Today we will deal with two common diseases concerning the gastrointestinal tract – Crohn’s disease & ulcerative colitis. They can be summarized under the term inflammatory bowel diseases (IBD). Let’s dive into it!
Crohn’s Disease
This is a chronic inflammatory bowel disease of unknown origin that usually occurs between the ages of 15 and 35 - men and women are equally affected. The disease manifests itself in the form of granulomatous inflammation, which affects the entire GI tract discontinuously and is particularly common in the terminal ileum (the end part of the small intestine)
Symptomes
Often relapsing, although chronically active forms are also possible. The symptoms often include:
bloodless, chronic diarrhea with symptoms similar to appendicitis
Tenesmen (painful urge to stool)
anorectal abscesses & fistulas
malabsorption syndromes: weight loss, growth disorders and anemia
extraintestinal syndromes: entheropathic arthritis, uveitis / epliscleritis and skin changes (e.g. erythema nodosum or pyoderma gangrenosum)
Diagnostics
Laboratory: CRP ↑, Anemia, potentially ASCA [an antibody against Saccharomyces cerevisiae] in 60% of the cases
Stool examination: exclusion of infectious bowel diseases - Calprotectin ↑, Lactoferrin ↑ indicate inflammatory processes in the intestine
Sonography: edematous thickened colon wall, possibly abscesses / fistulas visible
MRI or X-Ray according to Sellink
Ileoscopy and esophagogastroscopy: if Crohn's disease is suspected, the entire GI tract must be examined → long map-shaped ulcers ("snail traces") & hemorrhagic aphthous mucosal defects ("pinpoint lesions")
Biopsy: usually hyperplastic lymph nodes and typical epithelial cell granulomas
Therapy
Disease activity is assessed using the Crohn's Disease Activity Index (CDAI), which takes into account stool frequency, general condition, pain, body weight and extraintestinal manifestations, among other things.
Nicotine abstinence (!)
Topical glucocorticoids in active episodes (e.g. Budesonid which acts almost exclusively in the GI tract)
As a therapy escalation immunosuppressants such as TNF-α-antibodies (e.g. infliximab) are also used.
It is important to know that operations are used cautiously, as there is a strong tendency towards postoperative recurrences and no cure is possible due to the irregular infestation.
Ulcerative Colitis
This is also a chronic inflammatory bowel disease of unknown origin that usually occurs at a young age - white people are more often affected. The disease manifests itself first in the distal (aboral) rectum and from there continuously spreads proximally over the entire large intestine - the terminal ileum is rarely also affected, known as "backwash ileitis".
Symptoms
The guiding symptom is bloody-slimy diarrhea (often> 10 per day). In addition to that:
stomach pain & tenesmen
fever & massive feeling of illness especially during an acute episode
primary sclerosing cholangitis, arthritis and uveitis, episcleritis, erythema nodosum and pyoderma gangrenosum
There are also possible complications, such as massive bleeding, toxic megacolon, perforation and colorectal cancer.
Diagnostics
The Ulcerative Colitis can be differentiated into an chronic-intermittent, chronic-continuous and acute-fulminate form.
Laboratory: CRP ↑, Anemia, potentially pANCA [also associated with Lupus]
Stool examination: exclusion of infectious bowel diseases - Calprotectin ↑, Lactoferrin ↑ indicate inflammatory processes in the intestine
In the imaging the small intestine is normal & colon often lost his haustration, referring to the special segmentation of the colon (“bicycle tube”)
Colonoscopy shows inflamed, reddened colonic mucosa, contact bleeding and loss of wrinkle relief & haustration
Therapy
5-Aminosalicylate-Drugs [e.g. Mesalacin]: retarded, antiinfalmmatory & immunosuppressive effects
Topical glucocorticoids in active episodes [e.g. Budesonid]
As a therapy escalation immunosuppressants such as TNF-α-antibodies (e.g. infliximab), calcineurin inhibitors or purine antagonists [e.g. Azathioprine] are used.
A complete colon resection leads to healing - usually this is done in form of a proctocolectomy with ileoanal pouch anastomosis (connecting the small intestines with the anus after removing the colon).
Comparison: Crohn’s Disease vs Ulcerative Colitis
First thing to mention is that Crohn's Disease affects all parts & layers of the bowel and small intestines while the Ulcerative Colitis only affects the superficial layers.
The following table summarizes everything again in comparison.
In General
| Symptoms | Crohn’s Disease | Ulcerative Colitis |
|---|---|---|
| Stool Frequency & Type | ↑ or ↓ - often non-bloody | ↑↑↑ - bloody slimy |
| Nutritional status | ↓ | often normal |
| Pain | mostly continuous rather right lower abdomen | usually only before or during defecation rather left lower abdomen |
| Fistulas | common | rare |
Endoscopy & Imaging
| Characteristics | Crohn’s Disease | Ulcerative Colitis |
|---|---|---|
| Occurrence | Discontinuous involvement of the entire GI tract preferred location: terminal ileum and colon | Continuous involvement starting in the rectum involvement limited to the colon & healing through proctocolectomy possible |
| Histology | Transmural infestation granulomas giant cells | Mucosa and submucosa affected no granulomas |
Checklist
By now ...
✅ you can explain the term inflammatory bowel disease (IBD)
✅ you know the symptoms, diagnostics and therapy of Crohn’s Disease
✅ you know the symptoms, diagnostics and therapy of Ulcerative Colitis
✅ you are able to distinguish between Crohn’s Disease & Ulcerative Colitis
Do not forget to follow in order to not miss out on new content!
See you soon!
Congratulations @noogie! You have completed the following achievement on the Hive blockchain and have been rewarded with new badge(s) :
Your next target is to reach 1250 upvotes.
You can view your badges on your board and compare yourself to others in the Ranking
If you no longer want to receive notifications, reply to this comment with the word
STOPCheck out the last post from @hivebuzz: