The Clinical Presentation and Progress of Inflammatory Bowel Disease

Abstract

rectal bleed~ng but without diarrhoea, these are mostly patients with proctitis. Full e~amination, sigmoidoscopy and biopsy and barium enema w~n be required. Patients with anal lesions, a normal reotum or localised les/ions with ukeI'3!tion are classified as likely to have Orohn's disease. Those with n'O anal lesion, a diffusely granular rectum and either a normal or diffusely abnOl'mal sigmoid or colon on barium enema are called idiopathic proctocolitis. 'rhe problem that must be emphasised is that this second group cannot be definitely diagnosed without rectal biopsy and follow up. The presence of a single gmnuloma is enough to change the diagnosis to Crohn's disease, follow up may also change the diagnosis and occ~siona11y examination of a coJectomy spedimen may alter the diagnosi,s. Hence the need for rectal biopsy at every stage of the disease. 2. "Classical" Crohn's disease. A truogy of abdominal pain, diarrhaea and weight lass is narmally present. If the patient has an abdominal mass and an anal lesian the diagnasis can be made with some canfidence. Sa the recognition 'Of anal lesions is all important, particuIarly as many are surprisingly pain-free sa that the patient describes them as piles or is unaW3!re 'Of their presence. Crohn's anal lesians 3!re either a fissure 'Or a fistula, ocoasianalJy a diffuse inflammation and oedema of the anus is the sole finding. The lesions have a char­ acter;istic cyanotic calaur but as with the rectal findings shauld always be can­ firmed by histalagy if the diagnasis has nQ!t been made. Intestinal disease is a11ten acoampanied by ('Or may ocoasional1y present with) malabsarptian, chranic obstruction, interna,l and external fistulae and protein losing enteropathy. A discussion 'Of all these camplications is beyond the scope of this presentatian. 3. Duodenal Crohn's disease. It is naw well recagnised that Cmhn's disease may be a widespread abnormality in the small and large intestine even though the obvious manifestations are local. Duodenal Orohn's disease is yet another lacal lesion. this may present with dyspepsia and radiolagical and endoscopic abnormal,ities and is sometimes misdiagnosed as duodenal ulcer. Hawever systemic illness and anaemia should alert the clinioian. Furthermore the endosoopic appear­ ance may be more diffuse than simple uloeration with a oobblestane mucosal ~l,ange and multiple ulcers.