Inflammatory bowel disease is a group of diseases that involves chronic recurrent inflammation of the bowel and includes Crohn’s disease as well as ulcerative colitis. The two conditions are actually quite different and have different prognosis and treatment.
This is an inflammatory bowel condition which can affect any part of the gastrointestinal tract. It is most common in the small bowel (particular the last part of the small bowel called terminal ileum) and the colon. It is predominately a disease that occurs at young age (before age 30) but can develop later in life as well.
Cause of Crohn’s disease is unknown although family history of Crohn’s disease increases your risk of developing Crohn’s disease.
Symptoms of Crohn’s disease varies depending on the part of the gastrointestinal tract affect and the severity of it. Hallmark of Crohn’s disease is full thickness inflammation of bowel wall and ulceration. With time, complications such as stricture (narrowing) or fistula (abnormal communication) may occur. Symptoms may include abdominal pain, bloating, bloody diarrhoea, weight loss, rectal bleeding, pain or discharge around the anus and fever. Some patient may also develop inflammation in other organs such as the eye, liver and joints. These symptoms typically have a remitting and relapsing pattern.
Diagnosis and investigation can be difficult so a wide range of investigations are usually required. Typical investigation would include blood tests, x-rays, CT scans, specialised radiology tests such as small bowel series, MRI and colonoscopy.
Crohn’s disease is best treated by a gastroenterologist and a colorectal surgeon. Main treatment is medication to suppress the inflammation followed by medications to prevent the inflammation from recurring. A variety of anti-inflammatory medications are available.
Selective group of patients will benefit from surgery to treat Crohn’s disease. It i s usual necessary when patients develop a complication such as obstruction or fistula.
Ulcerative colitis (UC) is a chronic inflammatory condition that only affects the rectum and large bowel. The cause is unknown. It can occur at any age but most commonly in ages 20s to 40s. It can also occur in the elderly.
Inflammation always begins in the rectum and extends a variable distance towards the start of the large bowel. It is always continuous with no skip lesions (which is a feature of Crohn’s disease). Usual symptoms includes diarrhoea, passage of blood and mucus, urge to defaecate and abdominal pain. It may result in weight loss, anaemia, malnutrition and electrolyte imbalance. Severe complications such as toxic megacolon and perforation are uncommon but can be life threatening. UC increase the risk of bowel cancer and the risk increases with the duration of disease.
Diagnosis is made on symptoms, colonoscopy finding and biopsy results.
Most patients with UC are treated medically and best achieved by combined efforts between a gastroenterologist and a surgeon. Most medical treatments are based on anti-inflammatory medication or immunosuppresants. Some patients will require surgery and this will usually involve removing the entire large bowel with or without removal of the rectum as well. Indications of surgery include failure of medical treatment, complication of UC (such as toxic megacolon, perforation or acute haemorrhage) and development of malignancy in the large bowel.