Fiske Hannah W, Ward Christopher, Shah Samir A, Holubar Stefan D, Al-Bawardy Badr, Barnes Edward L, Binion David, Bohm Matthew, Brand Myron, Clarke Kofi, Cohen Benjamin L, Cross Raymond K, Dueker Jeffrey, Engels Michael, Farraye Francis A, Fine Sean, Forster Erin, Gaidos Jill, Ginsburg Philip, Goyal Alka, Hanson John, Herfath Hans, Hull Tracy, Kelly Colleen R, Lazarev Mark, Levy L Campbell, Melia Joanna, Philpott Jessica, Qazi Taha, Siegel Corey A, Watson Andrew, Wexner Steven D, Williams Emmanuelle D, Regueiro Miguel
Department of Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Division of Gastroenterology, Lahey Hospital and Medical Center, Burlington, MA, USA.
Crohns Colitis 360. 2024 Apr 11;6(2):otae022. doi: 10.1093/crocol/otae022. eCollection 2024 Apr.
Since 2009, inflammatory bowel disease (IBD) specialists have utilized "IBD LIVE," a weekly live video conference with a global audience, to discuss the multidisciplinary management of their most challenging cases. While most cases presented were confirmed IBD, a substantial number were diseases that mimic IBD. We have categorized all IBD LIVE cases and identified "IBD-mimics" with consequent clinical management implications.
Cases have been recorded/archived since May 2018; we reviewed all 371 cases from May 2018-February 2023. IBD-mimics were analyzed/categorized according to their diagnostic and therapeutic workup.
Confirmed IBD cases made up 82.5% (306/371; 193 Crohn's disease, 107 ulcerative colitis, and 6 IBD-unclassified). Sixty-five (17.5%) cases were found to be mimics, most commonly medication-induced ( = 8) or vasculitis ( = 7). The evaluations that ultimately resulted in correct diagnosis included additional endoscopic biopsies ( = 13, 21%), surgical exploration/pathology ( = 10, 16.5%), biopsies from outside the GI tract ( = 10, 16.5%), genetic/laboratory testing ( = 8, 13%), extensive review of patient history ( = 8, 13%), imaging ( = 5, 8%), balloon enteroscopy ( = 5, 8%), and capsule endoscopy ( = 2, 3%). Twenty-five patients (25/65, 38%) were treated with biologics for presumed IBD, 5 of whom subsequently experienced adverse events requiring discontinuation of the biologic. Many patients were prescribed steroids, azathioprine, mercaptopurine, or methotrexate, and 3 were trialed on tofacitinib.
The diverse presentation of IBD and IBD-mimics necessitates periodic consideration of the differential diagnosis, and reassessment of treatment in presumed IBD patients without appropriate clinical response. The substantial differences and often conflicting treatment approaches to IBD versus IBD-mimics directly impact the quality and cost of patient care.
自2009年以来，炎症性肠病（IBD）专家利用“ IBD直播”这一面向全球观众的每周一次的视频直播会议，来讨论其最具挑战性病例的多学科管理。虽然大多数展示的病例为确诊的IBD，但有相当一部分是疑似IBD的疾病。我们对所有IBD直播病例进行了分类，并识别出“疑似IBD疾病”，从而得出临床管理的启示。
自2018年5月起病例已被记录/存档；我们回顾了2018年5月至2023年2月期间的所有371例病例。根据其诊断和治疗检查对疑似IBD疾病进行了分析/分类。
确诊的IBD病例占82.5%（306/371；193例克罗恩病、107例溃疡性结肠炎和6例未分类的IBD）。发现65例（17.5%）为疑似IBD疾病，最常见的是药物性（=8）或血管炎（=7）。最终导致正确诊断的评估包括额外的内镜活检（=13，21%）、手术探查/病理（=10，16.5%）、胃肠道外活检（=10，16.5%）、基因/实验室检测（=8，13%）、对患者病史的广泛回顾（=8，13%）、影像学检查（=5，8%）、气囊小肠镜检查（=5，8%）和胶囊内镜检查（=2，3%）。25例患者（25/65，38%）因疑似IBD接受了生物制剂治疗，其中5例随后出现不良事件，需要停用生物制剂。许多患者被处方使用类固醇、硫唑嘌呤、巯嘌呤或甲氨蝶呤，3例试用了托法替布。
IBD和疑似IBD疾病的多样表现需要定期考虑鉴别诊断，并对未出现适当临床反应的疑似IBD患者的治疗进行重新评估。IBD与疑似IBD疾病之间的巨大差异以及往往相互冲突的治疗方法直接影响患者护理的质量和成本。
