Crohn's disease and ulcerative colitis are the principal types of inflammatory bowel disease. They are characterised by their episodic progression: Phases of inflammation and related symptoms alternate with symptom-free intervals. Those phases of rest can last over long periods.
It is still not certain what causes inflammatory bowel disease. Based on current knowledge, a complete cure is not possible.
In Crohn’s disease, all sections of the gastrointestinal tract can be affected. The inflammation can invade all wall layers of the intestinal areas affected. Expansion is irregular, with healthy and inflamed sections alternating. In addition there is a tendency to abnormal connections to surrounding tissue (fistulisation) and abscesses.
In most cases, Crohn’s disease first appears between the ages of 15 and 35. Men and women are roughly equally affected. In Germany, there are around 5 new cases per 100,000 inhabitants every year. Crohn’s disease cannot currently be cured; only the symptoms can be treated.
Crohn’s disease is a serious illness. During symptom-free phases, a normal life is possible but an acute flare-up is painful and may require patients to take up bed rest or even be committed to a hospital. Crohn’s disease increases the risk of developing colon cancer.
In the case of colitis ulcerosa, the inflammation is restricted to the colon. The occurrence is episodic. Principally affected are the mucous layers on the surface of the colon. The inflammation spreads evenly from the rectum up the colon, with the distance affected varying from case to case. Inflammatory ulcers develop, with slight bleeding. Typical symptoms of the disease are bloody stool, diarrhoea and pain in the abdomen.
Colitis ulcerosa is a serious disease. In phases of intermission normal life may be possible for the patient, but an acute episode is often not only painful, it may force the patient to stay in bed, and even a stay in hospital may be necessary. Colitis ulcerosa comes with an added risk of contracting cancer of the bowel.
Particularly vulnerable to colitis ulcerosa are young adults between the ages of 16 and 25. In Germany there are around four cases of the disease per 100,000 head of the population every year. Men are more frequently affected than women. Even children may contract the disease.
Typical symptoms are diarrhoea and abdominal pain or cramps. Stools may contain mucus and blood. Symptoms of intestinal obstruction (ileus) can occur. Additionally, patients may experience fever, weight loss, tiredness and exhaustion. During active phases of the disease, performance is often very much limited.
In both diseases, around half of patients experience changes outside the gastrointestinal tract: These affect in particular the joints, skin, eyes, liver and the biliary tract.
Until today, the exact causes of inflammatory bowel disease remain unknown. It is considered certain, however that the inflammation occurs due to a combination of different factors:
Ulcerative colitis and Crohn’s disease are not typical hereditary diseases but different genes seem to carry a disposition for a certain tendency to develop the condition.
It is suspected that there is a malfunction of the immune system when dealing with bacteria in the gut flora. Dietary habits can activate the disease. Most patients are intolerant to certain types of food. Experts presume that smoking increases the risk of developing the disease.
Psycho-social stress is suspected to activate inflammatory bowel disease if there is a corresponding disposition.
There is no special diet or dietary therapy capable of bringing about an intermission for people suffering from Crohn’s disease or colitis ulcerosa. The symptoms of acute inflammation can however be alleviated by temporary change of diet in favour of easily digestible, low fibre foods. In many cases, patients become intolerant of certain foodstuffs.
Many patients suffer, as the disease progresses, from specific deficiencies like anaemia, low iron, lack of folic acid or reduced bone density. Medication can be taken to compensate for these conditions.
Basically patients are advised to make frequent breaks a part of their daily routine, and avoid stress as far as possible.
During the physical exam, physicians check whether there is any pain when pressure is applied to the abdomen. They will also examine the patient’s mouth and anus for typical symptoms.
Blood tests will show how extensive the intestinal inflammation is and how much blood is being lost. For this purpose, CRP levels are measured initially and continuously, and blood counts are taken. In addition, physicians can test the blood for elevated liver parameters.
Physicians will also use ultrasound to examine the abdomen, both during initial diagnosis and during check-ups.
A bacteriological test of the stools can exclude an infection with enterobacteria as the cause of the symptoms.
A colonoscopy is the best test for diagnosing Crohn’s disease or ulcerative colitis. Mucus samples are taken from every intestinal section affected and examined in the laboratory. This helps to ascertain whether an inflammation is present and what its nature is.
In some case, the diagnosis needs to be repeated as the disease progresses. For the diagnosis it is important to exclude other inflammatory, toxic, vascular or bacterial causes as well as colon cancer.
Medicinal products are the first-line treatment for inflammatory bowel disease. The treatment aims to alleviate the patient’s symptoms by suppressing the inflammation and ensuring long, symptom-free intervals.
Therapy generally depends on the severity and extent of the disease, the response to previous treatments and the individual situation of the patient.
In some cases, inflammatory bowel disease can no longer be controlled with medicinal products. In this case, or if colon cancer or cancer precursors have been found, surgery cannot be avoided.