An estimated more than 1 million Americans have ulcerative colitis or Crohn’s disease, the two most common forms of inflammatory bowel disease (IBD). These conditions, which can be painful and debilitating, cause chronic inflammation of the digestive tract.
Ulcerative colitis and Crohn’s disease are very similar â€” so similar, in fact, that they’re often mistaken for one another. Both inflame the lining of your digestive tract, and both can cause severe bouts of watery diarrhea and abdominal pain. But Crohn’s disease can occur anywhere in your digestive tract, often spreading deep into the layers of affected tissues. Ulcerative colitis, on the other hand, usually affects only the innermost lining (mucosa) of your large intestine (colon) and rectum.
Ten to 15 people out of every 100,000 in the United States develop ulcerative colitis, while about seven in 100,000 get Crohn’s disease. No one knows exactly what causes these diseases, although your immune response and certain genetic and environmental factors may play a role.
There’s no known medical cure for either ulcerative colitis or Crohn’s disease. However, therapies are available that may dramatically reduce your signs and symptoms and even bring about a long-term remission.
Ulcerative colitis and Crohn’s disease share many common symptoms. These signs and symptoms, which may develop gradually or come on suddenly, include:
Ulcerative colitis and Crohn’s disease also differ in several key respects. Although Crohn’s disease often affects the lower part of the small intestine (ileum) or the colon, it can flare up anywhere in the digestive tract from the mouth to the anus. It usually consists of inflammation that may include large ulcers extending deep into the intestinal wall. Inflammation can appear in several places simultaneously, with areas of healthy tissue in between.
If you have ulcerative colitis, you’ll likely have inflammation only in the innermost lining of your colon and rectum. The affected areas will be continuous, with no patches of normal tissue. You may also develop small bleeding ulcers.
Signs and symptoms of both diseases may range from mild to severe. If you have a mild case of Crohn’s disease, you’ll likely have some abdominal discomfort and your stools may be loose or more frequent than usual. But if your case is severe, you may have incapacitating abdominal discomfort and you may have bowel movements so frequently that it interrupts your daytime activities and your sleep. You may also experience weight loss, fever and other complications.
Signs and symptoms of mild ulcerative colitis include an urgent need to move the bowels, even when sleeping, more frequent stools, loose or liquid stools, and blood in your bowel movements. In more severe cases, you may have the signs and symptoms above as well as fever, weight loss, a poor energy level, and other signs outside the gastrointestinal tract, such as arthritis.
In general, though, the course of IBD varies greatly. You may remain completely without signs and symptoms after the initial one or two episodes of the disease. Or you may have recurrent episodes of abdominal pain, diarrhea, and sometimes fever or bleeding.
No one is quite sure what causes IBD, although there’s a consensus as to what doesn’t cause it. Researchers no longer believe that stress is the main culprit, although stress can often aggravate symptoms. Instead, current thinking focuses on the following possibilities:
IBD affects about the same number of women and men. Risk factors may include:
Your doctor will likely diagnose IBD only after ruling out other possible causes for your symptoms, including irritable bowel syndrome (IBS), diverticulitis and colorectal cancer. To help confirm a diagnosis of ulcerative colitis or Crohn’s disease, you may have one or more of the following tests and procedures:
Both Crohn’s disease and ulcerative colitis can cause a number of complications, some of which can be serious.
Crohn’s disease may result in your developing one or more of the following:
No one knows exactly what causes these complications. Some researchers believe that the same immune system response that produces inflammation in your intestines may cause inflammation in other parts of your body.
The most serious acute complication of ulcerative colitis is toxic megacolon. This occurs when your colon becomes paralyzed, preventing you from having a bowel movement or passing gas. Signs and symptoms include abdominal pain and swelling, fever and weakness. You might also become disoriented or groggy. If toxic megacolon isn’t treated, your colon may rupture, causing peritonitis, a life-threatening condition requiring emergency surgery. Fortunately, this complication is rare. Having ulcerative colitis also makes it more likely you’ll develop liver disease, as well as skin, joint and eye inflammation.
Finally, both ulcerative colitis and Crohn’s disease increase your risk of colon cancer. Despite this increased risk, however, more than 90 percent of people with IBD don’t get colon cancer.
If you have ulcerative colitis, your risk is greatest if you’ve had the disease for at least eight to 10 years and if it has spread through your entire colon. You’re less likely to develop cancer if only a small part of your colon is diseased. The same is believed to be true for Crohn’s disease. The longer you’ve had the disease and the larger the area affected, the greater your risk of colon cancer.
Nevertheless, if you’ve had any type of inflammatory bowel disease for eight or more years, see your gastroenterologist at least once a year. He or she will likely recommend that you have regular colonoscopies.
The goal of medical treatment is to reduce the inflammation that triggers signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for IBD usually involves either drug therapy or surgery.
Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
Immune System Suppresors
These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. Because these drugs can be effective in treating IBD, scientists theorize that damage to digestive tissues is caused by your body’s immune response to an invading virus or bacteria or even to your own tissue. By suppressing this response, inflammation is also reduced. Immunosuppressant drugs include:
Although antibiotics generally have no effect on ulcerative colitis, they can heal fistulas and abscesses in people with Crohn’s disease. Typical antibiotics include:
In clinical trials, nicotine skin patches â€” the same kind smokers use â€” seem to provide short-term relief from flare-ups of ulcerative colitis. In fact, the patches appear to eliminate symptoms in four out of 10 people. How nicotine patches work isn’t exactly clear, and no one should take up smoking as a treatment for ulcerative colitis. The risks from smoking far outweigh any potential benefit. Smoking is especially harmful for people with Crohn’s disease.
Other MedicationsIn addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on how the severity of your IBS, your doctor may recommend one or more of the following:
Several new treatments that one day may effectively relieve symptoms with fewer side effects are in various stages of research.
One being studied is the use of human growth hormone (HGH) in combination with a high-protein diet to treat Crohn’s disease. In a clinical trial, people treated with HGH saw a reduction in their signs and symptoms after four months. Side effects, which included swelling and headaches, disappeared after about four weeks. More research is needed to confirm these findings and to determine the long-term benefits and risks of HGH therapy for people with Crohn’s disease.
Drugs that block a protein produced by your immune system known as tumor necrosis factor (TNF) also are being tested for the treatment of Crohn’s disease. These include CDP-571, etanercept (Enbrel) and thalidomide. None are specifically approved for use in Crohn’s disease.
Researchers are also testing synthetic versions of naturally occurring proteins, such as interleukin-10, for the treatment of Crohn’s disease. Testing also continues on the common blood-thinning medication, heparin. It may help control inflammation in ulcerative colitis. One of the first gene-based drugs to emerge as a result of the latest genetic research may be keratinocyte growth factor-2, a medication aimed at stimulating the growth of healthy tissue in people with ulcerative colitis and chronic wounds such as bed sores. Results in animal studies looked promising, but the results of an initial human trial designed to test the safety of the medication were disappointing. The study did find that the drug was well-tolerated, so a higher dose may prove more effective.
If diet and lifestyle changes, drug therapy or other treatments don’t relieve your signs and symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract or to close fistulas or remove scar tissue.
In cases of Crohn’s disease, surgery can buy years of remission at best. At the least, it may provide a temporary improvement in your symptoms. During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections in a procedure known as resection. He or she may also close fistulas or drain abscesses. One of the most common surgeries for Crohn’s is strictureplasty, a procedure that widens a segment of the intestine that has become too narrow. Laparoscopic surgery using small incisions can lead to improved outcomes and shorter hospital stays for some people with Crohn’s disease.
Even so, the benefits of surgery for Crohn’s are only temporary. The disease often recurs, frequently near the reconnected tissue or elsewhere in the digestive tract. Nearly three of four people with Crohn’s disease eventually need some type of surgery. Of those, about half will need a second procedure and another 10 percent to 30 percent may require a third operation.
On the other hand, if you have ulcerative colitis, surgery can often eliminate the disease. But that usually means removing the entire colon and rectum (proctocolectomy). In the past, after this surgery you would wear a small bag over an opening in your abdomen to collect waste. But a procedure that has been used for about 20 years â€” ileoanal anastomosis â€” eliminates the need to wear a bag. Instead, your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus. This allows you to expel waste normally, although you may have as many as five to seven watery bowel movements a day because you no longer have your colon to absorb water. Between 25 percent and 40 percent of people with ulcerative colitis will eventually need surgery.
Crohn’s disease and ulcerative colitis don’t just affect you physically â€” they take an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. In some cases, you may barely be able to leave the house. When you do, you might worry about an accident, and this anxiety only makes your symptoms worse.
Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. You may also feel hampered by dietary restrictions or embarrassed by the nature of your disease. All of these factors â€” isolation, embarrassment and anxiety â€” can severely alter your life. Sometimes they may lead to depression.
One of the best ways to feel more in control is to find out as much as possible about IBD. In addition to talking to your doctor, look for information in books and on the Internet. You might find it especially helpful to talk to people who share your condition. Organizations such as the Crohn’s & Colitis Foundation of America (CCFA) have chapters set up across the country. Your doctor, nurse or dietitian can locate the chapter nearest you, or you can contact the organization directly. In many parts of the country, local newspapers also publish the times and locations of various support group meetings. If possible, take your family with you to meetings. The more they know about your disease, the better able they’ll be to understand what you’re going through.
Although support groups aren’t for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among people who understand what you’re going through.
Some people find it helpful to consult a psychologist or psychiatrist who’s familiar with inflammatory bowel disease and the emotional difficulties it can cause. Although living with ulcerative colitis or Crohn’s disease can be discouraging, the outlook is brighter than it was even just a few years ago.
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