Crohns Colitis 360. 2024 Apr 11;6(2):otae022. doi: 10.1093/crocol/otae022.eCollection 2024 Apr.

Hannah W Fiske ¹, Christopher Ward ², Samir A Shah ³, Stefan D Holubar ⁴, Badr Al-Bawardy ^5 6, Edward L Barnes ⁷, David Binion ⁸, Matthew Bohm ⁹, Myron Brand ⁵, Kofi Clarke ¹⁰, Benjamin L Cohen ¹¹, Raymond K Cross ¹², Jeffrey Dueker ⁸, Michael Engels ¹³, Francis A Farraye ¹⁴, Sean Fine ¹⁵, Erin Forster ¹⁶, Jill Gaidos ⁵, Philip Ginsburg ⁵, Alka Goyal ¹⁷, John Hanson ¹⁸, Hans Herfath ⁷, Tracy Hull ⁴, Colleen R Kelly ¹⁹, Mark Lazarev ²⁰, L Campbell Levy ²¹, Joanna Melia ²⁰, Jessica Philpott ¹¹, Taha Qazi ¹¹, Corey A Siegel ²¹, Andrew Watson ²², Steven D Wexner ²³, Emmanuelle D Williams ¹⁰, Miguel Regueiro ¹¹

Author information

¹Department of Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.

²Division of Gastroenterology, Lahey Hospital and Medical Center, Burlington, MA, USA.

³Gastroenterology Associates Inc., The Warren Alpert Medical School of Brown University, Providence, RI, USA.

⁴Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA.

⁵Division of Gastroenterology, Yale School of Medicine, New Haven, CT, USA.

⁶Division of Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

⁷Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.

⁸Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

⁹Division of Gastroenterology, Indiana University School of Medicine, Carmel, IN, USA.

¹⁰Division of Gastroenterology, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA.

¹¹Department of Gastroenterology, Hepatology, & Nutrition, Cleveland Clinic, Cleveland, OH, USA.

¹²Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.

¹³Division of Gastroenterology, Lehigh Valley Health Network, Allentown, PA, USA.

¹⁴Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.

¹⁵Division of Gastroenterology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.

¹⁶Division of Gastroenterology, Medical University of South Carolina, Charleston, SC, USA.

¹⁷Department of Pediatric Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA.

¹⁸Division of Gastroenterology and Hepatology, Atrium Health, Charlotte, NC, USA.

¹⁹Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA.

²⁰Division of Gastroenterology, Johns Hopkins Medical Center, Baltimore, MD, USA.

²¹Center for Digestive Health, Section of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

²²Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

²³Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.

Abstract

Background: 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.

Methods: 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.

Results: 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 (n = 8) or vasculitis (n = 7). The evaluations that ultimately resulted in correct diagnosis included additional endoscopic biopsies (n = 13, 21%), surgical exploration/pathology (n= 10, 16.5%), biopsies from outside the GI tract (n = 10, 16.5%), genetic/laboratory testing (n = 8, 13%), extensive review of patient history (n = 8, 13%), imaging (n = 5, 8%), balloon enteroscopy (n= 5, 8%), and capsule endoscopy (n = 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.

Conclusions: 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.