Mimics of IBD Sunanda Kane MD MSPH Mayo Clinic Rochester.
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Transcript of Mimics of IBD Sunanda Kane MD MSPH Mayo Clinic Rochester.
Mimics of IBD
Sunanda Kane MD MSPH
Mayo Clinic Rochester
Mimics of IBD
• Discrimination based on:– Location– Symptoms (including EIM)– Endoscopic appearance– Radiographic appearance
sgi Diagnostic
Antibody Antigen Non-IBD (%) CD (%) UC (%)
ASCA
Anti-Saccharomyces cerevisiae antibody
5% 5565% 5%
DNase Sensitive pANCA
Histone H1, bacterial antigen?
<5% 1025% 5065%
OmpC E. coli <5% 3850% 2%
IBD-Specific Serologic Immune Markers
Mimics in Esophagus
• HSV infection
• HIV ulcers
• Pill esophagitis
Colonic Ulceration: Crohn’s?
Right sided Colonic Thickening: Crohn’s?
MRE of Woman with EN and Abdominal Pain
Normal!
Small Bowel Mimics
• TB, Yersinia
• Neoplasm
• Drugs- NSAIDs, SARBs
• Celiac
• Autoimmune enteritis NOS
• Meckel’s diverticulum
• Endometriosis
Colon Mimics
• Prep effect
• Normal colon
• Histo, CMV, C diff
• Neoplasm- Kaposi’s sarcoma, leukemia
• SRUS
• Drugs-ipilimumab
• SCAD
Either Location
• Radiation
• Neoplasm
• IBS
• Bechet’s
• Ischemia
Perianal Mimics
• Trauma: obstetric or GI surgery
• Infection: TB, LGV
• Ischemia
• Neoplasm
Small Bowel Obstruction in CD Patient
Patient with Crohn’s and Pain
Patient with Crohn’s and Continued Weight Loss
Mimics of IBD
• Consider alternative when high dose prednisone does not work
• Always think about infection, ischemia or neoplastic process
• Conditions can overlap, can have two entities at once