Inflammatory bowel disease (IBD) consists of an umbrella of bowel disorders namely, ulcerative colitis, Crohn’s disease and intermediate colitis. IBD is often suspected to be due to heredity. Environmental influence is also not ruled out. Certain predisposing factors such as diet, oral contraceptives, hygiene, stress, smoking etc are also suspected to trigger IBD.
Clinical diagnosis is achieved through signs and symptoms of the patient. Physical findings of the inflammatory bowel disease (IBD) are:
- Pallor and weight loss of chronic disease is present.
- Tenderness on the affected colon may be revealed.
- High temperature is noted in acute condition.
- Abdominal tenderness, with distension is very characteristic of toxic mega-colon.
- Rectal examination may reveal perianal inflammation in the form of fissures, abscess or fistula, though these are much more common in Crohn’s disease.
- Examination of the skin, tongue, joints and eyes are important to exclude general complication of this disease.
Barium Enema For Ulcerative Colitis
- It should be given with caution particularly during acute exacerbation.
- Barium enema examination, usually with air contrast, can be performed safely in most cases and is extremely helpful in identifying the extent and severity of the disease.
- Barium enema finding in this disease are:
- Loss of haustration or inner lining of the intestine.This is an early finding and is thought to be due to paralysis of the mucosal muscles.
- Irregularities of colon wall represent small ulcerations. As the disease progresses, pseudo-polyps become a prominent finding.
- In advance cases the colon assumes the appearance of a rigid contracted tube due to the scar that forms with repair.
In all patients with ulcerative colitis, a barium view of the whole of the colon should be taken at a convenient time to exclude malignancy. As the incidence of malignancy is strikingly high especially after 10 years of the disease, it is appropriate to obtain a yearly barium examination and colonoscopy.
For Crohn’s Disease
- Barium enema X-ray will reveal partial obliteration of the haustration.
- Segmental involvement may be noticed with intervening normal segments. The involved portion shows rigid wall with stenosis of the lumen.
- Fissures may be seen.
- Nodules may be present due to edema and if separated by linear ulcers, ‘cobblestone’ appearance is produced on radiology.
Endoscopy With Biopsy
For Ulcerative Colitis
- Proctosigmoidoscopy (rectal and sigmoid colon examination through the endoscope) is a helpful and specific diagnostic aid, as ulcerative colitis involves rectum in 90 to 95% of cases.
- Mucosa of both the rectum and sigmoid colon is erythematous and granular. Superficial ulceration may be seen.
- The mucosa is friable and with more severe case, diffuse hemorrhagic inflammation is obvious with patches of exudates and macroscopic ulcers.
- The use of flexible sigmoidoscopy has improved diagnostic accuracy and patient’s acceptability.
- Colonoscopic examination is of value in determining the extent and activity of the disease. Colonoscopy is more helpful in diagnosing carcinoma in association with ulcerative colitis.
- These tumors are more evenly distributed throughout the colon with approximately 50% being found proximal to splenic flexure.
- The biopsy specimen may be taken with a surgical biopsy forceps or with suction type of instrument.
For Crohn’s Disease
- If sigmoidoscopy reveals a normal rectum, the diagnosis goes in favor of Crohn’s disease, as in 95% of cases rectum is early involved in ulcerative colitis.
- Endoscopy reveals the mucosa to be edematous and less granular with scattered ulcers. Patches of normal mucosa may be seen.
- Rectal palpation will reveal palpable lumpy thickening of the rectal wall with narrowing.