What is the difference between Ulcerative Colitis and Crohn's
Disease?
Ulcerative colitis and Crohn's disease are two types of Inflammatory Bowel
Disease (IBD). The large intestine (colon) is inflamed in ulcerative colitis,
and this involves the inner lining of the colon. In Crohn's disease the
inflammation extends deeper into the intestinal wall. Crohn's disease can also
involve the small intestine (ileitis), or can involve both the small and large
intestine (ileocolitis).
How is IBD different from Irritable Bowel Syndrome?
IBD develops due to inflammation in the intestine which can result in bleeding,
fever, elevation of the white blood cell count, as well as diarrhea and cramping
abdominal pain. The abnormalities in IBD can usually be visualized by
cross-sectional imaging (for instance a CT scan) or colonoscopy. Irritable Bowel
Syndrome (IBS) is a set of symptoms resulting from disordered sensation or
abnormal function of the small and large bowel. Irritable Bowel Syndrome is
characterized by crampy abdominal pain, diarrhea, and/or constipation, but is
not accompanied by fever, bleeding or an elevated white blood cell count.
Examination by colonoscopy or barium x-ray reveals no abnormal findings.
What is the cause of IBD?
There is no single explanation for the development of IBD. A prevailing theory
holds that a process, possibly viral, bacterial, or allergic, initially inflames
the small or large intestine and, depending on genetic predisposition, results
in the development of antibodies which chronically "attack" the intestine,
leading to inflammation. Approximately 10 percent of patients with IBD have a
close family member (parent, sibling or child) with the disease, which lends
support to a genetic predisposition in some patients.
Is IBD caused by stress?
Emotional stress due to family, job or social pressures may result in worsening
of the Irritable Bowel Syndrome but there is little evidence to suggest that
stress is a major cause for ulcerative colitis or Crohn's disease. Although IBD
is not caused by stress recent studies show that there may be a relationship
between the two--stressful periods in life may lead to a flare of disease
activity in persons with the underlying diagnosis of IBD.
How is IBD diagnosed?
There is no single test that can make the diagnosis of IBD or completely rule
out its existence reliably. Colonoscopy, cross-sectional imaging studies of the
colon or the upper GI tract, along with newer blood tests that detect markers
that are commonly associated with IBD, along with a patient's history and
physical exam, can all be useful in helping your doctor establish a diagnosis of
IBD.
What are the complications of IBD?
Ulcerative colitis and Crohn's disease can lead to diarrhea, bleeding, anemia,
weight loss, fevers, malnutrition and fistulae. IBD can also have
extra-intestinal manifestations where areas other than your gastrointestinal
system such as your skeletal system, your skin or your eyes may be involved.
What medical treatments are available for IBD?
Various formulations of 5-ASA, a drug which has been used to treat IBD for over
50 years, are available as oral preparations, suppositories and enemas. These
are often one of the first drugs used to treat IBD.
Corticosteroid therapies, such as prednisone or hydrocortisone, are given when
the 5-ASA products are insufficient to control inflammation. These drugs can be
given orally, rectally as suppositories or enemas, or intravenously.
Drugs which suppress the body's immune response in IBD (known as
immunomodulators) are used. Azathioprine and 6-mercaptopurine (6-MP) are the two
most commonly used immunomodulators for anti-immune therapy.
Finally, a newer class of medications called "biologics" is used for patients
with moderate to severe disease. Biologics include medications like infliximab (Remicade®),
a medication given thru an IV infusion, and adalimumab (Humira®) and
certolizumab pegol (Cimzia®), medications given via subcutaneous injection.
Are there complications from the medical treatments?
Sulfasalazine, a 5-ASA product first used to treat IBD in the 1940s, may cause
nausea, indigestion or headache in about 15 percent of patients and worsening
diarrhea in about 4 percent of patients. The newer drugs have fewer side
effects. Chronic corticosteroid therapy can lead to fluid retention and high
blood pressure, some rounding of the face and softening of the bones similar to
osteoporosis. These complications usually prompt attempts to discontinue
corticosteroid treatment as soon as possible. The anti-immune drugs require
periodic monitoring of the blood count since some patients will develop a low
white blood cell count. These drugs, however, are usually well-tolerated in many
patients. Biologics can alter a patient's ability to respond to any stressors to
their immune system and in some patients may make it harder for their body to
fight off infections.
Is diet management important for patients with IBD?
Physicians prefer to maintain good nutrition for those diagnosed with IBD. If
you are responding well to medical management you can often eat a reasonably
unrestricted diet. A low-roughage diet is often suggested for those prone to
diarrhea after meals. If you appear to be milk sensitive (lactose intolerant),
you are advised to either avoid milk products or use milk to which the enzyme
lactase has been added.
How successful is medical therapy?
With early and proper treatment the majority of patients with IBD lead healthy
and productive lives. Some patients may require surgery for treatment of
complications of IBD such as an abscess, bowel obstruction or inadequate
response to treatment.
What are surgical options for IBD?
Crohn's disease of the small or large intestine can be treated surgically for
complications such as obstruction, abscess, fistula or failure to respond
adequately to treatment. The disease may recur at some time after the operation.
Ulcerative colitis is curable with removal of the entire colon. This may require
creating an "ileostomy" (with attachment of the ileum to the external abdominal
wall with an external application pouch) or may involve the direct attachment of
the small intestine (ileum) to the anus. This type of surgery, known as "IPAA
surgery," does not require an external application pouch
IMPORTANT REMINDER:
The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.