Resources

Title Type
Abdominal striae in a 14 year old Crohn’s disease patient due to steroid use
Active small bowel Crohn’s disease with an associated abscess adjacent to iliostomy
Adalimumab Induces and Maintains Mucosal Healing in CD patients (EXTEND trial results)

Adalimumab Induces and Maintains Mucosal Healing in Patients With Crohn’s Disease: Data From the EXTEND Trial

Adenocarcinoma arising in a chronic entero-enteric fistula
Anal fissure
Anastomotic dilation
Anastomotic structuring due to recurrent Crohn’s disease
Anti-TNFs for induction of remission in CD (Cochrane review)

Cochrane meta-analysis of anti-TNF therapies for induction of remission in Crohn's disease

Anti-TNFs for maintenance of remission in CD (Cochrane review)

Cochrane meta-analysis of anti-TNF therapies for maintenance of remission in Crohn's disease

Aphthous ulceration associated with mild colonic Crohn’s disease
Appendectomy is followed by increased risk of Crohn's disease

Chart showing cumulated risk of Crohn's disease among case patients that were subjected to appendectomy before the age of 10 years

Arthritis in a patient with IBD

Image of arthritis in feet of patients with IBD

Axial CT showing complex penetrating Crohn’s disease with an intra-abdominal abscess

Axial CT demonstrates complex penetrating Crohn’s disease with an intra-abdominal abscess (arrowhead)

Axial HASTE image shows thickened ileum with surrounding fat hypertrophy

Axial HASTE image shows thickened ileum (red arrow) with surrounding fat hypertrophy ( yellow arrow)

Axial TRUFISP shows severely thickened small bowel loops with a skip segment

Axial TRUFISP shows severely thickened small bowel loops ( yellow arrows) with a skip segment ( red arrow) which demonstrates mild functional holdup

Azathioprine and 6-Mercaptopurine for the Prevention of Postoperative Recurrence in Crohn's Disease: A Meta-Analysis

Meta-analysis evaluating the efficacy and safety of purine analogs (azathioprine, 6-mercaptopurine (6-MP)) in the prevention of postoperative recurrence in Crohn's disease.

Bristol Stool Scale

Medical aid designed to classify the form of human faeces into seven categories. Sometimes referred to in the UK as the Meyers scale.

Budesonide for induction of remission in Crohn's disease (Cochrane Review)

Cochrane meta-analysis on budesonide for induction of remission in Crohn's disease

Budesonide for maintenance of remission in Crohn's disease (Cochrane review)

Cochrane meta-analysis of budesonide for maintenance of remission in Crohn's disease

Capsule endoscopic view of stenosing small bowel Crohn’s disease
Capsule endoscopic views of small bowel Crohn’s disease
Capsule endoscopy showing moderate terminal ileal Crohn's disease
Capsule endoscopy showing sporadic aphthous ulceration in mild small bowel Crohn's disease
Capsule for capsule endoscopy
CDAI Calculator

Calculator for Crohn's Disease Activity Index, from IBD Support Australia

Clinical course in Crohn’s disease (IBSEN study)

Shows four predefined curves reflecting different patterns of CD in terms of the severity of bowel symptoms from diagnosis to 10-year follow-up, and percentage of patients in IBSEN source study whose symptoms matched this disease course

Colonic lymphoid hyperplasia in a patient with newly diagnosed, quiescent Crohn’s disease
Colonoscope
Comparison of step-up vs. top-down (SUTD) treatment strategies

Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial

Contrast study demonstrating a recto-vaginal fistula
Coronal fat saturated Haste image from an MRCP shows irregularity of intrahepatic ducts
Coronal TRUFISP image showing thickened caecal pole and terminal ileum

Arrow highlights thickened caecal pole and terminal ileum. 

