Crohn’s
& Ulcerative Colitis: Know the Difference? ( courtecy;- web MD )
It could be an inflammatory bowel disease (IBD).
But which one?
There are two:
Crohn’s disease and ulcerative colitis.
They have a lot in common, including long-term inflammation in your digestive system.
But they also have some key differences that affect treatment.
By the way, if you
hear some people just say “colitis,”
that’s not the same thing. It means inflammation of
the colon.
With “ulcerative colitis,”
you have sores (ulcers) in the lining of your colon, as well as inflammation
there.
The symptoms of
Crohn’s disease or ulcerative colitis (UC) can be similar. They include:
- Belly cramps and pain
- Diarrhea
- Constipation
- An urgent need to have a bowel
movement
- Feeling like your bowel
movement wasn’t complete
- Rectal
bleeding
- Fever
- Smaller appetite
- Weight loss
- Fatigue
- Night sweats
- Problems with your period. You might skip them, or their timing
might be harder to predict.
You might not have
all of those symptoms all the time. Both conditions can come and go, switching
between flares (when symptoms are worse) and remission (when symptoms ease up
or stop).
Crohn’s and
ulcerative colitis are most often diagnosed in teenagers and young adults --
although they can happen at any age -- and tend to run in families.
Ulcerative colitis
affects only the inner lining of the colon, also called the large intestine.
But in Crohn’s
disease, inflammation can appear anywhere in the digestive tract, from the mouth to
the anus.
And it generally affects all the layers of the bowel walls, not just the inner
lining.
2. Where the inflammation is.
People with Crohn’s
disease often have healthy areas in between inflamed spots. But with UC, the
affected area isn't interrupted.
3. Certain symptoms.
Most people who
have Crohn's also
have symptoms of
ulcerative colitis. But rectal bleeding, or blood in the stools, is much more common
in people who have UC than those with Crohn’s.
Because Crohn’s
disease affects more of the body, it can cause some problems that doctors don't
usually see in people who have ulcerative colitis. For instance:
- Mouth sores
between the gums and lower lip, or along the sides or bottom of the tongue.
- Anal tears (fissures), ulcers, infections, or narrowing.
Since the
differences between the two conditions mostly revolve around where in the digestive system inflammation
happens, the best way for a doctor to give you the right diagnosis is to take a
look inside.
You might get tests
such as:
X-rays that
can show places where your intestine is blocked or unusually narrow.
Contrast X-rays, for
which you'll swallow a thick, chalky, barium liquid so doctors can see how it
moves through your system.
CT scans and MRIs to rule out other conditions that might cause symptoms
similar to an inflammatory bowel disease.
Endoscopy, in
which a doctor uses a tiny camera on a thin tube to see inside your digestive system.
Specific types of endoscopy can:
- Examine lower part of your large intestines.
Your doctor will call this test "sigmoidoscopy."
- Look at your entire large intestine. This is a colonoscopy.
- Check the lining of the esophagus, stomach,
and duodenum. This is an EGD (esophagogastroduodenoscopy).
- Additional testing to look at your small intestine using a
pill-sized camera. This is often called pill, or capsule, endoscopy.
- See the bile ducts in the liver and
the pancreatic duct. This test is called ERCP (endoscopic retrograde
cholangiopancreatography).
Scientists are
working to make two blood tests
better at helping to diagnose ulcerative colitis and Crohn’s. They check on
levels of certain antibodies found in the blood:
- “pANCA” (perinuclear anti-neutrophil antibodies)
- “ASCA” (anti-Saccharomyces Cerevisiae antibody)
Most often, people
with ulcerative colitis have the pANCA antibody in their blood, and those with
Crohn’s disease have ASCA in theirs. But for now, the tests have uncertain accuracy
and should only be used in addition to the above testing.
Sometimes, even
after all these tests, doctors might not be able to tell which of the two
conditions you have. That's true for 1 in 10 people with IBD. They show signs
of both diseases. So they get a diagnosis of “indeterminate colitis,” because
it’s not clear which ailment it is.
Because of the
similarities between the conditions, many treatments of ulcerative colitis and
Crohn’s disease overlap. These things help for both:
Stress management is
also key. Stress doesn’t cause IBD, but it can lead to flare-ups. So try to cut
down on the things that make you tense, and find ways to relax. Exercise is a
great way to do that. So are other healthy things you might enjoy and find meaningful,
such as hobbies, meditation,
prayer, volunteering, and positive relationships.
