Did you know that millions of people are impacted and live with Crohn’s disease or ulcerative colitis? We may have heard of Crohn’s and colitis in passing, but may not fully understand them. These diseases are collectively known as inflammatory bowel disease, or IBD.
Motherhood Story with the help of Dr Saravana Kumar, a Consultant Gastroenterologist and Hepatologist at Ramsay Sime Darby Parkcity Medical Centre, brings to light these diseases and for those in the IBD community to be better understood.
Dr Saravana provides a helpful and thorough overview of the diseases, and what a patient would expect in terms of treatment options and living with IBD.
What Is the Difference Between Crohn’s and Colitis Diseases?
Ulcerative colitis and Crohn’s disease are the two main forms of inflammatory bowel diseases. They are both conditions characterised by chronic inflammation of the digestive tract.
Some similarities are:
- Both diseases often develop in teenagers and young adults although the disease can occur at any age
- Ulcerative colitis and Crohn’s disease affect men and women equally
- The symptoms of ulcerative colitis and Crohn’s disease are very similar
- The causes of both UC and Crohn’s disease are not known and both diseases have similar types of contributing factors such as environmental, genetic and an inappropriate response by the body’s immune system
The differences between ulcerative colitis and Crohn’s disease are:
- Ulcerative colitis is limited to the colon while Crohn’s disease can occur anywhere between the mouth and the anus
- In Crohn’s disease, there are healthy parts of the intestine mixed in between inflamed areas. Ulcerative colitis, on the other hand, is continuous inflammation of the colon
- Ulcerative colitis only affects the inner most lining of the colon while Crohn’s disease can occur in all the layers of the bowel walls
Which One Is a More Serious Condition?
Crohn’s disease is more serious.
Are There Different Symptoms in Both Diseases?
Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs. Symptoms may range from mild to severe. You are likely to have periods of active illness followed by periods of remission.
Signs and symptoms that are common to both Crohn’s disease and ulcerative colitis include:
- Diarrhoea
- Fatigue
- Abdominal pain and cramping
- Blood in your stool
- Reduced appetite
- Unintended weight loss
How To Tell the Difference Between the Two?
In ulcerative colitis, only your large bowel is involved, whereas in Crohn’s it can affect any part from your mouth to the anus.
Biopsies read by a histopathologist of affected areas can tell the difference between both as Ulcerative colitis only affects the inner most lining of the colon while Crohn’s disease can occur in all the layers of the bowel walls
What Is the Cause of These Conditions?
The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but aren’t the cause of IBD.
One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.
Heredity also seems to play a role in that IBD is more common in people who have family members with the disease. However, most people with IBD don’t have this family history.
Some risk factors include:
- Age. Most people who develop IBD are diagnosed before they’re 30 years old. But some people don’t develop the disease until they’re in their 50s or 60s.
- Race or ethnicity. Although Caucasians have the highest risk of the disease, it can occur in any race.
- Family history. You’re at higher risk if you have a close relative—such as a parent, sibling or child—with the disease.
- Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease.
Smoking may help prevent ulcerative colitis. However, its harm to overall health outweighs any benefit, and quitting smoking can improve the general health of your digestive tract, as well as provide many other health benefits.
- Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium and others. These medications may increase the risk of developing IBD or worsen the disease in people who have IBD.
How Are They Treated?
The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission and reduced risks of complications. IBD treatment usually involves either drug therapy or surgery.
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. Anti-inflammatories include corticosteroids and aminosalicylates, such as mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Which medication you take depends on the area of your colon that’s affected.
Immune system suppressors
These drugs work in a variety of ways to suppress the immune response that releases inflammation-inducing chemicals into the body. When released, these chemicals can damage the lining of the digestive tract.
Some examples of immunosuppressant drugs include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan) and methotrexate (Trexall).
Biologics
Biologics are a newer category of therapy in which therapy is directed toward neutralising proteins in the body that are causing inflammation. Some are administered via intravenous (IV) infusions and others are injections you give yourself. Examples include infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), certolizumab (Cimzia), vedolizumab (Entyvio) and ustekinumab (Stelara).
Antibiotics
Antibiotics may be used in addition to other medications or when infection is a concern—in cases of perianal Crohn’s disease, for example. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).
Other medications and supplements
In addition to controlling inflammation, some medications may help relieve your signs and symptoms, but always talk to your doctor before taking any over-the-counter medications. Depending on the severity of your IBD, your doctor may recommend one or more of the following:
- Antidiarrheal medications. A fibre supplement—such as psyllium powder (Metamucil) or methyl cellulose (Citrucel)—can help relieve mild to moderate diarrhoea by adding bulk to your stool. For more-severe diarrhoea, loperamide (Imodium A-D) may be effective.
- Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). However, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and diclofenac sodium likely will make your symptoms worse and can make your disease worse as well.
- Vitamins and supplements. If you’re not absorbing enough nutrients, your doctor may recommend vitamins and nutritional supplements.
Nutritional support
When weight loss is severe, your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your IBD. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term.
If you have a stenosis or stricture in the bowel, your doctor may recommend a low-residue diet. This will help to minimise the chance that undigested food will get stuck in the narrowed part of the bowel and lead to a blockage.
If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your IBD signs and symptoms, your doctor may recommend surgery.
- Surgery for ulcerative colitis. Surgery involves removal of the entire colon and rectum and the production of an internal pouch attached to the anus that allows bowel movements without a bag.
In some cases, a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.
- Surgery for Crohn’s disease. Up to two-thirds of people with Crohn’s disease will require at least one surgery in their lifetime. However, surgery does not cure Crohn’s disease.
During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.
The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimise the risk of recurrence.
What Is the Impact on a Person’s Lifestyle?
A patient with IBD can have a normal lifestyle if their disease under control. If complications occur requiring surgery or persistent relapse despite treatment—this can severely affect the quality of one’s life.
What Is the Worst-Case Scenario of Having Crohn’s or Colitis Disease?
Bowel obstruction, bowel perforation, death.
Can a Person Prevent Themselves from Getting This IBD?
Not really. Once diagnosed, one needs to avoid the risk factors that can cause flare ups of the disease.
Sharing Is Caring
We hope you have found the above sharing from Dr Saravana to be insightful in understanding IBD, and do share this article with friends and family or those who may be seeking to understand more about IBD from an expert’s point of view.
Source: Dr Saravana Kumar, a Consultant Gastroenterologist and Hepatologist at Ramsay Sime Darby Parkcity Medical Centre
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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