Crohn's Disease & Ulcerative Colitis

What is Crohn’s Disease?

• Crohn’s disease (CD) belongs to a group of diseases collectively called Inflammatory Bowel Disease (IBD) which also includes Ulcerative Colitis (UC).
• It is a chronic disease that can cause inflammation anywhere from the mouth to the anus anywhere along the lining of the digestive tract.
• It most commonly affects the small intestine and the colon. The disease can show up along different parts of the digestive tract in a continuous or patchy distribution. It typically involves both the superficial and deep layers of the intestinal wall.

Symptoms of CD

Symptoms of CD depend on the severity and location of the intestinal inflammation and can range from none or mild, to severe. Symptoms may develop gradually or come on suddenly, without warning, which includes:

• abdominal pain and cramping,
• persistent diarrhea (loose, watery, numerous bowel movements),
• blood in the stool and
• fever
• Ulcers of the mouth,
• lack of appetite & unexplained weight loss
• fatigue,
• nausea and vomiting

With severe diarrhea and the digestive tracks’ inability to absorb nutrients, nutritional deficiencies may occur over time.

Causes of CD

An exact cause of CD is unknown. There is a complex interaction between an individual’s genetic make-up, their immune system and foreign substances in the environment (including dietary factors and microbes living in our gut) that are responsible for the chronic uncontrolled inflammation in CD.

An exact cause of CD is unknown. There is a complex interaction between an individual’s genetic make-up, their immune system and foreign substances in the environment (including dietary factors and microbes living in our gut) that are responsible for the chronic uncontrolled inflammation in CD.

Who gets CD and how common is it?

• Men and women appear to be affected equally
• Symptoms usually start between the ages of 15-35 but can develop at any time during one’s lifetime.
• More than 80% of patients with CD do not have a recognized genetic disposition. Smoking is an important controllable risk factor in CD.
• People who smoke with this disease tend to have more severe forms of the disease and are at higher risk of needing surgery.

How is CD diagnosed?

• There is no single test to confirm the diagnosis of CD. Instead, multiple tests are usually used in combination to help arrive at the diagnosis depending on the symptoms that lead individuals to seek care.
• Ultimately, a colonoscopy or flexible sigmoidoscopy must be performed to directly visualize the intestine internally and to obtain small tissue samples (biopsies) for evaluation under the microscope.
• Blood tests which look for antibodies and markers of inflammation along with stool specimen tests for hidden blood and infection may also be used to help confirm or exclude the diagnosis of CD

What are the complications of CD?

CD may cause symptoms outside the digestive tract including:

• inflammation of the eye (conjunctivitis, episcleritis, uveitis, iritis),
• inflammation of joints (arthritis),
• weakening of bones (osteoporosis),
• skin rashes (erythema nodosum, pyoderma gangrenous),
• inflammation of the liver or bile ducts (primary sclerosing cholangitis),
• kidney stones, gallstones and in children,
• delayed growth or sexual development due to the use of steroids,
• Malnutrition and malabsorption.

Crohn’s disease may also lead to several complications over time which may be related to the disease or due to the effects of medications used to treat the disease.

Treatment options:

Several groups of drugs are used to treat Crohn’s disease and are listed below:

• Amino salicylates
• Corticosteroids
• Immune modifiers
• Antibiotics
• Biologic therapies or bDMARDs

What is the clinical course and prognosis in CD?

Most people with CD with the proper medical care tend to live healthy, productive lives with a normal life span. Maintenance of remission and surveillance for complications are the major goals which lead to maintaining quality of life in patients with CD. Regular visits with a gastroenterologist and developing a longstanding relationship are vital to managing this disease

Ulcerative Colitis

What is Ulcerative Colitis?

• Ulcerative colitis (UC) is a disease marked by inflammation of the lining of the colon and rectum, together known as the large intestine.
• This inflammation causes irritation in the lining of the large intestine which leads to the symptoms of UC. Though UC always affects the lowest part of the large intestine (the rectum), in some patients it can be present throughout the entire colon.
• UC belongs to a group of diseases called inflammatory bowel diseases which also includes Crohn’s disease (CD).
• Though it was once thought that UC and CD were two different diseases, as many as 10% of patients may have features of both diseases and this is called indeterminate colitis.
• It is important to note that inflammatory bowel disease (IBD) is different from irritable bowel syndrome (IBS).

Symptoms of UC

The symptoms of ulcerative colitis depend on the severity of inflammation and the amount of the colon that is affected by the disease.

In patients with mild to moderate inflammation, symptoms can include:

• rectal bleeding
• diarrhea,
• mild abdominal cramping,
• stool urgency and
• Tenesmus (discomfort and the feeling that you have not completely emptied your rectum after a bowel movement).

When more severe inflammation is present, patients often develop fever, dehydration, severe abdominal pain, weight loss, loss of appetite or growth retardation (in children and adolescents with UC).

Individuals with moderate or severe inflammation may also have to wake up at night to have bowel movements and may lose control of bowel movements.

Causes of UC

• The way in which patients get ulcerative colitis is still poorly understood.
• There seems to be an interaction between the unique genetic makeup of an individual, environmental factors, and a patient’s specific immune system that triggers the disease.

How is UC diagnosed?

Your doctor will usually suspect the diagnosis of ulcerative colitis based on your symptoms, but confirmation of the diagnosis requires testing.

• Blood test is often checked to look for markers of inflammation or anemia (low blood counts), though these tests can be normal in patients with mild disease.
• Tests of your stool to look for evidence of an intestinal infection are often obtained.
• Radiologic images including x-rays and CT scans are usually not recommended but may be performed. All patients with symptoms consistent with UC should have a colonoscopy or flexible sigmoidoscopy to confirm the diagnosis assuming that they are healthy enough to undergo the procedure. During this procedure, your gastroenterologist will be able to directly examine the lining of your colon and rectum to look for evidence of inflammation and take small biopsies to be examined under a microscope to look for the cause of the inflammation.

What are different types of treatment for UC?

Medical treatment of ulcerative colitis generally focuses on two separate goals:

• The induction of remission (making a sick person well) and
• The maintenance of remission (keeping a well person from getting sick again).

Treatment options includes:

• Steroids
• Immunomodulator
• Surgery