Medicines can get
inflammation under control:
"5-ASAs"
work on the lining of your GI tract to lower inflammation. They work best in
the colon. You might take them to treat an ulcerative colitis flare, or as a
maintenance treatment to prevent relapses of the disease.
Steroids curb the
immune system to treat ulcerative colitis. Due to side effects, you probably
wouldn't stay on them for a long time.
For severe disease,
you may need drugs that work on the immune system. These include:
- 6-mercaptopurine (6-MP, Purinethol)
- adalimumab (Humira)
- adalimumab-atto (Amjevita), a biosimilar to Humira
- azathioprine (Azasan,
Imuran)
- certolizumab pegol
(Cimzia)
- cyclosporine
- golimumab (Simponi, Simponi Aria)
- infliximab (Remicade)
- infliximab-abda (Renflexis),a biosimilar to Remicade
- infliximab-dyyb (Inflectra), a biosimilar to Remicade
- methotrexate (Rheumatrex,
Trexall)
- natalizumab (Tysabri)
- ustekinumab (Stelara)
- vedolizumab (Entyvio)
With the treatments
for mild symptoms, almost all -- 90% -- of ulcerative colitis cases go into
remission. If your UC is “refractory,” you’ll need continuous treatment with
steroids.
With Crohn’s
disease, complete remission is less common.
Some people
eventually need surgery. That includes up to 45% people with ulcerative colitis
and three quarters of people with Crohn’s.
You and your doctor
might talk about an operation if you have severe symptoms that aren’t helped by medications, if you get a blockage in your
digestive tract, or if you get a tear or hole in the side of the intestine.
If you have either
condition, you'll need to keep up with your checkups, even if your symptoms
start to ease up.
You may also need
to get colonoscopies more often and start them at a younger age. A colonoscopy
can check for cancer or polyps that need to come out. Experts recommend that
you start these tests within 8 to 10 years of developing UC or Crohn’s
symptoms, and then every 1 to 3 years after that.
Expert
Answers to Questions About Crohn’s Disease (
Even if you're
new to this, you know it's no fun. You probably also know that it's chronic,
meaning it's something that (at least as far as doctors know right now) you'll
have for the rest of your life.
Hopefully, your
medical team has told you that with their help, a good plan, and a dose of
determination from you, you can control your Crohn's.
But you probably
still have some questions. Here's what the experts have to say.
What is
this?
Crohn's -- named
for Dr. Burrill B. Crohn, the man who defined it in 1932 -- is an inflammatory
disease of the gastrointestinal (GI) tract. It can show up anywhere from your
mouth through your throat, into your intestines and colon and all the way to
the other end.
The disease can
get worse over time. Some 700,000 people in the U.S. have it. It appears to
strike men and women in nearly equal numbers.
Inflammation is how your body normally responds to irritation or infection. No
one's quite sure why the body does this when you have Crohn's. We do know
inflammation brings on the symptoms. It can damage the GI by causing things
like fissures (tears), fistulas (abnormal passages), and infections. All that
swelling can also cause blockages.
It's important
to let your doctor know about all your symptoms.
It makes sense
that what goes into your gut might play a part. But, that's just not clear yet.
"I wish we had a better answer to that," says Jason Harper, MD, a
gastroenterologist at the University of Washington Medical Center. "I
think, unfortunately, the answer most people seem to get…is this kind of
brushoff: 'Eh…it doesn't matter. Eat what feels good.' That's medical speak
for, 'We don't really know.'"
The belief that,
for example, eating spicy foods or gluten-heavy foods is bad for those with
Crohn's isn't scientifically proven. However, Harper says many people with the
disease have concluded that certain foods can lead to flare-ups. So, they avoid
those foods.
Of course, one
person's avoid-at-all-cost list might be another's go shopping list.
Harper says we
don't quite know yet "exactly how diet influences the course of Crohn's
disease. But it would be a mistake to say that diet is unrelated."
Eating right is
a big part of keeping your body healthy. So, Harper suggests, eat well, listen
to your body, and know that there is no one-size-fits-all diet approach.
Researchers
aren't exactly sure what triggers your immune system and brings the
inflammation that characterizes Crohn's. They do say genetics and your
environment play a part. If you have a parent or a sibling with Crohn's, you're
more likely to get the disease yourself.
