Elderly patients and inflammatory bowel disease

Table 2 Differential diagnosis of inflammatory bowel disease

Disease	Clinical characteristics	Additional features
Segmental colitis associated with diverticulosis	Diarrhoea with bleeding	Segmental peridiverticular distribution
	Abdominal pain	Rectum and proximal colon spared
Radiation colitis	Diarrhoea with bleeding and abdominal pain/cramps	Telangiectasia and fibrosis seen at histology
	Proctitis (urgency and tenesmus)
	Symptoms often weeks to years after abdominal or pelvic radiation
NSAID-induced colitis	Diarrhoea with recurrent abdominal pain	Lesions isolated
	Obstruction or perforation	Any part of intestine may be affected
	Iron deficiency anaemia	Diaphragm like small bowel strictures
		Exacerbate existing CD or UC
Ischaemic colitis	Sudden onset of abdominal pain	Segmental distribution of colitis
	Diarrhoea with bleeding	Typically sigmoid/left sided colitis
		Rectum spared and abrupt cut off with non-involved segment
Infective colitis	Diarrhoea with bleeding	Possible pseudomembranes with Clostridium difficile colitis
	Constitutional symptoms such as fever	Stool cultures usually diagnostic
		Rapid resolution with appropriate antibiotic therapy
Solitary rectal ulcer	Bleeding per rectum with straining	Mucosal thickening
		Crypt architectural distortion
		Collagen deposition and smooth muscle in lamina propria

NSAID: Nonsteroidal anti-inflammatory drug; CD: Crohn’s disease; UC: Ulcerative colitis.