Inflammatory bowel disease

Abstract Inflammatory bowel disease (IBD) is a group of chronic inflammatory disorders primarily affecting the gastrointestinal tract. Ulcerative colitis (UC) is a diffuse, continuous inflammatory condition limited to the colonic mucosa, whereas Crohn disease is a chronic, patchy transmural inflammatory disease that may affect one or more segments of the gastrointestinal tract from the mouth to the anus. The term indeterminate colitis, or IBD unclassified (IBD-U), has been used to describe chronic inflammation of the colon where there is diagnostic uncertainty between Crohn colitis and UC (approximately 10% of children). Approximately 25% of all cases of IBD present in children and young people, with 5% of children aged under 5 years at the time of diagnosis. Abdominal pain, weight loss, and (bloody) diarrhoea are amongst the presenting symptoms. Inflammation at other sites, including arthritis and uveitis, may also occur. Primary management is medical, with steroids, immunosuppressants, and elemental diet all playing a role. Where these fail or cause significant side effects, surgery may be necessary. In UC, total colectomy with staged J pouch reconstruction is the operation of choice. In Crohn disease, limited bowel-sparing resection is preferred where possible, as recurrent disease is common. Complications are not infrequent.