Also, smokers
seem to be more likely to get it, as are those who take non-steroidal
anti-inflammatory drugs (NSAIDs), birth-control pills, and antibiotics. And it
may be what you're eating. Those who follow a high-fat diet seem to have higher
odds of getting it, too.
"This
disease is 100 percent controllable," says Atilla Ertan, MD, medical
director of the Gastroenterology Center of Excellence and Digestive Disease
Center at Memorial Hermann Hospital in Houston. "If your immune system is
friendly, if you follow your medications properly, if your insurance,
obviously, is going to be helpful for you, and [if] you follow the [doctor's]
instructions, this disease is not probably going to [greatly] affect your
quality of life," Ertan says. All your life events can be enjoyable...if
you listen to your doctor."
Take your
medicines. Stick with them. Don't stop. Many people with Crohn's, Ertan says,
go into remission and can stay in remission by standing pat. Because there is
no cure for Crohn's, getting to remission and staying there is the main goal of
those with the disease and those treating it.
To get there,
your doctors may prescribe:
Biologics:
These drugs target specific parts of your immune system to ease inflammation.
You'd get them through an IV or a shot. Examples include:
- Adalimumab (Humira)
- Adalimumab-atto (Amjevita), a biosimilar to Humira
- Certolizumab (Cimzia)
- Golimumab (Simponi)
- Infliximab (Remicade)
- Infliximab-abda (Renflexis), a biosimilar to Remicade
- Infliximab-dyyb (Inflectra), a biosimilar to Remicade
- Natalizumab (Tysabri)
- Ustekimumab (Stelara)
- Vedolizumab (Entyvio)
Immunomodulators:
These medicines target your whole immune system. You may take these by mouth or
get a shot. Methotrexate (Trexall), azathioprine (Azasan, Imuran), and
mercaptopurine (Purinethol, Purixan) are the best-known examples of these.
Steroids:
These also target your immune system. Your doctor would only have you take
these for a short time because they can bring some heavy side effects. They
aren't intended for long-term use.
Antibiotics:
These can handle any infections that may come up.
Aminosalicylates:
You may hear these called "5-ASA" meds. You'd take these by mouth or
through your bottom. They can ease inflammation in the lining of the
intestines.
The doctor may
also suggest over-the-counter remedies like anti-diarrhea drugs and pain
relievers. They normally go with your prescription regimen, not in place of it.
"[People]
feel better, and it's human psychology, I think, they forget the rainy days and
they stop the medication," Ertan says. "That might be one of the
worst decisions they can make."
In some cases,
inflammation can damage your GI tract and can lead to blockages, bleeding or
even worse. So surgery is possible. Some 60% to 75% of those with Crohn's may
require it at some point. But it's definitely not preferable.
"Surgery
should be a last resort. I will do everything possible to save my Crohn's
patients from surgeries," Ertan says. "Obviously, we have no other
choice if there's obstruction, bleeding, cancer, that type of thing. But
surgery is like a revolving door. One surgery leads to another surgery."
Yes. Even those
in remission may have a relapse. It's important to remember, though, that
flare-ups are a part of Crohn's.
"Having an
autoimmune disease, having Crohn's disease, there are going to be ups and
downs," Harper says. "And some of those ups and downs are not things
that people have direct control over."
It's sometimes
hard to get through a day when you're cramping and making frequent trips to the
bathroom. Something as simple as eating out can be an ordeal. Staying at home
in pain is no vacation, either. It can all make you a little depressed.
"One of the
first pieces of advice I would give -- and this may be a little simplistic
sounding off the bat -- is be kind to yourself. Kindness goes a long way,"
Harper says.
"One of the
challenges of living with a chronic illness like Crohn's disease is the sense
of guilt that I think sometimes people have about 'Why am I not feeling well?'
as though this is something that can just be powered through. Crohn's disease
is going to have a mind of its own sometimes."
You know what's also
bad? When someone offers advice, often unsolicited, about your disease -- what
you should eat (or not), how you should exercise, what medicines you should be
taking, who you should be seeing.
"These
kinds of things come from a good place, but I don't think that's what people
need in the moment," Harper says. "I think what they need is just to
be kind to themselves and not layer another sense of 'I'm not feeling well' or
'I'm sick because I'm doing something wrong.' I think that's a very easy way to
get to a dark place."
When you're
down, Harper suggests, step back, realize that Crohn's is like that, and don't
beat yourself up.
These, along
with the diet question, are some of the first things people new to Crohn's ask
their doctors. The answers are: Yes, yes, yes, and yes.
