Making the Rounds: Ulcerative colitis and Crohn’s disease

Sunil Reddy, MD, PPG – Colon & Rectal Surgery, explains the differences between these inflammatory diseases and what patients can expect with treatment.

Definitions

Ulcerative colitis is an inflammatory condition of the colon. This disease is unique in that it is an   intrinsic problem of the bowel caused by autoimmune processes we don’t fully understand. In these situations, the body is attacking the colon and causing the inflammation, but we’re uncertain what triggers that reaction.  

Crohn’s disease is also an inflammatory bowel disease, but Crohn’s is more severe because it can involve any part of the bowel, from the mouth to the anus. Crohn’s is more chronic, and can sometimes cause other issues in addition to inflammation, like adhesions to other organs (fistulas) and perforation.

The differences

While Ulcerative colitis and Crohn’s are both autoimmune inflammatory bowel diseases, we’re still working to understand the pathology behind why people get them. The main difference is that, while Ulcerative colitis can cause inflammation in the colon, skin or bones, it does not go beyond the colon. With Crohn’s disease, the pattern of inflammation is different. Both the small bowel and large bowel can be involved. Crohn’s can affect multiple areas of the bowel at the same time.

Causes

We are still understanding what triggers these conditions. Genetics play a strong roll, as does exposure to good bacteria. We don’t typically see Crohn’s in third world countries, which tells us that good bacteria can prevent this disease.

Symptoms

Signs of Crohn’s and Ulcerative colitis cause pain in the stomach, diarrhea, weight loss, rectal bleeding, an inability to eat well and general sick feeling.

Diagnosis

When patients come in with these symptoms, depending on their history and exam findings, we screen to check for disease. If basic blood tests, a CT scan and colonoscopy reveal inflammation, we can biopsy the colon and give answers as to what kind of inflammation there is.

Treatment

A physician will typically control inflammation with medication, though sometimes surgery is required. Treatment depends on how bad the disease is and how long symptoms have been present.

Mild steroids and anti-inflammatory medications are sometimes used to control inflammation. The second stage is biologic therapy, including Humira® or Remicade®, which provide control over the disease for a longer duration of time. Sometimes surgery is required, depending on the severity of the inflammation. Surgery might be necessary to remove the large bowel or small bowel, or redirect the rectum.

Since we think that irritable bowel syndrome is a result of a lack of necessary gut bacteria, probiotics are recommended across the spectrum to replace gut bacteria that we need. Gut bacteria provide essential nutrients for survival and prevent pathogenic bacteria from getting into the bowel. Plain yogurt is a great option for eating good bacteria.

Risks

These chronic inflammatory conditions can progress to severe colitis, which means the colon is inflamed to the point where it starts disintegrating. Sometimes it attacks other organs in the body or connections to skin (fistula). Both conditions can progress into colon cancer, though this is more common with Ulcerative colitis. If you’ve had one of these conditions for a long duration, you’re at a higher risk of getting colon cancer.

Prevention

Since the cause of irritable bowel syndrome is not completely understood, there’s no real way to prevent it, but those at risk should start taking probiotics, eating healthy and watching for early signs, such as blood in the stool, cramping or diarrhea. Early diagnosis and proper treatment can improve symptoms.  

Living with irritable bowel syndrome

Those with these conditions can still have a good quality of life by staying on top of their medications, screenings to prevent colon cancer, physical activity, diet and focusing on the mental aspects. Talk to other patients. Get online and talk to those with similar problems to reduce stress.

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