High risk and low incidence diseases: Inflammatory bowel disease and its complications

Inflammatory bowel disease (IBD) and its complications can carry a high rate of morbidity and mortality.

This review highlights the pearls and pitfalls of IBD and its complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

IBD is a chronic, immune-mediated inflammatory disease of the gastrointestinal tract that includes Crohn's disease and ulcerative colitis. While IBD has a growing prevalence, it can be difficult to recognize in the ED setting due to variable presentations and overlap with other conditions. Clinicians must quickly identify patients at risk for complications such as perforation, abscess, obstruction, and toxic megacolon. Evaluation should focus on clinical severity, targeted laboratory testing, and selective imaging, while avoiding unnecessary studies in mild cases. Management includes early resuscitation, appropriate use of corticosteroids and antibiotics, and timely consultation with gastroenterology and surgery. Infectious causes, especially Clostridioides difficile, should be evaluated before corticosteroid initiation when feasible; however, in critically ill patients, corticosteroid therapy should not be delayed for stool testing alone and should be initiated with empiric antibiotics while awaiting results. Awareness of extraintestinal manifestations and thromboembolic risk is also important for comprehensive care.

An understanding of the complications of IBD can assist emergency clinicians in diagnosing and managing this potentially deadly disease.