Advertisement

When Should I Suspect Undiagnosed Inflammatory Bowel Disease in the Acute Care Setting? How Should I Manage a Suspected New Diagnosis of Inflammatory Bowel Disease?

  • Ghady RahhalEmail author
  • Mark Levine
Chapter

Abstract

Abdominal pain is one of the most common chief complaints in patients presenting for acute care. While less than 1% of the population suffers from inflammatory bowel disease (IBD), providers must maintain a high level of clinical suspicion in undiagnosed patients presenting with abdominal pain, vomiting, and diarrhea. Crohn’s disease (CD) and ulcerative colitis (UC) may present with both intestinal and extraintestinal manifestations and often require multiple different diagnostic tests to confirm the diagnosis. In patients suspected to have undiagnosed IBD, clinicians should initially focus on hydration, electrolyte replacement, pain control, consideration of non-IBD-related causes of abdominal symptoms, and evaluation for acute complications of IBD, such as obstruction or perforation. If discharged, patients with a moderate to high risk of undiagnosed IBD should follow up with gastroenterology.

Keywords

Inflammatory bowel disease Ulcerative colitis Crohn’s disease Sulfasalazine Mesalamine 

References

  1. 1.
    Epidemiology of the IBD. Centers for disease control and prevention, centers for disease control and prevention, 31 Mar 2015. www.cdc.gov/ibd/ibd-epidemiology.htm.
  2. 2.
    Cioffi M, et al. Laboratory markers in ulcerative colitis: current insights and future advances. World J Gastrointest Pathophysiol. 2015;6(1):13.  https://doi.org/10.4291/wjgp.v6.i1.13.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Khor B, Gardet A, Xavier RJ. Genetics and pathogenesis of inflammatory bowel disease. Nature. 2011;474:307–17.CrossRefGoogle Scholar
  4. 4.
    Peyrin-Biroulet L, Panés J, Sandborn WJ, Vermeire S, Danese S, Feagan BG, et al. Defining disease severity in inflammatory bowel diseases: current and future directions. Clin Gastroenterol Hepatol. 2016;14(3):458–354.CrossRefGoogle Scholar
  5. 5.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55(6):749–53.  https://doi.org/10.1136/gut.2005.082909.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Gashin L, Villafuerte-Galvez J, Leffler DA, Obuch J, Cheifetz AS. Utility of CT in the emergency department in patients with ulcerative colitis. Inflamm Bowel Dis. 2015;21(4):793–800.CrossRefGoogle Scholar
  7. 7.
    Govani SM, Guentner AS, Waljee AK, Higgins PD. Risk stratification of emergency department patients with Crohn’s disease could reduce computed tomography use by nearly half. Clin Gastroenterol Hepatol. 2014;12(10):1702–7.CrossRefGoogle Scholar
  8. 8.
    Griffey RT, Fowler KJ, Theilen A, et al. Considerations in imaging among emergency department patients with inflammatory bowel disease. Ann Emerg Med. 2017;69(5):587–99.CrossRefGoogle Scholar
  9. 9.
    Srinath AI, Walter C, Newara MC, Szigethy EM. Pain management in patients with inflammatory bowel disease: insights for the clinician. Ther Adv Gastroenterol. 2012;5(5):339–57.CrossRefGoogle Scholar
  10. 10.
    Travis S, Stange E, Lémann M, Øresland T, Bemelman W, Chowers Y, et al. European evidence-based consensus on the management of ulcerative colitis: current management. J Crohns Colitis. 2008;2(1):24–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Washington University School of MedicineSt. LouisUSA

Personalised recommendations