Crohn’s disease and ulcerative colitis are the two most common forms of inflammatory bowel disease. Consultant Gastroenterologist Dr Simon Scott Campbell from BMI The Alexandra Hospital answers the most frequently asked questions about these two conditions.
Dr Campbell is a board member for Crohn’s and Colitis UK.
What is Crohn’s disease and what is colitis?
Crohn’s and colitis are the two most common forms of inflammatory bowel disease (IBD).
IBD is a crohnic condition, meaning it persists over time. There is no cure for IBD; people with the condition have it for life.
There are 4 types of IBD: Crohn’s disease, ulcerative colitis, indeterminate colitis and microscopic colitis.
Crohn’s disease causes inflammation in the gut. It can affect the gastrointestinal tract anywhere from the mouth to the anus, although the most common area affected is the end of the small intestine (the ileum).
Colitis is a generic term for inflammation of the large bowel (colon). Most people with colitis have ulcerative colitis, which causes inflammation and ulceration of the inner lining of the colon and rectum.1
What are the common symptoms of Crohn’s and colitis?
Inflammatory conditions affecting the gut almost always give symptoms of diarrhoea.
Other common symptoms include abdominal cramps, tiredness and fatigue, loss of weight or appetite, anaemia and mouth ulcers.
You might also experience bloating and wind, and may suffer from constipation too.2
Do the symptoms of Crohn’s and colitis differ?
In Crohn’s disease abdominal pain can often predominate as well as weight loss and watery diarrhoea, while in ulcerative colitis bloody diarrhoea predominates.
However, in general most symptoms are shared.
It’s important to note that IBD affects people in many different ways. So two people with Crohn’s disease will not necessarily have the same symptoms.3
How can you differentiate symptoms of IBD from symptoms of IBS?
In the early stages of inflammatory bowel disease, symptoms can be impossible to differentiate from irritable bowel syndrome (IBS).
Weight loss, bloody diarrhoea and significant diarrhoea (four or more bowel movements per day) are not typical of IBS, so can indicate IBD.
Still, investigations are often needed to help differentiate between the two conditions. These might include stool analysis, colonoscopy or even capsule endoscopy.
Are Crohn’s and colitis hereditary or can you develop the condition?
The cause of inflammatory bowel disease remains unknown.
Genetic or hereditary risk is increased in offspring from parents with Crohn’s disease and ulcerative colitis. There have been more than 50 genes identified as contributing to the risk of developing IBD.4
There is more of a genetic risk involved in Crohn’s disease. Around 15% of patients with Crohn’s disease will have a family member with IBD.5
However, it is far from a certainly that you will pass on inflammatory bowel disease to your children.
Can IBD be prevented?
No, unfortunately inflammatory bowel disease cannot be prevented.
It can present at any age, but there is an increased incidence in early adulthood.
How is inflammatory bowel disease diagnosed?
Diagnosis can be made using a combination of stool sampling, blood tests, colonoscopy, capsule endoscopy and also scans such as CT or MRI.
You will probably only need to have some of these tests and not all, however as the condition is crohnic and can get worse, you may have to have repeat tests as time goes on.6
What should I do if I think I may have Crohn’s or colitis?
If you think you have inflammatory bowel disease, you should speak to your doctor now and not put it off.
If the condition is left undiagnosed, you may become dehydrated or malnourished and you may end up having to go to hospital for special drug treatments. Occasionally surgery is needed to remove the bowel.
In the long term there is a small increased risk of bowel cancer, however this risk is significantly lowered with effective management of IBD.
What treatments are available for IBD?
The majority of treatments for inflammatory bowel disease revolve around drug therapy. This might be in tablet form or it might be injectable drug treatments (both intravenous and subcutaneous).
Drug treatments are designed to reduce inflammation, which in turn reduces the damage to the bowel wall and helps the bowel wall to heal.
Over the last ten years or so there has been an explosion of new drug treatments for Crohn’s and colitis, which have dramatically changed the outlook of IBD in the long term.
Surgery is only used as a last resort in extreme cases. In the severest cases, the colon may be removed and a stoma created. This diverts waste from your digestive system in place of the colon.
Because of the improved effectiveness of new drugs, surgery is becoming less and less common for people with IBD.
What can help to manage the condition?
Effective management of inflammatory bowel disease requires close follow-up with an expert in the field.
The goal of treatment is to keep patients in remission, allowing them to have a normal quality of life where their IBD has minimal effect on their day-to-day activities.
If you are suffering with Crohn’s or colitis, carefully following the drug treatment prescribed by your specialist is paramount.
The condition follows a relapsing and remitting pattern, and during a relapse you may be prescribed different or extra medications. Make sure you take these as advised also.
Remember to look after your mental wellbeing too
As with any crohnic illness, IBD can affect you mentally as well as physically.
Talking can be the first step towards getting the help you need. Talk to your doctor, talk to your loved ones, talk to a counsellor.
Joining a support group – such as Crohn’s and Colitis UK – can also be incredibly helpful.
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