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