Coronal TRUFISP images indicate thickened segments of bowel

Coronal TRUFISP images indicate thickened segments of bowel (yellow arrows) with an intervening normal segment of bowel ( red arrow)

Coronal TRUFISP showing moderate wall thickening of the terminal and distal ileum secondary to Crohn’s disease

Coronal TRUFISP showing moderate wall thickening of the terminal and distal ileum secondary to Crohn’s disease

Crohn’s anastomotic stricture preventing endoscopic neo-terminal ileal intubation
Crohn’s colitis associated snail-tract ulceration predominantly affecting the anti-mesenteric border
Crohn’s pan-colitis moderate
Deep ulceration in severe Crohn’s colitis
Diagnosis of tuberculosis
Diagram showing different types of colectomy

Diagram showing different kinds of colectomies

Diagram showing resections in the rectum or anus
Diaphragm Disease

Capsule endoscopy video of diaphragm disease

Dilatation of small bowel proximal to a thickened slightly strictured distal segment of ileum

Yellow arrow shows dilatation of small bowel proximal to a thickened slightly strictured distal segment of ileum ( red arrow)

Discontinuation of infliximab in Crohn's disease patients in stable remission (STORI trial)

Approximately 50% of patients with Crohn's disease who were treated for at least 1 year with infliximab and an antimetabolite agent experienced a relapse within 1 year after discontinuation of infliximab. However, patients with a low risk of relapse can be identified using a combination of clinical and biologic markers.

Discontinuous ulceration in Crohn’s colitis
Double balloon enteroscopy (scope image)
Double balloon enteroscopy technique
ECCO IBD Curriculum
ECCO Opportunistic Infections Consensus Checklist (2014)
ECCO Toolkits for Therapies in IBD
ECCO-EFCCA Crohn's Disease Patient Guidelines
ECCO-EFFCA Ulcerative Colitis Patient Guidelines
Effects of cigarette smoking on the long-term course of Crohn's disease

Smoking status & increased risk of requiring immunosuppressive therapy & surgery in Crohn's disease

Endoscopy suite
Episcleritis

Image of episcleritis

Erythema nodosum in Crohn’s disease

Image of erythema nodosum in Crohn’s disease patient

Factors determining recurrence of Crohn’s disease after surgeryMost Crohn’s disease patients will require surgery. Source: National Cooperative Crohn’s Disease Study: Factors determining recurrence of Crohn’s disease after surgery
Frequency of fistulae in relation to Crohn's disease duration
Gastroscope
Grading of disease activity in Crohn's disease

Grading of disease activity in Crohn's disease

Harvey-Bradshaw Calculator
High signal at the site of a complex trans-sphincteric fistula; with resolution after 4 months anti-TNF
How a colonoscopy is carried out

Animation showing colonoscopy procedure. Note that refers to colonoscopy for purpose of cancer screeening during animation.

How to interpret values in patients failing anti-TNF therapy2x2 matrix showing four scenarios encountered in patients with insufficient clinical response to anti-TNF antibody drugs.
IBDQ (Inflammatory Bowel Disease Questionnaire)

The McMaster IBDQ is the most widely used HRQL instrument for IBD patients.

Ileal Aphthous Ulcer

Capsule endoscopy video of ileal aphthous ulcer

Image from Coronal Fat suppressed HASTE sequence of MRCP showing normal bile ducts
Incidence rates of Crohn's disease in 20 European centres
Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine

Meta-analysis suggesting an approximate fourfold increased risk of lymphoma in IBD patients treated with azathioprine/6-MP. This could be a result of the medications, the severity of the underlying disease, or a combination of the two.

Infectious agents causing an episode of infectious gastroenteritis could play a role in the initiation of IBD

Acute gastroenteritis is followed by an increased risk of inflammatory bowel disease

Inflammation at CD anastomosis
Infliximab
Influence of age at diagnosis on site and clinical type of Crohn's disease

At diagnosis, small bowel disease is more frequent in younger patients while colonic disease is more frequent in older patients

Ischaemic colitis

Ischaemic colitis; note the discontinuous, sub-mucosal haemorrhage / inflammation, not seen in UC

Jejunal Crohn’s disease
Laparoscopic assisted panproctocolectomy
Laparoscopic view of fat encasing the terminal ileum in a patient with Crohn’s disease
Long-term Evolution of Disease Behavior in Crohn's Disease

Kaplan-Meier estimates of remaining free of penetrating and/or stricturing complications since onset (diagnosis) of the disease.

Longstanding untreated Crohn’s colitis resulted in pseudopolyposis

Surveillance biopsies demonstrated high grade dysplasia. The colectomy specimen contained a Duke’s A cancer.

