novo and exacerbation of underlying inflammatory bowel disease can be difficult, and the role of NSAIDs in aggravating ulcerative colitis or Crohn s disease or other inflammatory bowel disease is controversial (SEDA-10, 76) (SEDA-15, 95). A case-control study showed no association between appendi-cectomy for acute appendicitis and the use of NSAIDs (SEDA-22, 111). 

Clinical Applications. Lipophilic Tc-exametazime has been shown to label leukocytes without affecting cell viability (Mortelmans et al. 1989 Peters et al. 1986 Roddie et al. 1988). HMPAO-labeled leukocytes have been used to locate site(s) of focal infection (e.g., abdominal abscess, abdominal sepsis) (Kelbaek et al. 1985) it is also indicated in conditions of fever of unknown origin, and in conditions not associated with infection such as inflammatory bowel disease (Arndt et al. 1993 Lantto et al. 1991). Labeled leukocytes have offered superior information when compared with bone scanning for the detection of osteomyelitis in children (Lantto et al. 1992). In a retrospective study in 116 patients with infection suspected to involve orthopedic implants, osteomyelitis, and septic arthritis, HMPAO-labeled leukocytes have been an effective tool in the diagnosis of chronic osteomyelitis and joint infection involving implants (sensitivity > 97%, specificity > 89%) (Devillers et al. 1995). 

The differential diagnosis includes appendicitis with an appendicular abscess, inflammatory bowel disease or leukaemic deposit (in which case the wall thickening is likely to be eccentric) (Alexander et al. 1988) (Fig. 6.14). 

Schwerk WB, Beckh K, Raith M (1992) A prospective evaluation of high resolution sonography in the diagnosis of inflammatory bowel disease. Eur J Gastroenterol Hepatol 4 173-182... 

Unfortunately, there are no specific US features of the intestinal walls that can be usefully employed in the differential diagnosis between UC and Crohn s disease or other inflammatory bowel diseases. However, the site and degree of bowel wall thickness and other features of the bowel wall may be helpful in differentiating between UC and CD (Table 8.2). Indeed, the diagnosis of Crohn s disease seems to be easier than... 

Pera A, Cammarota T, Comino E et al (1988) Ultrasonography in the detection of Crohn s disease and in the differential diagnosis of inflammatory bowel disease. Digestion 41 180-184... 

Lim JH, Ko YT, lee DH et al (1994b) Sonography of inflammatory bowel disease findings and diagnostic value in differential diagnosis. Am J Roentgenol 163343-347... 

Major clinical indication is represented by the evaluation of patients with suspected Inflammatory Bowel Disease (IBD), in particular in the diagnosis and follow-up of patients with Crohn s disease. MR of the small bowel allows an optimal evaluation of parietal inflammatory changes represented by wall thickening and contrast enhancement. 

Malignancy In a retrospective study of 123 inflammatory bowel disease patients treated with thiopurine therapy, cancer was identified in 51 patients (4.7%), including colorectal cancer (15 patients), melanoma (2 patients), nonmelanoma skin cancer (7 patients) and non-Hodgkin lymphoma (5 patients). A diagnosis of non-melanoma skin cancer was significantly associated with thiopurine exposiue (OR 5.0, 95% Cl 1.1-22.8). Six of seven non-melanoma skin cancers occurred in Caucasian patients, with a highly significant association with thiopurine use (OR 12.4,95% Cl 2.3-67.4) [79 ]. 

FIGURE 36-2. Recommendations for treating chronic diarrhea. Follow these steps (1) Perform a careful history and physical examination. (2) The possible causes of chronic diarrhea are many. These can be classified into intestinal infections (bacterial or protozoal), inflammatory disease (Crohn s disease or ulcerative colitis), malabsorption (lactose intolerance), secretory hormonal tumor (intestinal carcinoid tumor or VIPoma), drug (antacid), factitious (laxative abuse), or motility disturbance (diabetes mellitus, irritable bowel syndrome, or hyperthyroidism). (3) If the diagnosis is uncertain, selected appropriate diagnostic studies should be ordered. (4) Once diagnosed, treatment is planned for the underlying cause with symptomatic antidiarrheal therapy. (5) If no specific cause can be identified, symptomatic therapy is prescribed. 

Not every solid lesion in a postoperative patient means ovarian cancer recurrence. The combination of CA-125 and a baseline imaging study usually aids in the differential diagnosis. Postoperative hematomas, adhesions between bowel loops, or locahzed trapped fluid may mimic recurrent disease. Benign forms of diffuse peritoneal thickening such as a result of postoperative inflammatory complications or bacterial peritonitis cannot be differentiated from peritonitis carcinomatosa. Furthermore, chemical peritonitis following intraperitoneal chemotherapy also results in diffuse peritoneal thickening [32]. 

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