Signs and symptoms of crohns disease and ulcerative colitis

Inflammatory bowel disease (IBD) is a term for two conditions (Crohn’s disease and ulcerative colitis) that are characterized by chronic inflammation of the gastrointestinal (GI) tract. Prolonged inflammation results in damage to the GI tract.

What are the main types of IBD?

Croh’s Disease and Ulcerative Colitis

What are the common symptoms of IBD?

• Persistent diarrhea.
• Abdominal pain.
• Rectal bleeding/bloody stools.
• Weight loss.
• Fatigue.

What causes IBD?

The exact cause of IBD is unknown, but IBD is the result of a weakened immune system. Possible causes are:

• The immune system responds incorrectly to environmental triggers, such as a virus or bacteria, which causes inflammation of the gastrointestinal tract.
• There also appears to be a genetic component. Someone with a family history of IBD is more likely to develop this inappropriate immune response.

How is IBD diagnosed?

• A combination of endoscopy (for Crohn’s disease) or colonoscopy (for ulcerative colitis) and imaging studies, such as:
  • Contrast radiography.
  • Magnetic resonance imaging (MRI).
  • Computed tomography (CT).
• Stool samples.
• Blood tests.

How is IBD treated?

• Types of common medications to treat IBD:
  • 5-aminosalicyclic acids.
  • Immunomodulators.
  • Corticosteroids.
  • Biologics.
• Surgeries to remove damaged portions of the gastrointestinal tract.

Treating Crohn’s and Colitis

It’s important to know that neither Crohn’s nor ulcerative colitis can be cured, though doctors will work with patients to manage symptoms. The two illnesses are generally treated with the same types of medication, although each patient may respond differently to the same drug. The goal of treatment is to reduce the inflammation, which in turn reduces symptoms, allows your body to repair damaged tissue, and helps slow the progression of the disease.

Today, many patients get a relatively new class of drugs, called biologics, which are live antibodies that are given to patients to help their immune cells fight the inflammation. Other classes of drugs include immunomodulators, which help tamp down the immune system’s inflammatory response, and aminosalicylates, the oldest class of drugs, which are used to help keep the disease in remission. According to the Crohn’s and Colitis Foundation, immunomodulators can take up to six months to become fully effective, so doctors usually prescribe them along with fast-acting steroids that patients will ideally go off of once the immunomodulators reach their full potential. “I absolutely think that with these new drugs, it’s a new era in the treatment of inflammatory bowel disease,” says Dr. Cohen.

Diet is also an important factor in managing flare-ups of both diseases. High-fiber vegetables like broccoli and cauliflower, uncooked produce, and unpeeled fruit are foods that people with IBD have difficulty digesting. Dairy and fatty or greasy foods can also trigger symptoms. Try eating cooked vegetables, nut butters instead of whole nuts, and lean meats and fish. But each body is different. Working with a dietitian can help you determine which foods you should avoid

When Surgery Is Needed

If medication isn't reducing the inflammation and IBD progresses, surgery may be needed. This is where people with ulcerative colitis tend to fare better.

“If the colon gets bad enough in ulcerative colitis, it’s removed and replaced with an internal pouch, which functions like a colon,” says Cohen. According to the Mayo Clinic, colectomy surgery — whether partial or full — usually requires additional procedures that reconnect the remaining portions of the digestive system so they can     still rid the body of waste.

However, things are looking up. A study published in December 2019 in the Journal of Gastrointestinal Surgery found that due to advances in medicine and medical care for IBD patients over the past decade, the number of hospitalized patients with ulcerative colitis who require a colectomy decreased by nearly 50 percent between 2007 and 2016.

According to the Crohn’s and Colitis Foundation, proctocolectomy with ileal pouch–anal anastomosis — usually called J-pouch surgery — is the most common surgery performed on people with UC who have not responded to medication. Surgeons remove the rectum and colon and then create a temporary opening in the abdomen, called a loop ileostomy, which will allow waste to move from the small intestine into an ostomy bag that sits outside the body while the digestive system heals from the surgery. In some cases a stoma, or permanent opening in the abdomen that funnels waste into an external bag, is required, notes the Mayo Clinic.

Since Crohn’s can occur anywhere in the digestive tract, simply removing the colon won’t cure the disease. According to the Cleveland Clinic, 70 to 80 percent of people with Crohn’s disease will eventually require surgery. Typically in people with Crohn’s, smaller pieces of the colon will be removed to try and preserve as much of the healthy intestines as possible. This requires more frequent surgeries.

In severe cases, Crohn’s can cause tears or holes in the bowel, causing a fistula, or a tunnel that leads from one section of the bowel to another. Fistulas are serious and need to be repaired. About one-half of Crohn’s patients will require surgery within 10 years of diagnosis, compared with about 10 to 30 percent of adults with ulcerative colitis. But treating both Crohn’s and ulcerative colitis early and effectively may slow the progression of the diseases, and delay the need for surgery.

Additional reporting by Kaitlin Sullivan.

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