Low rectal anastomotic stricture with visible anal fistula internal opening
MaRIA (Magnetic Resonance Index of Activity) score

Link to original paper by Rimola J et al.: Magnetic Resonance Imaging for Evaluation of Crohn’s Disease: Validation of Parameters of Severity and Quantitative Index of Activity

Mayo Score

Extract from ECCO UC consensus, showing Mayo Score

Mayo Score Calculator

Mayo Score calculator, available on globalrph.com

Mild colitis, with a small polyp shown to be hyperplastic
Mild recurrence of CD within neo-terminal ileum and at anastomosis”
Moderate ileocaecal Crohn's disease
Moderate left sided ulcerative colitis
Moderate sigmoid colon ulceration
Moderate to severe caecal Crohn’s disease
Montréal classification

Extract from ECCO UC consensus, showing Montréal classification of disease activity

Montreal Classification

Overview of Montreal Classification

MR enterography showing terminal ileal thickening and fat hypertrophy

Yellow arrow shows thickened wall fat hypertrophy

MRI showing enterocutaneous fistula with locule of gas

MRI showing enterocutaneous fistula (red arrow) together with locule of gas (yellow arrow)

Mucosal cobblestoning in a patient with severe left sided Crohn’s colitis
Mucosal hyperenhancement of distal ileal loops consistent with active disease

Mucosal hyperenhancement of distal ileal loops consistent with active disease

Multiple discharging external fistula opening with seton in situ
Multiple stricturoplasties in a patient with fibrotic small bowel Crohn’s disease
MUSIC: mucosal healing in patients with moderate to severe ileocolonic CD following treatment with certolizumab pegol

Results from MUSIC trial examining endoscopic improvement of mucosal lesions in patients with moderate to severe ileocolonic Crohn's disease following treatment with certolizumab pegol

Normal colonoscopy
Normal gastroscopy
Normal small bowel viewed by capsule endoscopy
Normal terminal ileum, with erythematous colitis in cecum
Oedema and ulcerations produce a mucosal cobblestone appearance
Oral ulceration in Crohn’s disease

Image of oral ulceration in Crohn’s disease patient

Parks Classification
Patient infusion of infliximab
Patient self-injection using adalimumab (Humira) pen
PCDAI Calculator

Pediatric Crohn's Disease Activity Index Calculator

Perianal Crohn’s disease persisting following proctectomy
Perianal Crohn’s disease with seton to allow drainage
Perianal disease with drainage seton
Perianal excoriation due to recurrent leakage of faecal matter in a patient with Crohn’s disease
Perianal ulceration with sepsis, fistula & severe inflammation

Perianal ulceration can cause multiple problems for the surgeon and gastroenterologist.  Images show a 20 year old female who first presented with sepsis and na anorectal fistula with severe anal inflammation.  Sepsis was drained by many procedures, and some healing achieved with the aid of biological agents. 

Peristomal pyoderma

Image of peristomal pyoderma

Placebo-controlled trials of antibiotics for maintenance of medically induced remission in Crohn's disease
Placebo-controlled trials of AZA or mercaptopurine (MP) for maintenance of medically induced remission in Crohn's disease
Placebo-controlled trials of budesonide for maintenance of medically induced remission in Crohn's disease
Placebo-controlled trials of mesalazine for maintenance of medically induced remission in Crohn's disease
Postoperative recurrence of penetrating Crohn’s disease occurs more rapidly than with stricturing Crohn’s disease

Recurrence patterns after first resection for stricturing or penetrating Crohn's disease

Progression of digestive disease damage

Development of the Crohn's disease digestive damage score, the Lémann score

Pyoderma gangrenosum

Image of pyoderma gangrenosum

Rating Form of IBD Patient Concerns (RFIPC)

Original study by Drossman DA et al. outlining the RFIPC

RCTs of anti-TNFα including IFX, ADA & CTZ for maintenance of medically induced remission in luminal Crohn's disease
Re-operation rates for ileocolonic disease

Re-operation rates for ileocolonic disease (summary of multiple studies)

Rectal Crohn’s disease seen on scope retroflexion
Rectal stricture due to Crohn’s disease
Rectal stricture due to Crohn’s disease
Retained capsule

Capsule endoscopy video of retained capsule. The patient required interval laparotomy to remove the capsule.

