ABSTRACT
The management of ulcerative colitis and Crohn’s disease is quintessentially that of shared care. Patients are often young (two-thirds present aged less than 40 years) and there are frequently implications for employment and insurance as a result. Patients are generally well when in remission, but have unpredictable relapses of embarrassing and disabling symptoms. These relapses can be rapidly alleviated by prompt treatment and the risk of serious complications can be reduced by continuity of care. Despite similarities in the initial treatment of ulcerative colitis and Crohn’s disease, subsequent management may differ radically, especially with respect to surgery. Every attempt should therefore be made to obtain a specific diagnosis by considering the symptoms, and the endoscopic, histological and radiological features of each patient. The principal diagnostic differences are summarized in Table 7.1. In the 10% of patients in whom the conditions cannot be distinguished, the term ‘indeterminate colitis’ (having features of both) is better than an indiscriminate label of inflammatory bowel disease.
