When Should I Suspect Undiagnosed Inflammatory Bowel Disease in the Acute Care Setting? How Should I Manage a Suspected New Diagnosis of Inflammatory Bowel Disease?

Abdominal pain is one of the most common chief complaints in patients presenting for acute care. While less than 1% of the population suffers from inflammatory bowel disease (IBD), providers must maintain a high level of clinical suspicion in undiagnosed patients presenting with abdominal pain, vomiting, and diarrhea. Crohn’s disease (CD) and ulcerative colitis (UC) may present with both intestinal and extraintestinal manifestations and often require multiple different diagnostic tests to confirm the diagnosis. In patients suspected to have undiagnosed IBD, clinicians should initially focus on hydration, electrolyte replacement, pain control, consideration of non-IBD-related causes of abdominal symptoms, and evaluation for acute complications of IBD, such as obstruction or perforation. If discharged, patients with a moderate to high risk of undiagnosed IBD should follow up with gastroenterology.