They are bowel inflammatory diseases. Ulcerative Colitis affects the large bowel. In medical language, it is mentioned as NURC – Non Specific Ulcerative Rectocolitis. Rectocolitis because it also involves the rectum; non specific because its cause is unknown. Ilitis (Crohn’s Disease) affects the last portion of the small bowel (ileum) and it may also affect the large bowel and other portions of the digestive tract.
2) Do the terms Crohn’s Disease, Ilitis and Regional Enteritis mean the same thing?
Ilitis means ileum inflammation. The ileum is the distal portion (last) of the small bowel. In 1932, when dr. Burril B. Crohn and his colleagues identified ilitis for the first time as a disease they called it Regional Ilitis. “Regional” means basically that in this disease there are sick areas in the bowel which alternate with healthy areas.
The term Regional Enteritis was employed furtherly to describe that inflammation when it is present in other intestinal areas, not only in the ileum. Nowadays we know that this disease can also affect the colon (large bowel), where then a known condition as “GRANULOMATOSIS COLITIS” would take place (granulome are microscopic lesions that are found in the intestine wall of Crohn’s disease patients.
In order to avoid misunderstandings, the name Crohn’s Disease can be used to describe the disease wherever it may be present.
3) Are Ulcerative Colitis and ESPASTIC COLITIS the same?
No, they are not. ESPASTIC COLITIS is an incorrect term used to describe a disturbance of motility in the bowel called “Irritable Bowel Syndrome”. That syndrome does not present inflammation and does not have relation with the IBDS.
4) What is the incidence of the Inflammatory Bowel Diseases?
The incidence in Brazil is unknown. It is estimated that there are more than 2 million patients of IBD in the United States.
Men and women seem to be affected equally. Although Crohn’s Disease and NURC affect individuals of all ages, they affect youngsters mostly, where almost all cases are diagnosed before the age of 30.
It is estimated that, in the United States, at least 200.000 children of age under 16 suffer from these diseases.
5) What are the first symptoms of NURC and Crohn’s Disease?
NURC’s first symptoms are diarrhea (often with blood), evacuatory urgency and bad odor.
The diarrhea may either evolve slowly or start suddenly. Joint pain and skin lesions may also be present. In Crohn’s Disease, abdominal pain and diarrhea happen frequently after meals. Joint pain, appetite loss, weight loss and fever are common. Other early symptoms of Crohn’s Disease are lesion in the anal region, including hemorrhoids, lesions, fistula and abscesses.
6) What exams are performed for the diagnosis of these diseases?
There is no specific exam to identify the IBDs but patients may take barium X-rays (of the upper part – intestinal transit or of the lower part – opaque enema) or rectosigmoidoscopy and colonoscopy (light TUBE introduced in the anus).
7) What is the cause of Crohn’s Disease and NURC?
The exact cause of IBDs is unknown. It is known, however, that are not TRANSMITTABLE and that alterations in the defenses of the body occur in patients of these diseases and that triggers an inflammatory process.
8) Are these diseases inherited?
Researchers have not verified any specific gen that could “transmit” the diseases. Therefore, they are not considered genetic diseases.
However, it is known that the diseases tend to occur most frequently among members of families where cases of the diseases had been registered before.
9) Can emotional stress trigger one Bowel Inflammatory Disease?
Considering that body and mind are connected, emotional stress can influence the course of Crohn’s Disease, Ulcerative Colitis or any other disease.
Although emotional issues occasionally come before the appearance or recurrence of one IBD, that does not mean, necessarily, that those issues were the cause. It is likely that the anxiety experienced by people who have IBD is one reaction to the painful symptoms and limitations that are consequences of the condition.
10) What drugs are used to treat those conditions?
Drugs most used are sulfalazine, mesalazine and corticoids. All of them reduce inflammation. Sulfalazine is used to treat mild to moderate symptoms to both diseases as well as to try to stop recurrence, once remission has been obtained (reduce of intensity).
Corticoids are used when symptoms are more severe: the dosage is reduced gradually until discontinuity when symptoms are better. Other drugs are azatioprine and 6-mercaptopurine – they are immunosupressor drugs that try to reduce the symptoms, heal the fistula and reduce or eliminate the dependence some people have to corticoids.
Metronidazol has been useful to treat perianal complications of Crohn’s Disease and antibiotics are also used to fight local infections. Anti-TNFs, biological drugs have been used with excellent results both to Crohn’s Disease – since 1999 – and ulcerative colitis – since 2005, in several patients with specific prescription. The
only medication approved up to date is Infliximabe. This drug is applied intravenous.