"I have
hundreds of [people] that are very happily married, and they have healthy
kids," Ertan says. "I explain to them -- and at the beginning they
have some hesitation -- about pregnancy. If proper measures are arranged, they
should have a normal pregnancy with no major events."
Everybody's
different. You don't have to tell anyone if you don't want to. "No one
should ever feel under an obligation to discuss their health history if they're
not ready and comfortable in doing so," Harper says.
And if the
people you're telling aren't ready, "It's going to be like learning a
completely new language. So disclosing to people who don't even know what the
condition is may not be very helpful."
So what's the
alternative? "I think a good place to start, if people are comfortable in
doing so, is to reach out to the broader IBD community," Harper says.
But online
forums or local groups may not be for everybody. "Some people like that,
others don't. The ones that don't like it often tell me they just hear how
miserable everybody is, and they want to have a more positive
perspective," Hans Herfarth, MD, professor of medicine at the University
of North Carolina and co-director of the UNC Multidisciplinary Center for IBD
Research and Treatment, says.
Still, if
talking helps, someone is out there to listen.
"The best
thing you can do is to surround yourself with a medical team that you trust and
that you are on the same page with and that you feel confident they are
recommending things for you that are thoughtful, that are specific to you,
and…are up to date [with] the latest recommendations," Harper says.
"And that everything that they're saying to you comes from a place of
understanding of who you are."
Get comfortable
with doctors and other medical professionals. "You want a care team. You
want a doctor whom you trust, whose nurse you trust," Harper says.
"You may have pharmacists. You may have dieticians. You may have a whole
team of people you're going to be working with. For somebody who's brand new to
this and hasn't really needed the medical profession very much, this is kind of
like going from 0 to 60 overnight."
It can be
overwhelming, but Harper says there's one rule you should follow. "Find a
team that you're comfortable with."
Crohn's
Disease and Your Heart
Experts know
about the connection between Crohn's and blood clots in the veins. But they are
still working to understand the link between Crohn's and heart and blood vessel
disease. They believe that the inflammation caused by Crohn's leads to damage
in the lining of blood vessels, causing heart disease.
Doctors aren’t
sure, but they think the long-term inflammation that Crohn’s causes could make
you more likely to have clogged arteries. Your doctor may call this
atherosclerosis. It fills the inner walls of your arteries with tiny bits of
fatty deposits called plaque. If a piece breaks off or grows big enough to
block blood flow, you could have a heart attack or stroke.
How Crohn's
disease raises your risk for this condition isn’t clear. But it can happen to
people with other autoimmune conditions, like lupus and rheumatoid arthritis.
So it may have something to do with the substances your body makes during
long-term inflammation.
People with
Crohn's disease have abnormally high:
CONTINUE READING BELOW
- Erythrocyte sedimentation rates
- High-sensitivity C-reactive protein (CRP) levels
- Homocysteine
All three of
those link to heart disease. Some substances your body makes can also raise
your odds of blood clots in your veins. Just like when plaque clogs or breaks
off in an artery, a clot that breaks off in a vein can cause life-threatening
lung problems.
People with
Crohn's can have hardened arteries at a younger age than people who don’t. But
they also tend to have lower rates of obesity, diabetes, and other things that
can cause heart disease.
The risk is highest in young, adult women.
The chance of a
heart attack or stroke seems highest during flares -- when your Crohn's disease
is active and your symptoms are bothering you. Some research may show a link
between flares and people with Crohn’s admitted to the hospital for heart failure.
Corticosteroids control
inflammation, so they’re often the first medication your doctor prescribes.
They can also raise your blood pressure and blood sugar. Doctors aren’t
sure if they play a role in clogged arteries.
Mesalamine (Apriso,
Asacol, Delzicol, Lialda, Pentasa) is another drug doctors often try early on.
It can inflame your heart muscle, a condition your doctor calls myocarditis.
Symptoms go away when you stop taking it.
Talk to your
doctor about your risk for heart disease. He can do blood tests to see if
you’re likely to have clogged arteries. Imaging tests can also check for
inflammation in your blood vessels and heart.
To lower your
chance of heart problems, keep your disease under control and prevent flare-ups
as much as you can. If your doctor finds a problem, he may prescribe heart
medicine. Some Studies show that some heart disease meds, like statins and ACE
inhibitors, may also help Crohn's disease.
মন্তব্যসমূহ
একটি মন্তব্য পোস্ট করুন