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- Idiopathic inflammatory disease of the colonic mucosa that can affect any section of the colon from the rectum to the cecum
- >95% of patients have rectal involvement, with 50% of cases limited to rectum and sigmoid.
- 20% have pancolitis.
- US: 9–12 new cases/100,000 persons/year
- Predominant age: 15–35 years; 2nd and smaller peak in the 7th decade
- Predominant sex: Female > Male (slight)
- Similar to general population; 1 study showed 30% with inactive disease at onset of pregnancy relapsed.
- Treatment with sulfasalazine does not seem to affect pregnancy outcome.
- Patients should delay pregnancy until disease is inactive.
- Better sanitation, indoor work environments, and fatty foods increase risk.
- NSAIDs can activate disease.
- Appendectomy is protective against later development of disease.
- Negative association with smoking: Relative risk of smokers is 40% of nonsmokers.
- Family history in 5–10% in population surveys and 20–30% in referral-based studies
- More common in the Jewish population
- Patients with long-term disease who do not have colectomy are at increased risk for colon cancer.
- Aspirin (≥300 mg/d) and ursodeoxycholic acid (10 mg/kg) have been shown to be preventive.
Breastfeeding may be protective for pediatric inflammatory bowel disease (IBD).
Unknown; hypotheses include allergy to dietary components and abnormal immune responses to bacterial or “self” antigens; final outcome is mucosal inflammation secondary to immune cell infiltration.
Commonly Associated Conditions
- Extracolonic manifestations in 10–15%
- Arthritic conditions, including large joint arthritis, sacroiliitis, and ankylosing spondylitis
- Pyoderma gangrenosum
- Episcleritis and uveitis
- Sclerosing cholangitis
- Asymptomatic fatty liver (common); occasional hepatomegaly
- Primary sclerosing cholangitis: 1–4%
- Cirrhosis of liver: 1–5%
- Bile duct carcinoma
- Thromboembolic disease: 1–6%