11) Do these drugs have side effects?
All medications may have side effects. Sulfalazine may cause nausea, headache, vomit, anemia, other alterations in the blood and skin eruptions. The physician should observe his patient and beware of the appearance of those effects in order to decide to either continue or stop the use of the medication.
12) Can surgery cure either Crohn’s Disease or Ulcerative Colitis ?
Surgery might be necessary in Crohn’s Disease when clinical treatment is not efficient to control the symptoms or when there is complication, such as intestinal obstruction. Surgery may allow the patient to remain symptom-free but does not cure the disease, once recurrence in the same area or around the area where surgery has been performed (anastomosis) is very common.
In the Ulcerative Colitis, surgical total remove of the colon or rectum (full proctocolectomy) provides definitive cure.
In most of the cases, one artificial opening of the ileum in the abdominal wall (ileostomy) should be performed, through which stool goes out and is collected in one pouch adhered to the skin.
Another type of surgery is the ileo-anal anastomosis, in which the rectum is preserved (deletes only the cover of mucosal lining), which shall be attached to a bag made with ileus. This usually allows the patient to evacuate, while preserving the use of the rectal muscles.
13) When a surgery is necessary to treat Ulcerative Colitis, will it be possible to avoid Ileostomy?
There are recent surgeries where one ileum pouch is created inside the abdomen to collect stool. With those surgeries the use of pouch becomes unnecessary. One of them consists of one “continent” ileostomy, where an ileum pouch is built inside the abdominal wall. This pouch should be emptied regularly through a small tube that surpasses the “valve”. Another kind of surgery is the ileoanal anastomosis, in which the rectum is preserved (only the inner tissue is removed) and is united to one pouch made with the ileum. That allows the patient to evacuate normally, preserving the use of rectal muscles.h
14) Does a diet play an important role both in Crohn’s Disease and Ulcerative Colitis?
A healthy diet is essential to any chronic disease but especially in those where there is appetite loss, diarrhea and, sometimes, bad absorbing of food, factors that damage the assimilation of fluids, nutrients, vitamins and minerals.
Although the diet is not the cause of the diseases, it is true that mild food disturbs less that the spicy or fiber-rich ones when the condition is in action. Except for milk restriction in patients who present intolerance to lactosis, most gastroenterologists tend to be more flexible as for the diet of patients who have these diseases.
Although studies in people with Crohn's disease of the colon are not numerous or complete, many researchers believe that the risk of cancer in these patients is lower than in ulcerative colitis, although higher than in the general population. In both cases (ulcerative colitis and Crohn's disease), cancer risk seems to be associated with long-term illness that affects the colon in its entirety. Cancer of the small intestine is extremely rare in the general population. Despite the risk of its occurrence in cases of long duration of Crohn's disease, the number of cases is too small.
15) Can people with IBD develop cancer?
It is important to know that colon and rectum cancer are both frequent in the general population. Studies have shown that people who have had Ulcerative Colitis that affected all the colon and for periods of time not shorter than 8 to 10 years run a significant risk to develop cancer. People with Ulcerative Proctitis do not seem to have an increased risk of having cancer.
Although studies on people with Crohn’s Disease are not complete nor many, several researchers believe that the risk of cancer in those patients is lower than to those with Ulcerative Colitis, although higher than to the population as a whole. In both cases (Ulcerative Colitis and Crohn’s Disease), the risk of cancer seems to be associated to a long term disease that affects the colon as a whole. Besides the risk of its appearance in long term cases of Crohn’s, the number of cases is very small.
16) What should be done to diagnose the cancer of colon?
Even when the disease is not active it is convenient to perform one opaque enema and or colonoscopy in regular intervals of 1 or 2 years.
During colonoscopy, small fragments of the mucose should be removed to be examined by a pathologist (biopsy). This procedure will help to detect microscopic alterations in the structure of the cells which are believed to be pre-maligned (“epithelial dysplasia”).
In the case of an important epithelial dysplasia there is a strong possibility of cancer in some portions of the colon and this is why, in those cases, most doctors prescribe proctocolectomy.
17) Is it possible to lead a normal life and have IBD?
Although they are chronic diseases, the IBDs are not considered fatal diseases. Almost all patients lead a useful and productive life, while sometimes they might need hospitalization during those periods of high activity of the disease. However, in-between those periods of time, when the condition is in its worst, most patients feel well and become reasonably free of symptoms, leading a very normal life.
