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Inflammatory bowel disease – Crohn’s disease and ulcerative colitis

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What is inflammatory bowel disease?

Inflammatory bowel disease is the chronic inflammation of all or part of your digestive system(gut). Inflammatory bowel disease is the term used for two conditions, Crohn’s disease and ulcerative colitis. Both conditions can be debilitating and lead to complications.

What is the difference between inflammatory bowel disease and ulcerative colitis?

Although the 2 conditions have similar symptoms and similar treatments there are differences between them. Crohn’s disease can affect any part of the digestive system whereas ulcerative colitis affects the large intestine (colon) and the rectum.

The digestive tract

The digestive tract or gut is a long tube that’s starts at your mouth and ends at the anus. When we eat food passes down the oesophagus, then into the stomach and then into the small intestine.

For more information on ulcerative colitis click here.

What is Crohn’s disease?

Crohn’s disease is a long term inflammatory bowel condition that commonly starts between the ages of 15-40. Crohn’s disease gets its name from Dr Burrill Crohn a doctor who first reported cases in the 1930’s.

What causes Crohn’s disease?

The exact cause of Crohn’s disease is unknown. It is thought that it might be caused by the immune system not working correctly and attacking all bacteria even the healthy bacteria. It was once thought that diet or stress may have played a part but now it is thought to aggravate the symptoms but not cause it.  Crohn’s also tends to be more common in people who smoke and if you have a close relative with the condition you are more likely to develop it. Crohn’s is also more common in Jewish people and Caucasian (white) people. Crohn’s disease occurs more in the Western world such as the UK and USA, this suggests the modern lifestyle may play a part or it might be that it goes undiagnosed in the developing world.

What are the symptoms of Crohn’s disease?

Crohn’s disease causes long-lasting inflammation of the lining of the digestive tract. Inflammation is the body’s immune systems reaction to injury or irritation and can cause redness, swelling and pain. Symptoms vary from person to person the symptoms you experience will depend on the area of the digestive tract that is affected and may include the following:

  • Severe and persistent diarrhoea
  • Fatigue, extreme tiredness.
  • Fever, many people experience a low-grade temperature.
  • Unexplained weight loss
  • Blood in your stools.
  • Abdominal pain and cramps.

Symptoms can come and go and range from mild to severe during a flare-up.  The inflammation can affect the large intestine, small intestine or both and affects the body’s ability to digest food and eliminate waste in a healthy way. Children with Crohn’s disease may grow at a slower rate than expected.

What is the diagnosis for Crohn’s disease?

If you experience any change of bowel habit or have any of the symptoms mentioned above then you should go and see your doctor. Your doctor will speak to you about your symptoms and check for other causes of your symptoms, such as diet, medications or travel. Your doctor may examine your stomach and carry out standard tests like blood pressure, weight and temperature. To confirm a diagnosis of Crohn’s disease you will require one or more tests. Blood tests to check for levels of inflammation, infection and anaemia may be carried out. You may be asked to give a stool sample to look for hidden blood in stools or infection.  You may then have an endoscopy, this is the general term for a thin, flexible tube, which has a tiny camera and light on the end. The tube is inserted into the body via a natural opening or a small incision, this enables the doctor to look at your internal organs. When the endoscope is inserted into your anus to look at your colon this is known as a colonoscopy. If you have symptoms coming from the upper part of your digestive system then you may have an upper GI endoscopy, the tube in this exam is inserted through your mouth. The doctor can also take a biopsy during the procedure. A CT or MRI scan may also be required to look at the extent and exact location of the inflammation.

What is the treatment for Crohn’s disease?

There is currently no cure for Crohn’s so treatment will depend on your symptoms and the severity of the condition. If symptoms are mild then you may require no treatment.

Treatment for Crohn’s is aimed at relieving symptoms and preventing them from returning. Treatment option include medicines, diet, lifestyle changes and surgery.

There is no research to say that any particular food causes Crohn’s. However, some people find certain foods might trigger their symptoms or make them worse. It would be worth to keep a food diary to identify any possible food triggers. If you have any blockages then you should avoid eating anything that is hard to digest, such as nuts, seeds, fruit and vegetable skins, rice and beans.

A course of steroids is usually the first treatment your doctor might suggest, steroids can improve symptoms by reducing the inflammation. These medications can have side effects so when your symptoms start to improve your dose might start to be reduced.

If your symptoms don’t improve or return then further treatment may be necessary. Medicines to supress your immune system may be prescribed. These drugs also reduce inflammation.

There are also over the counter drugs which can ease some of the milder symptoms, loperamide can be helpful in reducing diarrhoea though you should discuss taking these drugs with your doctor and they should be not taken long term. To purchase loperamide click here. Painkillers such as paracetamol can help control pain but again you should speak to your doctor as they may not be suitable for you. To purchase paracetamol click here.

A high percentage of people with Crohn’s will require surgery at some point. The 2 most common operations are surgery to widen the narrowed part of the intestine or surgery to remove the damaged portion of the intestine. Sometimes the whole colon and perhaps the rectum might need to be removed, this procedure is called either a proctocolectomy with permanent ileostomy or a proctocolectomy with an ileoanal pouch.  This means that the small intestine is used to pass waste out of your body instead of your colon. The small intestine is either used to form an internal pouch or the surgeon will create a hole in the abdominal wall and the waste is collected into an external bag.

Are there any long-term effects of Crohn’s disease?

Crohn’s disease is an ongoing disease and so has flare-ups and there are times when you have few or no symptoms.  The disease affects people differently, some people might have frequent and severe flare-ups and others might have few flare-ups and have long spells with no symptoms.

