Crohn’s
Cronh’s Disease and Ulcerative Colitis Background
Crohn’s disease (CD) and ulcerative colitis are the major forms of chronic inflammatory bowel diseases (IBD) in the western world, and occur in young adults with an estimated prevalence of more than one per thousand inhabitants (Hugot, et al., 1996). These diseases can affect any portion of the gastrointestinal system all the way from the mouth to the anus and are associated with many other medical problems such as arthritis, skin condition, cancer, and kidney stones. Ulcerative Colitis is most likely to be diagnosed in early adolescence while Cronh’s Disease is more likely to be diagnosed between the ages of fifteen and thirty but can more rarely be diagnosed later in life. Both of these diseases are still being researched thoroughly and many questions remain.
The most common symptoms of IBD include abdominal pain, cramping, and diarrhea. In some more severe cases symptoms may also include rectal bleeding, urgent bowel movements, constipation and reoccurring fever. Most doctors will work to diagnose IBD doctors through the use a series of blood tests to determine if certain antibodies are present and to diagnose which type of inflammatory bowel disease is present in the patient. Blood tests will show particular signs of an immune response associated with inflammation and intestinal disease. In some cases stool samples can be collected to examine the content of the stool or there may also be a colonoscopy performed to examine the intestines first hand. However, by discovering the presence of white blood cells in a patient’s stool will indicate some type of an inflammatory disease, and then in can be further deduced as to whether it has arisen from an IBD.
One study looked at the whether the use of antibiotics 2 — 5 years before diagnosis was associated with the development of inflammatory bowel disease (IBD) and found that subjects diagnosed with IBD were more likely to have been prescribed antibiotics 2 — 5 years before their diagnosis (Shaw, Blanchard, & Bernstein, 2011). This possibly implicates antibiotic use as a predisposing factor in IBD etiology. However, there are many more potential contributing factors that are also subject. However, there is evidence that shows a greater risk if a close relative has the disease, suggesting a strong genetic component.
There is also research being conducted that is attempting to identify the disease specific loci for Cronh’s and UC. Identifying shared and disease-specific susceptibility loci for Cronh’s disease (CD) and ulcerative colitis (UC) would help define the biologic relationship between the inflammatory bowel diseases. More than 30 CD susceptibility loci have been identified. These represent important candidate susceptibility loci for UC. Loci discovered by the index genome scans in CD have previously been tested for association with UC, but those identified in the recent meta-analysis await such investigation. One study analyzed 45 single nucleotide polymorphisms, tagging 29 of the loci recently associated with CD in 2527 UC cases and 4070 population controls and collectively such data can help genetic relationship CD and UC and characterize common, as well as disease-specific mechanisms of pathogenesis (Anderson & al, 2009).
Cronh’s Disease and Ulcerative Patient Implications
Both diseases are severe and have many of the same symptoms. Whereas Crohn’s disease may cause inflammation anywhere along the digestive tract, UC generally occurs only in the large intestines. Furthermore, with Crohn’s the inflammation may appear in random patches while the inflammation in the UC is more uniform and generally the colon wall is thinner and more likely to produce bleeding from the rectum during bowel movements.
Figure 1 – Primary Differences (Columbia St. Mary’s, N.d.)
There is no cure for either disease however the symptoms of both diseases can be mitigated to some extent. With Crohn’s surgery may be performed to remove the diseased sections since they occur in patches. Furthermore, the drugs used to treat Crohn’s disease and ulcerative colitis are similar. The mainstays of treatment, 5-ASA medications and corticosteroids, are used to treat both conditions. However, there are some medications that have only proved effective in treating one form of IBD or the other. For instance, Cimzia (certolizumab pegol) and Humira (adalimumab) are currently only used to treat Crohn’s disease, although they are under study for use in ulcerative colitis (Tresca, 2013).
A 40-year-old male patient that you are caring for has been diagnosed with ulcerative colitis. He reports that one of his aunts was diagnosed with Crohn’s disease years ago and wants to know whether there is any similarity. I would be honest with this patient and tell them that they have a long and difficult path ahead. However, at the same time the research on both diseases is progressing rapidly and there may be breakthrough treatments ahead. There is no reason to be pessimistic about the future of living with such a disease. On the other hand, there are several reasons that one can still find optimism despite a diagnosis of Crohn’s or UC.
Both Crohn’s and UC are serious conditions that must be taken seriously. Crohn’s has a small advantage in the fact that there are more options with surgery to remove diseased sections of the intestines that have been harmed. That can provide some relief to patients. UC is more uniform in regard to its damage to the intestine and can cause complications for long stretches in the intestinal tract. Therefore there are fewer options to combat a diagnosis of UC since surgery could not possibly remove that much tissue in the intestines. Therefore there is a small advantage in the comparison that favors Crohn’s, yet this advantage is minimal considering the seriousness of both conditions.
Works Cited
Anderson, C., & al, e. (2009). Investigation of Crohn’s Disease Risk Loci in Ulcerative Colitis Further Defines Their Molecular Relationship . Gastroenterology, 523-529.
Columbia St. Mary’s. (N.d.). Differences Between Crohn’s Disease and Ulcerative Colitis. Retrieved from Gastroenterology Services: http://www.columbia-stmarys.org/Crohn_vs_Ulcerative_Colitis
Hugot, J., Puig, P.R., Olson, J., Lee, J.B., naom, I.D., Gossum, A., . . . Thomas, G. (1996). Mapping of a susceptibility locus for Crohn’s disease on chromosome 16. Nature, 821-823.
Shaw, S., Blanchard, J., & Bernstein, C. (2011). Association Between the Use of Antibiotics and New Diagnoses of Crohn’s Disease and Ulcerative Colitis. The American Journal of Gastroenterology, 2133-2142.
Tresca, A. (2013, October 13). The Differences Between Ulcerative Colitis and Crohn’s Disease. Retrieved from Inflammatory Bowel Disease: http://ibdcrohns.about.com/od/ulcerativecolitis/a/diffuccd.htm
Web MD. (N.d.). Slideshow: A Visual Guide to Inflammatory Bowel Disease (IBD). Retrieved from Slideshows: http://www.webmd.com/ibd-crohns-disease/crohns-disease/ss/slideshow-inflammatory-bowel-overview
Web MD. (N.d.). Slideshow: A Visual Guide to Inflammatory Bowel Disease (IBD). Retrieved from Slideshows: http://www.webmd.com/ibd-crohns-disease/crohns-disease/ss/slideshow-inflammatory-bowel-overview