Risk factors for postoperative recurrence of Crohn’s disease after resection

Postoperative recurrence observed in high proportion of patients after resection different from ileocolon, although at lower frequency than observed after ileocolonic resection

Risk of radiation exposure
Risk of radiation exposure

Online calculator that outlines radiation risk from various medical interventions and places these in context of other risk factors.

Rutgeert's Score
Rutgeerts i1 ileitis
Rutgeerts i2 ileitis
Rutgeerts i3 ileitis
Rutgeerts i4 ileitis
Severe Crohn’s colitis
Severe Crohn’s colitis (note relative rectal sparring)
Severe ileocaecal Crohn's disease
Severe perianal Crohn's disease
Severe sigmoid inflammation
Severe thickening of the proximal and distal sigmoid colon

Red arrows show severe thickening of the proximal and distal sigmoid colon. Note a normal intervening segment which is markedly dilated

SF-36 QoL Survey

Original SF-36 survey, in public domain provided by the RAND Corporation. Commercial, updated version is also available.

Shingles (Varicella zoster reactivation) associated with anti-TNF
Simple endoscopic score (SES-CD)

Simple Endoscopic Score for Crohn's Disease (SES-CD) is a simple, reproducible, and easy-to-use endoscopic scoring system for Crohn's disease.

Small bowel stricture with extensive proximal small bowel dilatation

Small bowel stricture (arrow) with very low T2 MR signal characteristic of fibrosis, with extensive proximal small bowel dilatation containing food residue.

Small colonic aphthous ulcers in (very) mild Crohn’s colitis
Smokers at increased risk for first reoperation for recurrent Crohn’s disease

Risk for first reoperation for recurrent Crohn’s disease at any site for non-smokers, smokers & quitters

Smoking increases risk of disease relapse in Crohn’s disease patients

Oral contraceptive use and smoking are risk factors for relapse in Crohn's disease

Standard growth charts (girls & boys)

Standard growth charts for girls & boys, 2-18 years (UK Department of Health)

Strictureplasty overview

Medscape article outlining types of strictureplasty

Stricturing Crohn's disease delaying capsule transit
Stricturing disease behavior & weight loss at diagnosis are risk factors for developing severe Crohn’s disease

Predictors of severe Crohn's disease

Stricturing ileal Crohn’s disease (Contrast CT)

Contrast CT showing a short segmental strictures of the ileum with multiple dilated small bowel loops and air-fluid levels, signifying an obstructive element. The involved segments shows increased mural enhancement suggestive of inflammation.  

T1 fat saturated image post contrast shows mucosal hyperenhancment of the caecum and terminal ileum consistent with active inflammation

T1 fat saturated image post contrast shows mucosal hyperenhancment of the caecum and terminal ileum consistent with active inflammation

Terminal ileal and ileo-caecal Crohn’s disease
Terminal ileal and pan-colonic Crohn’s disease
Terminal ileal ulceration
Thickened distal ileal loop with surrounding fat hypertrophy

Red arrow indicates thickened distal ileal loop with surrounding fat hypertrophy

Thickened distal ileum with entero-enteric fistulae

Thickened distal ileum with entero-enteric fistulae (yellow arrow)

Thickened strictured segment of ascending colon

Red arrow indicates a thickened strictured segment of ascending colon

Through the scope (TTS) balloon dilatation of an ileo-caecal anastomsis in a patient with Crohn’s disease
Traditional corticosteroids for induction of remission in Crohn's disease (Cochrane review)

Cochrane meta-analysis finding that corticosteroids are effective for induction of remission in patients with CD, particularly when used for more than 15 weeks. 

Trans-abdominal ultrasound
Transverse colonic aphthous ulceration in a patient with mild Crohn’s colitis
Truelove & Witts Score

Extract from ECCO UC Consensus showing Truelove & Witts score

Upper GI endoscopy

Histology: "...extensive ulceration, moderate active chronic inflammation…regenerative changes"

Uveitis

Three images of uveitis

WELCOME study: response to induction with certolizumab pegol following infliximab failure

Response to open-label induction therapy with certolizumab pegol was achieved by 62% of patients with moderate to severely active Crohn's disease and secondary failure to infliximab.

Worldwide CD incidence rates and/or prevalence over time

Worldwide CD incidence rates and/or prevalence by country over time.

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