Ambulatory Report – Ulcerative Colitis Flare – 8.26.16

Thanks to Rachel Stern for presenting a case of a 27yo F with a history of ulcerative colitis p/w abdominal pain and bloody stools who underwent an exhaustive work up and ultimately diagnosed with an ulcerative colitis flare.
  • Per Dr. Cello, 15-20% of people diagnosed with UC or Crohn’s have a change in the diagnosis after biopsies are actually taken!  Here’s a quick review of general differences between the two:
    • UC Crohn's
  • Always take the time to review primary imaging with the radiologists
    • Of note, also per Dr. Cello, you can miss evidence of inflammation (ie. fat stranding) in very thin people on CT
  • So what’s the deal with UC and Cancer?  (great review from the NEJM)
    • IBD w/o colonic inflam & UC limited to the rectum are NOT @ inc risk of CRC
    • Colitis-associated dysplastic lesions are often flatter and have less distinct borders, and they can even be invisible when standard endoscopic techniques are used
    • Those w/ PSC assoc w/ IBD are at high risk for CRC
    • Crohn’s disease – the risk of small-bowel adenocarcinoma is 20 to 30 times higher
    • Other cancer assoc w/ IBD
      • Primary intestinal lymphoma – significantly higher risk in IBD, but low absolute incidence still
      • Cholangiocarcinoma – 2-4x higher risk than general population
      • Increased cancer risk in those exposed to thiopurines & TNF-a antagonists – Lymphoma, AML, non-melanoma skin cancer
    • Beaugerie – Cancers Complicating IBD – NEJM 2015

Evernote Link: https://www.evernote.com/l/ADWV7-o-2e9JDbdCS4ODdAzfE0jZXFpvj48

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