VIDEO: Recognize IBD mimickers, but avoid ‘casting too large of a net’
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In this Healio video exclusive, Riha G. Bhatt, MD, highlights key takeaways from her presentation at NASPGHAN, where she described common mimickers of inflammatory bowel disease and how to streamline a differential to avoid misdiagnosis.
“As we all know, there is not a singular test for IBD but rather, a diagnosis of IBD is made on a constellation of symptoms, signs, battery of tests, including lab work, stool studies, imaging and endoscopy,” Bhatt, assistant professor of pediatric gastroenterology at Monroe Carell Jr. Children’s Hospital at Vanderbilt, said. “Even with all those tests, it may not be a clear diagnosis of IBD. There are a lot of diseases that can mimic chronic changes we see with IBD, and this may result in a misdiagnosis.”
According to Bhatt, providers should consider other conditions when patients do not respond to typical IBD medications or symptoms worsen despite treatment.
“I’m sure we have all had true IBD patients who do not respond to steroids or are refractory to [anti-tumor necrosis factor], but we also want to keep an open mind to the possibility of other disease processes in our IBD patients,” Bhatt said.
To avoid “casting too large of a net,” Bhatt recommends categorizing IBD mimickers by considering the age and geographic location of the patient as well as the affected area of the GI tract, and further organizing the differential based on infectious and noninfectious etiologies, such as history of NSAID use, among others.
“It is very important to know that conditions can overlap — IBD and something else,” Bhatt said. “It is often easy to be lulled into a simple pattern recognition and this sometimes causes us to anchor on a diagnosis of IBD, which can lead us down the wrong road and lead us to miss important and very treatable conditions.”
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Bhatt RG. Don’t be fooled: Mimickers of IBD. Presented at: NASPGHAN; Oct. 4-7, 2023; San Diego.
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