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Inflammatory bowel disease flare in dementia — SCE Geriatric Medicine MCQ

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HardGastroenterologyInflammatory bowel disease flare in dementiaSCE Geriatric Medicine

An 84-year-old man with mild dementia and ulcerative colitis presents with worsening diarrhoea, weight loss and nocturnal stools. CRP is 64 mg/L and faecal calprotectin is high; stool cultures are negative. He has osteoporosis and diabetes. What is the most appropriate management?

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Correct answer: E — Assess disease activity and treatment risks through gastroenterology review, avoiding attribution to ageing or dementia

Nocturnal diarrhoea, weight loss and raised inflammatory markers suggest active inflammatory bowel disease or another organic pathology. Dementia should not prevent equivalent assessment and treatment, but comorbidities alter the risk profile of steroids, immunosuppression and admission. Loperamide alone would miss active inflammation. The pearl is that older adults can have active specialist disease, not merely geriatric syndromes.

Reference: BSG IBD guidance; NICE NG97; BNF