Over time, the inflammation can lead to the narrowing and scarring of the bowel wall, over time this can cause obstruction and block the flow of the digestive contents. Ulcers can also develop anywhere in your digestive tract. These ulcers cans extend completely through the intestinal wall creating a fistula. A fistula can cause symptoms such as a contestant throbbing, pain, high temperature or blood/pus in your stools.

Arthritis is a common complication of Crohn’s, it is thought this might be due to the inflammation in the bowel causing an overreaction in the immune system, leading to an inflammatory reaction in other areas of the body.

People with Crohn’s also have an increased risk of kidney stones and gallstones.

Though rare, a severe flare up can lead to complications such as a perforation, this happens when a hole develops in the bowel wall. The contents of the bowel can then spill out into the stomach and can cause a life-threatening infection called peritonitis. This requires urgent medical attention, symptoms may develop quickly and include severe pain, vomiting and fever.

If your Crohn’s disease affects all or most of your colon then you have a slightly increased risk of colon cancer.  People who are at risk will be advised to have regular check-ups.

What is ulcerative colitis?

Ulcerative colitis is a long-term condition in which the colon and rectum become inflamed, causing redness, swelling and pain, ulcers can also develop.

What causes ulcerative colitis?

The exact cause is unknown though it is believed that ulcerative colitis is an auto-immune disease. This means that the immune system that normally protects the body from infection attacks healthy tissue. It also appears that ulcerative colitis is hereditary, meaning if a family member has it you are more at risk of developing it also. Ulcerative colitis can develop at any age but is more commonly diagnosed in 15-25 year olds.

What are the symptoms of ulcerative colitis?

The main symptoms of ulcerative colitis are like those of Crohn’s and include recurring diarrhoea, this is due to the colon and rectum not absorbing as much water as usual. The diarrhoea may contain blood and pus. Other symptoms include abdominal pain and the need to empty your bowels frequently. You may also experience fatigue, and weight loss. Ulcers can develop on the colon’s lining, these can bleed or produce pus.

The severity of symptoms will depend on how much of the colon and rectum are inflamed. Some people may go for weeks or even years with few or no symptoms then have a flare-up. During a severe flare-up other symptoms such as mouth ulcers, painful and swollen joints, high temperature or blood in stools may develop.

How can I avoid getting ulcerative colitis?

There is no evidence that what you eat causes the condition but certain foods can aggravate your symptoms. Keep a food diary to eliminate the foods that cause your symptoms to flare. Foods that commonly cause symptoms are:

  • Dairy foods
  • Caffeine
  • Spicy foods
  • Fizzy drinks
  • Alcohol

You should also ensure you stay healthy get enough rest and exercise regularly. Stress can also make your symptoms worse so learn how to manage stress levels.

What is the diagnosis for ulcerative colitis?

If you are experiencing any of the associated symptoms then you should visit your doctor. Your doctor will discuss your symptoms and check for other causes of your symptoms, such as diet, medications or travel. Your doctor may examine your stomach and carry out standard tests like blood pressure, weight and temperature. To confirm a diagnosis, you will require one or more tests. Blood tests to check for levels of inflammation, infection and anaemia may be carried out. You may be asked to give a stool sample to look for hidden blood in stools or infection.  You may then have an endoscopy, this is the general term for a thin, flexible tube, which has a tiny camera and light on the end. The tube is inserted into the body via a natural opening or a small incision this enables the doctor to look at your internal organs. When the endoscope is inserted into your anus to look at your colon this is known as a colonoscopy. If you have symptoms coming from the upper part of your digestive system then you may have a upper GI endoscopy, the tube in this exam is inserted through your mouth. The doctor can also take a biopsy during the procedure. A CT or MRI scan may also be recommended to see how much of the area is affected.

What is the treatment for ulcerative colitis?

Ulcerative colitis can’t be cured so treatment is aimed at relieving symptoms and prevent them from reoccurring. Medications such as steroids is usually the first treatment your doctor might suggest, steroids can improve symptoms by reducing the inflammation. These medications can have side effects so when your symptoms start to improve your dose might start to be reduced.

If your symptoms don’t improve or return then further treatment may be necessary. Medicines to supress your immune system may be prescribed. These drugs also reduce inflammation.

There are also over the counter drugs which can ease some of the milder symptoms, loperamide can be helpful in reducing diarrhoea though you should discuss taking these drugs with your doctor and they should be not taken long term. Painkillers such as paracetamol can help control pain but again you should speak to your doctor as they may not be suitable for you. To purchase paracetamol please click here.

If you run a low-grade fever then you may be given antibiotics to control the infection.  If after trying diet, lifestyle changes and drugs your symptoms are no better then your doctor might recommend surgery.  The most common form of surgery is to remove your colon and rectum, this procedure is called either a proctocolectomy with permanent ileostomy or a proctocolectomy with an ileoanal pouch.  This means that the small intestine is used to pass waste out of your body instead of your colon. The small intestine is either used to form an internal pouch or the surgeon will create a hole in the abdominal wall and the waste is collected into an external bag.

Are there any long-term effects of ulcerative colitis?

Over a third of people with ulcerative colitis go on and develop other conditions. Arthritis is a common problem causing inflammation in the joints, this can mirror the inflammation in the colon. Unlike typical arthritis symptoms, people can suffer symptoms when they are young and symptoms seem to improve when the inflammation in the colon is under control. People with ulcerative colitis are also at risk of thinner bones this could be due to taking certain drugs, because of the increase in the body’s inflammatory response or because the body isn’t absorbing calcium as it should.

People with ulcerative colitis are also at risk of DVT (Deep Vein Thrombosis), this is more common during a flare-up. If you have had years of severe symptoms then you have a slightly increased risk of colon cancer, you should have regular colonoscopies to check for signs as it can be treated more successfully if detected early.

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