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Inflammatory Bowel Disease - Description
ICD-9
555, Regional Enteritis
556, Ulcerative Enterocolitis
Both conditions are coded with a fourth digit indicating primary location of inflammation. See Inflammatory Bowel Disease ICD9
(
76 KB)
for more detail about ICD9 coding for IBD.
Description
Inflammatory bowel disease (IBD) is a chronic, relapsing immune-mediated disorder of the digestive tract. IBD probably represents an inappropriate cellular inflammatory response to commensal bacteria in a genetically susceptible host, though a specific cause remains unknown. Symptoms vary with the portions of the digestive tract involved, but classically include chronic diarrhea that is sometimes bloody, abdominal pain, and weight loss. Symptoms vary by individual and over time, ranging from severe and requiring hospitalization for dehydration or blood loss to vague and indolent.The term IBD covers two related disease entities: ulcerative colitis (UC), in which inflammation affects only the large intestine, and Crohn’s disease (CD), where any portion of the digestive tract from mouth to anus can be affected. There are significant areas of clinical and pathophysiologic overlap between the two and around 15% of children with IBD do not fit readily into either and are labeled as “indeterminate colitis” or IBD-U (inflammatory bowel disease unclassified type).
Genetics
Inherited susceptibility clearly plays a role in IBD. Disease frequency in patients with an affected first-degree relative is as high as 15% and individuals who are homozygous for mutations in the CARD15/NOD2 gene carry a 40-fold increased risk of disease. Nevertheless, inheritance patterns are complex, there are multiple genetic foci implicated, and the majority of new cases present with no family history. [Barrett: 2008]Prognosis
While mortality in treated patients is generally low, morbidity is high. Inability to absorb adequate calories and nutrients leads to failure to thrive, growth retardation, abnormal sexual maturation, and sequelae of vitamin and micronutrient deficiencies. Chronic inflammation leads to anemia and, in CD, to abscess, stricture, and fistula formation. Both CD and UC carry an increased risk for colorectal cancers, particularly when disease has been present for many years. Significant school, sports, and other activity limitations occur with flares or with poorly controlled disease and the social stigma associated with fecal urgency or surgical ostomy can be extreme. Many children develop comorbid anxiety and depression. UC that is refractory to medical therapy can be managed by surgical removal of the colon. CD is lifelong and incurable, though relapses can be minimized with optimal medical and surgical management.Prevalence
IBD affects an estimated 440/100,000 people in the US with a bimodal age distribution, peaking around age 20 and again at age 60. The prevalence of IBD in people younger than 20 is around 70/100,000. [Kappelman: 2007] Nearly 25% of patients with IBD overall present before the age of 20. [Wong: 2008]Impact
Individuals with IBD have a substantially greater number of hospitalizations and ED visits than the typical population. [Kappelman: 2010]Pearls And Alerts
On Ongoing Assessment Page
Helpful Articles
PubMed search for recent articles on Inflammatory Bowel Disease
Ruemmele FM.
Pediatric inflammatory bowel diseases: coming of age.
Curr Opin Gastroenterol.
2010;26(4):332-6.
PubMed abstract
Inflammatory Bowel Disease Module Authors
| Author: | Mark Deneau MD, 1/2011 |
| Reviewing Author: | Stephen Guthery MS, MD, 1/2011 |
| Content Last Updated: | 1/2011 |
The authors listed above are responsible for the overall Inflammatory Bowel Disease Module. Authors contributing to individual pages in the module are listed on those pages.
Page Bibliography
Barrett JC, Hansoul S, Nicolae DL, et al.
Genome-wide association defines more than 30 distinct susceptibility loci for Crohn's disease.
Nat Genet.
2008;40(8):955-62.
PubMed abstract / Full Text
Kappelman MD, Porter CQ, Galanko JA, Rifas-Shiman SL, Ollendorf DA, Sandler RS, Finkelstein JA.
Utilization of healthcare resources by U.S. children and adults with inflammatory bowel disease.
Inflamm Bowel Dis.
2010;.
PubMed abstract
Kappelman MD, Rifas-Shiman SL, Kleinman K, Ollendorf D, Bousvaros A, Grand RJ, Finkelstein JA.
The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States.
Clin Gastroenterol Hepatol.
2007;5(12):1424-9.
PubMed abstract
Wong A, Bass D.
Laboratory evaluation of inflammatory bowel disease.
Curr Opin Pediatr.
2008;20(5):566-70.
PubMed abstract