Inflammatory bowel disease–like conditions: gastrointestinal lymphoma and other neoplasms

Abbreviations

Introduction

The incidence of both gastrointestinal (GI) malignancies and inflammatory bowel disease (IBD) is rising worldwide. Endoscopic features of GI malignancies, particularly various phenotypes of lymphoma, can mimic those in Crohn’s disease (CD) and ulcerative colitis (UC). GI lymphoma is among the top list of differential diagnosis of IBD; and their management is different. Great overlaps in endoscopic features exist between GI lymphoma and IBD, such as erythema, ulcers nodularity, polypoid lesions, and strictures, which make the differential diagnosis difficult. Other GI neoplasms can also present with nodularity, ulcers, and polypoid lesions, similar to that seen in IBD.

Patients with IBD undergoing medical therapy, especially the use of purine analogs, carry a the risk for development of GI or extra-intestinal lymphomas. Fortunately, lymphomas in this setting are largely extranodal and GI lymphomas are rare. Furthermore, radiation therapy for GI cancer may result in radiation enteritis, colitis, or proctitis, which also share some of the endoscopic features with those in IBD. Radiation-associated GI injury is discussed in a separate chapter ( Chapter 22 : Inflammatory bowel disease–like conditions: radiation injury of the gut).