Approach to a Suspected IBD Patient

Inflammatory bowel disease (IBD) is emerging in Asia but there are many challenges in making the diagnosis. There is no gold standard for the diagnosis of IBD, which is often made based on a combination of clinical, endoscopic, radiological, and histological features, none of which are specific for the condition. Although there are many non-infectious mimics such as Bechet’s, drug induced enterocolitis and lymphoma, the main dilemma is differentiating IBD from infection; namely Crohn’s disease (CD) from intestinal tuberculosis (ITB). However, a careful history/examination, targeted investigations, along with histopathology (as outlined in the lecture) should make it possible to make a definitive diagnosis of IBD in the majority of cases. In cases where the diagnosis is still unclear, empirical treatment based on the most likely diagnosis can be started but careful reassessment is essential.