Specific factors are unknown

There is a genetic tendency to develop IBD, and the incidence rate among first-degree relatives is significantly higher than that among ordinary people.

Antibiotic treatment is partially effective

Various factors cause activation of Th1, Th2 and Th17 inflammatory pathways and increased secretion of inflammatory factors.

Diarrhea and bloody and mucoid stools

stomach ache

Other symptoms

Mild and moderate patients only have mild tenderness in the left lower abdomen, while severe patients have obvious tenderness.

If you have abdominal muscle tension, rebound tenderness, weakened bowel sounds, etc., pay attention to complications such as toxic megacolon and intestinal perforation.

Pyoderma gangrenosum

Dactylitis

Erythema nodosum and arthritis

First hair

chronic relapsing type

active period

remission period

Proctitis, left-sided colitis (involving the colon distal to the splenic flexure), extensive colitis (involving the colon proximal to the splenic flexure or the entire colon)

Intestinal wall tone decreases, colonic peristalsis disappears, and intestinal contents and gas accumulate in large quantities, causing acute colon dilation, which is generally the most severe in the transverse colon.

Hypokalemia, barium enema, use of anticholinergic drugs or opioids

Symptoms of systemic poisoning, intestinal type, abdominal tenderness, disappearance of bowel sounds

Significant increase in blood white blood cell count

X-ray abdominal plain film showed enlargement of the colon and disappearance of the colon bag

Mucosal blood vessel texture is blurred, disordered or disappeared, congestion, edema, brittleness, bleeding and purulent secretions attached

Diffuse erosion and multiple ulcers in obvious lesions

Chronic lesions commonly include rough mucosa, fine granular shape, inflammatory polyps and bridge-like mucosa.

Those with typical clinical manifestations → suspected diagnosis, further examination

Those with clinical manifestations, colonoscopy or radiographic features → proposed diagnosis and further examination

Clinical manifestations Colonoscopy or radiographic features Biopsy or surgical features → clinical diagnosis

Exclude infectious, neoplastic, ischemic, radioactive drug-induced lesions, etc. → Confirm the diagnosis

clinical type

severity

Range of lesions

Disease stage

Extraintestinal manifestations and complications

Fecal pathogens ( ), which can be cured with antibiotics

Mainly invades the right colon, the mucosa between ulcers is mostly normal, fecal amoebic trophozoites or cysts ( ), serum amebic antibodies ( ), anti-amoebic treatment is effective

History of exposure to infectious water, often with hepatosplenomegaly, stool test for schistosomiasis eggs ( ), biopsy and antibodies

Palpation of the mass with digital rectal examination, colonoscopy and biopsy can confirm the diagnosis

Occult blood test was negative, fecal calprotectin concentration was normal, and colonoscopy showed no evidence of organic disease.

ASA is suitable for the treatment of mild to moderate UC, not for the treatment of CD

Glucocorticoids are suitable for induction and remission treatment of moderate to severe UC

Hormones cannot be used for maintenance treatment

Early optimization of treatment: biologics immunosuppressants

The role of nutritional therapy is only to improve malnutrition and prevent nutritional risks

Maintenance treatment during remission is necessary

Diet management and mental and psychological adjustment play an important role

For inducing and maintaining remission in mild to moderate UC, 5-aminosalicylic acid (5-ASA) preparations and sulfasalazine (SASP) are commonly used

It is the first choice treatment for moderate and severe patients who have poor response to 5-ASA, and is only used to induce remission in the active phase.

Maintenance treatment for patients with poor efficacy of 5-ASA maintenance therapy, recurrent symptoms, and hormone dependence

Those complicated by massive bleeding, intestinal perforation and toxic megacolon who are ineffective after active medical treatment

Complicated colon cancer

Those who have unsatisfactory medical treatment results, those who cannot tolerate severe drug side effects, or those who seriously affect the patient's quality of life

Most common. Mostly in the right lower abdomen or around the umbilicus, with intermittent attacks

Pasty, possibly bloody stool

Mostly located in the right lower abdomen and around the umbilicus

More common and specific manifestations

May be the first symptom, including perianal fistulas, abscesses, and anal fissures

Associated with intestinal inflammatory activity and secondary infection

Manifested as weight loss, anemia, hypoalbuminemia, vitamin deficiency, etc.

Non-stenotic non-penetrating type (B₁), stenotic type (B₂), penetrating type (B₃), accompanied by perianal lesions (P)

Terminal ileum (L₁) colon (L₂), ileocolon (L₃), upper gastrointestinal tract (L₄)

Active phase, remission phase, mild, moderate and severe

Elevated white blood cells, decreased hemoglobin, increased erythrocyte sedimentation rate, increased C-reactive protein, and decreased albumin

Positive red and white blood cell and occult blood tests

May have autoantibodies positive

Colonoscope

gastroscopy

Capsule endoscopy and enteroscopy

Endoscopic ultrasound

Ulcer characteristics

paving stone sign

Inflammatory polyps and mucosal bridges

segmental stenosis

Target sign/double halo sign

wood comb sign

The corresponding mesenteric fat density increases and blurs; mesenteric lymph node enlargement, etc.

Symptoms include rough intestinal mucosal folds, longitudinal ulcers or fissures, cobblestone sign, pseudopolyps, multiple stenosis or intestinal wall stiffness, formation of flaccid ducts, pseudodiverticulum-like expansion of the intestinal tube, etc., and the lesions are segmentally distributed.

More extraintestinal tuberculosis, more positive tuberculosis screening, less fistulas and perianal lesions, transverse superficial ulcers, caseous granulomas, experimental anti-tuberculosis treatment

Ulcers can be shallow or deep. In the later stages, ulcers are mostly deep and large, and the surrounding inflammatory reaction is mild.

Metastatic right lower abdominal pain is often present, with tenderness limited to McBurney's points. Routine blood tests reveal a more significant increase in white blood cell count.

Schistosomiasis, amoebic enteritis, other infectious enteritis, ischemic enteritis, radiation enteritis, rheumatic diseases involving the intestines, etc.

Inducing and maintaining remission, preventing complications, and improving quality of life

mucosal healing

Aminosalicylates: Not suitable for remission induction and maintenance treatment of CD

Glucocorticoids: suitable for inducing remission in IBD, not for maintaining remission treatment

Immunosuppressants: used in combination for the treatment of active CD and alone for the treatment of remission CD

Early optimization of treatment: biologics, immunosuppressants, enteral nutrition

Nutritional Therapy: Not Just Nutritional Value in CD

Maintenance treatment during remission is necessary

Dietary management and mental and psychological management are of great significance

Aminosalicylic acid preparations

hormone

immunosuppressant

antibacterial drugs

biologics

total enteral nutrition

5-ASA is only used for maintenance treatment of CD with mild symptoms and localized lesions.

Commonly used medicines

Intestinal obstruction, abdominal swelling, acute perforation, uncontrollable massive bleeding and cancer