Ulcerative Colitis and Crohn’s Disease are different forms of inflammatory bowel disease (IBD). Both involve inflammation of the colon and/or small intestine. Symptoms of both may include abdominal pain, diarrhea, blood in the stool, weight loss and fevers. Because the symptoms of these two illnesses are so similar, it is sometimes difficult to definitively establish the diagnosis. In fact, approximately 10 percent of colitis cases are unable to be classified as either Ulcerative Colitis or Crohn’s Disease. Inflammatory Bowel Disease (IBD) should not be confused with Irritable Bowel Syndrome (IBS). These are very different disorders.
Ulcerative Colitis (UC) always involves the colon. Typically the disease begins in the rectum and extends up the colon to varying degrees. If the inflammation is limited to the rectum, this is called Ulcerative Proctitis. If the disease involves the entire colon it is called pancolitis. In UC, the inflammation is typically limited to the lining of the colon. Since UC involves the rectum and the end of the colon, it typically will present with bloody diarrhea and urgency.
Crohn’s Disease involves the colon , small intestine and/or the stomach. In at least half of cases, Crohn’s Disease involves the area near the junction of small and large intestine (the ileum and cecum). Unlike Ulcerative Colitis, inflammation in Crohn’s involves the full thickness of the bowel wall. For this reason, Crohn’s is more likely to be complicated by the development of strictures or fistulas. Symptoms of Crohn’s disease vary depending on the part of the bowel that is affected (small intestine, colon, or both). Symptoms may include abdominal pain, diarrhea, blood in the stool, weight loss or less commonly, constipation.
The exact cause of Inflammatory Bowel Disease is unknown. Researchers believe that the cause involves a malfunctioning immune system. The immune system normally protects the body from infection. In people with IBD, however, the immune system mistakes microbes, such as bacteria that are normally found in the intestines, for foreign or invading substances, and then launches an attack. In the process, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation. Additionally, regulation of this process does not occur and the “attack” may continue indefinitely. This leads to ulceration and scarring of the bowel.
It is estimated that approximately one million Americans have IBD. About half have Crohn’s Disease and half have Ulcerative Colitis. Crohn’s Disease is primarily a disease of adolescents and young adults, but may strike at any age. People are most commonly diagnosed with Ulcerative Colitis in their thirties although once again, it can occur at any age. IBD tends to run in families, so we know that genes definitely play a role in the development of the disease. Studies have shown that about 20 to 25 percent of IBD patients have a close relative with either Crohn’s or Ulcerative Colitis. If a person has a relative with the disease, his or her risk is about 10 times greater than that of the general population. If that relative happens to be a sibling, the risk is 30 times greater. Fortunately, IBD is not contagious. You cannot “catch it” from a friend, family member or coworker.
Because there is no cure for IBD, the goal of medical treatment is to suppress the inflammatory response. This allows the intestinal tissue to heal and as a result, controls symptoms. Once symptoms are under control, then medical therapy is used to decrease the frequency of disease flares. Medications used to treat IBD include mesalamine drugs (Pentasa, Asacol, Colazal, Sulfasalazine), immunomodulating agents (Azathioprine, 6-mercaptopurine, Purinethol, Imuran), antibiotics, steroids (Prednisone) or biologic agents (Remicade).
Because body and mind are so closely related, emotional stress can influence the course of Crohn’s or Ulcerative Colitis. Although people occasionally experience emotional problems before a flare-up of disease, this does not imply that stress causes the illness. It is much more likely that a patient’s emotional distress is a reaction to the symptoms of the disease itself. It is not surprising that many patients find it difficult to cope with a chronic illness. Hopefully, IBD patients can receive emotional support from their families and physicians. Although formal psychotherapy is generally not necessary, some patients are helped by speaking with a therapist knowledgeable about the effects of chronic illness.
Women with inflammatory bowel disease face special challenges. Many women with IBD wonder if they will be able to conceive and deliver a healthy baby. Some wonder if their child will be predisposed to IBD. Others wonder if the medications used to treat IBD are safe during pregnancy. These issues should be discussed with your gastroenterologist, but in short, the answers to these questions are “yes”. The single greatest predictor of conceiving and delivering a healthy baby is excellent control of disease at the time of conception. And once disease is under control, most medications used to treat IBD can be safely used during pregnancy. Notable exceptions include methotrexate and some antibiotics. But once again, it is imperative that you discuss this issue with your gastroenterologist before becoming pregnant.
Crohn’s Disease and Ulcerative Colitis are chronic diseases which often require lifelong medications or even surgery. But the good news is that the vast majority of women (and men) with Crohn’s or Ulcerative Colitis can enjoy a quality of life on par with those unaffected by IBD!
