Diagnosis and management of inflammatory bowel disease.

The onset of ulcerative colitis is characterized by diarrhea and bleeding, while granulomatous ileocolitis may be similar or more obscure with abdominal pain, bowel obstruction, loss of weight, iritis, arthritis or hypoalbuminemia. The diagnosis in ulcerative colitis is made by sigmoidoscopy and barium enema, while small bowel follow through is necessary in ileocolitis. Ulcerative colitis is treated by adrenocorticosteroids as retention enemas when limited to the left colon, intravenous ACTH or steroids in severe pancolitis and oral steroids in others. Sulphasalazine is used in addition to steroids in acute cases and as maintenance to prevent exacerbations. Proctocolectomy is indicated in those with severe disease with complications not responding to steroids. The treatment of Crohn's disease is similar but complicated by small bowel involvement and recurrence after surgery.