Ulcerative Colitis – Crohn’s Disease

What is Inflammatory Bowel Disease?

Inflammatory bowel disease is a group of conditions that cause chronic inflammation of the digestive tract. Crohn’s disease and ulcerative colitis are the two most common of these diseases.

What are the Symptoms?

Crohn’s disease and ulcerative colitis are similar diseases in many ways. Both cause swelling and ulcers along the digestive tract and can lead to abdominal pain and frequent diarrhea. Crohn’s disease can develop anywhere in the digestive tract, from the mouth to the rectum, and penetrates deeply into the layers of the wall. Ulcerative colitis usually does not affect the outer layer of the wall and only involves the colon.

There is still much to learn about Crohn’s disease and ulcerative colitis, and laboratory and clinical research into their causes and treatments is ongoing worldwide.

What are the Causes?

Scientists estimate that seven individuals out of 100,000 in the United States will develop Crohn’s disease, and 10 to 15 individuals out of 100,000 will develop ulcerative colitis. The exact cause of these diseases is unknown, but recent research suggests it may be triggered by a malfunction in the body’s immune system. Family history and certain environmental factors may also increase a person’s risk for Crohn’s disease and ulcerative colitis.

How is it Diagnosed?

Crohn’s disease and ulcerative colitis have many similarities and are often confused. Accurate diagnosis is important so that an individual can receive the most effective treatment for the disease. A gastroenterologist has extensive experience in diagnosing Crohn’s disease and ulcerative colitis and is familiar with distinguishing between the two based on symptoms and test results.

Two newer blood tests are useful in diagnosing inflammatory bowel disease. These check for anemia or signs of inflammation by determining certain antibodies in the blood, but they are only about 80 percent accurate.

A barium enema is a test performed on the patient where a barium solution is used (barium is a substance that allows cancers or other abnormalities to stand out in X-rays), and then a series of X-rays are taken. For patients in whom Crohn’s disease does not affect the upper parts of the digestive system, a barium enema may be the only test required for diagnosis.

Sigmoidoscopy is typically used to evaluate disorders of the lower colon, such as rectal bleeding or polyps. During the examination, a doctor uses a sigmoidoscope (a long, flexible tube about 10 mm in diameter) to examine the inner wall of the rectum and the lower part of the colon.

Colonoscopy is the most ideal examination for diagnosing inflammatory bowel disease. The doctor inserts a thin, flexible, illuminated tube long enough to view the entire colon, from the rectum to the small intestine. During this examination, the doctor can take tissue samples from the inner lining of the colon to be tested in the laboratory for clusters of inflammatory cells called granulomas. These clusters of cells are present in Crohn’s disease but are absent in ulcerative colitis, providing very useful information for distinguishing between the two diseases.

What is the Appropriate Treatment?

In the early stages of both Crohn’s disease and ulcerative colitis, medication is the recommended treatment. The goal of medical therapy is to suppress inflammation and allow the intestinal tissues to heal. Once diarrhea and abdominal pain are under control, medical treatment can reduce the frequency of flare-ups and maintain remission. Currently, there is no medical treatment that can cure inflammatory bowel disease.

In more advanced stages of the disease, surgery is often necessary. The type of surgery and prognosis is specific to each disease.

Medications

Medications are an effective means for treating the early stages of inflammatory bowel disease, relieving symptoms, and maintaining remission.

The most commonly prescribed medications include:

• Corticosteroids, such as prednisone and methylprednisolone. These powerful medications reduce inflammation in the intestine and may help manage fistulas.
• Aminosalicylic acids like sulfasalazine and mesalamine. These are anti-inflammatory agents and are often given as first-line treatment in the early stages.
• Immunosuppressants like 6-mercaptopurine and azathioprine. These medications control the immune response and may help maintain remission and reduce the dose of corticosteroids.
• Metronidazole, an antibiotic with a positive effect on the immune system. It is useful in patients with fistulas or abscesses, particularly in anal disease.

Biological agents such as infliximab, adalimumab, and golimumab. These medications, known as tumor necrosis factor blockers, neutralize a protein produced by the immune system. They are administered in moderate to severe cases of Crohn’s disease or ulcerative colitis that do not respond to or cannot tolerate other treatments. Infliximab is given by intravenous infusion, while the others are administered by subcutaneous injection. They may be combined with other immunosuppressive medications like azathioprine or mercaptopurine. Contraindications include a history of tuberculosis, fungal infections, and hepatitis B-C, as there may be reactivation of the disease during treatment. These medications are associated with a rare risk of developing certain types of cancer, such as lymphoma or skin cancer.

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