Whitney Barnes

Adult III Clinical

Crohn’s vs. Ulcerative Colitis…

What is Crohn's disease?

Crohn's disease is a lifelong inflammatory bowel disease (IBD).

Parts of the digestive tract get swollen and have deep sores
called ulcers. Crohn’s disease usually is found in the last part
of the small intestine and the first part of the large intestine.
But it can develop anywhere in the digestive tract, from the
mouth to the anus.

What causes Crohn's disease?

Doctors don't know what causes Crohn’s disease. You may get
it when the body’s immune system has an abnormal response
to normal bacteria in your intestine. Other kinds of bacteria
and viruses may also play a role in causing the disease.

Crohn’s disease can run in families. Your chances of getting it

are higher if a close family member has it. People of Eastern
European (Ashkenazi) Jewish family background may have a
higher chance of getting Crohn’s disease. Smoking also puts
you at a higher risk for the disease.

What are the symptoms?

The main symptoms of Crohn’s disease are belly pain and

diarrhea (sometimes with blood). Some people may have
diarrhea 10 to 20 times a day. Losing weight without trying is
another common sign. Less common symptoms include mouth
sores, bowel blockages, anal tears (fissures), and openings
(fistulas) between organs.

Infections, hormonal changes, smoking, and stress can cause

your symptoms to flare up. You may have only mild symptoms
or go for long periods of time without any symptoms. A few
people have ongoing, severe symptoms.

It’s important to be aware of signs that Crohn’s disease may

be getting worse. Call your doctor right away if you have any
of these signs:
 • You feel faint or have a fast and weak pulse.
• You have severe belly pain.
• You have a fever or shaking chills.
• You are vomiting again and again

How is Crohn's disease diagnosed?

Your doctor will ask you about your symptoms and do a

physical exam. You may also have X-rays and lab tests to find
out if you have Crohn’s.

Tests that may be done to diagnose Crohn's disease include:

• Barium X-rays of the small intestine or colon. In this test,

you will drink a white liquid to coat the inside of your
intestine so that the doctor can see it more clearly on an
X-ray.
• Colonoscopy or flexible sigmoidoscopy. In these tests, the
doctor uses a thin, lighted tube to look inside the colon.
• Biopsy. The doctor takes a sample of tissue and tests it to
find out if you have Crohn’s or another disease, such as
cancer.
• Stool analysis. This is a test to look for blood and signs of
infection in a sample of your stool.

How is it treated?

Your treatment will depend on the type of symptoms you have

and how bad they are.

The most common treatment for Crohn’s disease is medicine.

Mild symptoms of Crohn's disease may be treated with over-
the-counter medicines to stop diarrhea. But talk with your
doctor before you take them, because they may cause side
effects.

You may also use prescription medicines. They help control

inflammation in the intestines and keep the disease from
causing symptoms. (When you don't have symptoms, you are
in remission.) These medicines also help heal damaged tissue
and can postpone the need for surgery.

If your symptoms are severe and these medicines don't help,

you may need stronger treatment. You may get medicine
through a vein (IV). In rare cases, you may need surgery to
remove part of the intestine. Crohn's disease often comes back
after surgery.

There are a few steps you can take to help yourself feel better.
Take your medicine just as your doctor tells you to. Cut back
on sugar. Exercise, and eat healthy meals. Don't smoke.
Smoking makes Crohn’s disease worse.

Crohn’s disease makes it hard for your body to absorb

nutrients from food. A meal plan that focuses on high-
calorie, high-protein foods can help you get the
nutrients you need. Eating this way may be easier if you
have regular meals plus two or three snacks each day.
How do you cope with Crohn's disease?

Having Crohn’s disease can be stressful. The disease affects

every part of your life. Seek support from family and friends to
help you cope. Get counseling if you need it.

Many people with inflammatory bowel diseases look to

alternative treatments to improve their well-being. These
treatments have not been proven effective for Crohn’s disease,
but they may help you cope. They include massage,
supplements such as vitamins D and B12, and herbs like aloe
and ginseng.

What Is Ulcerative Colitis?

Ulcerative colitis affects the large intestine (also known as the

colon) and the rectum. It causes inflammation of the colon's
inner lining and the rectal wall, which become red, swollen,
and ulcerated, resulting in abdominal pain or cramping, rectal
bleeding, and diarrhea. Less common are fatigue, appetite
loss, and anemia. Some people also have joint pain, redness,
swelling, and liver problems.

An estimated 250,000 to 500,000 Americans have ulcerative

colitis, although Rubin believes that number is higher. "We
think the number is 700,000, and that's probably an
underestimate," he says, noting the statistics are taken from
small studies that may not represent the entire population.
Although most people are diagnosed before age 30, children as
young as 10 can develop the condition.
Ulcerative colitis is often confused with two other digestive
disorders: irritable bowel syndrome (IBS) and Crohn's disease.
The common irritable bowel syndrome affects both the small
and large intestines, causing abdominal pain, gassiness,
bloating, and changes in bowel habits -- constipation, diarrhea,
or both. IBS is also known as "spastic colon" and is easily
confused with ulcerative colitis.

Like ulcerative colitis, Crohn's disease causes inflammation in

the colon wall, but it can also inflame other organs, including
the small intestine and upper digestive tract. Other symptoms
include fever, anemia, and sometimes more serious
complications, such as intestinal blockage.

What Causes Ulcerative Colitis?

No one knows exactly what causes ulcerative colitis, but a

genetic link appears to play a part. Ashkenazi Jews are slightly
more likely to get it, and, while statistics vary, about 10% to
30% of people with the disease have at least one close family
member with it. Research also suggests it may be an
autoimmune disease, in which the body attacks its own healthy
organs and tissues. Contrary to popular belief, neither stress
nor specific foods cause ulcerative colitis, although both can
antagonize symptoms.

How Is Ulcerative Colitis Treated?

Medication, the core treatment, eases symptoms and sends

the disease into remission without flare-ups. Mild to moderate
ulcerative colitis often responds to drugs, such as
aminosalicylates that reduce the inflammation of the colon.
Doctors sometimes prescribe corticosteroid therapy, such as
prednisone or hydrocortisone, when aminosalicylates fail to
control the inflammation. In severe cases, medications that
suppress the body's immune system, which in turn reduces
inflammation, are used.

Because ulcerative colitis is a chronic disease, taking

medication on a regular basis is key. "A lot of people like to
think that once they get into remission, they don't need to
take medication. [But] the medication isn't only to control
symptoms; it's also to prevent them," Rubin says.
Does Ulcerative Colitis Cause Cancer?

Most people diagnosed with ulcerative colitis are concerned

they will develop colon cancer, but this is rare. The lifetime
incidence of colon cancer is 2.5% at 10 years, 7.6% at 30 years,
and 10.8% at 50 years. Those at higher risk for cancer have a
positive family history of colon cancer, long durations of
colitis, extensive colon involvement, and primary sclerosing
cholangitis, a complication of ulcerative colitis.

The American Cancer Society calls for screening with a

colonoscopy eight years after an ulcerative colitis diagnosis if
the whole colon is involved, and 12 to 15 years if only part of
the colon is affected. Follow-up screening should occur every
one to two years thereafter.

Does Surgery Help Ulcerative Colitis?

A small percentage of people may eventually require surgical

removal of their colon. (An opening is made in the abdominal
wall, and the end of the small intestine is attached to the skin
of the abdomen to form an opening; stool collects in a bag
attached over the opening.) This is done only if symptoms are
severe and don't respond to treatment, or if complications or
precancerous changes occur. Surgery is also, in essence, a
cure and removes the need for medication.