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

AntibodyAntigenNon-IBD (%)CD (%)UC (%) ASCA Anti- Saccharomyces cerevisiae antibody 5% 55  65% 5% DNase Sensitive pANCA Histone H1, bacterial antigen? <5% 10  25%50  65% OmpCE. coli<5% 38  50% 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