Crohn's Disease and Ulcerative Colitis: What are they?

Crohn's disease and ulcerative colitis are both chronic inflammatory bowel diseases, but they have distinct differences. A gastroenterologist makes a careful differential diagnosis based on symptoms, laboratory test results, and, importantly, colonoscopy to visualize the intestinal mucosa and other instrumental tests.

 

What do Crohn's disease and ulcerative colitis cause?

Which parts of the intestine are affected by Crohn's disease?

The most obvious difference between these two diseases, detectable by colonoscopy, is the intestinal tract affected. Crohn's disease can affect any part of the gastrointestinal tract, from the mouth to the anus. In most cases, however, it affects the terminal ileum, the last part of the small intestine, and quite frequently, the colon. In other cases, however, it may affect only the colon. During colonoscopy, the doctor often detects sections of inflamed intestine alternating with sections where the mucosa is healthy. In addition to inflammation, ulcers and aphthae or a narrowing of the terminal ileum may also be present. In Crohn's disease, the most frequently affected section of the colon is the ascending section.

 

Ulcerative colitis affects only the colon

In ulcerative colitis, only the colon and rectum are affected: the inflammation may extend over a section or the entire length of the colon. In this disease, the most affected part of the colon is often the descending part (left-sided colitis), while when the entire organ is inflamed, it is called pancolitis. If the rectum is affected, the term proctitis is used. In addition to inflammation, ulcers are almost always present in ulcerative colitis.

 

Crohn's disease and ulcerative colitis are very different diseases.

The different locations of the two diseases often imply different symptoms. In ulcerative colitis, blood in the stool is always present while it is rare in Crohn's disease. Conversely, anal fistulas are frequent in Crohn's disease and rare in ulcerative colitis. Finally, frequent in Crohn's disease are ileal stenoses, often evident even during a simple examination: by palpating the lower right part of the abdomen, the doctor can perceive the presence of a small mass. The different symptoms are also important for a correct differential diagnosis that allows the specialist to immediately implement a targeted and appropriate therapy.

 

Symptoms of Crohn's disease and ulcerative colitis

Symptoms of Crohn's disease

The disease may begin with mild symptoms, which evolve as it progresses or in case of a more acute onset, the most typical symptoms are:

• abdominal pain (especially in the lower right part);
• diarrhea;
• constipation;
• weight loss;
• blood in the stool (rare);

Extra-intestinal symptoms may also occur:

• fever;
• joint pain;

Furthermore, complications to keep in mind are:

• intestinal ulcers;
• ileal stenosis;
• anal fistulas and abscesses;

Symptoms of ulcerative colitis

The disease often has an acute onset and the most common symptoms may be:

• diarrhea;
• blood in the stool;

Extra-intestinal symptoms in ulcerative colitis may be:

• fever;
• joint pain;
• dermatological manifestations;

Treatments

Pharmacological treatment

The treatment of ulcerative colitis and Crohn's disease can be represented as a pyramid. At the base are lower-impact drugs, usually intestinal anti-inflammatories or certain topical corticosteroids that act on the intestine without being absorbed into the circulation.

If the disease does not respond to this type of treatment, doctors use immunosuppressants to regulate the immune system and biotechnological drugs or TNF inhibitors, which are extremely powerful immunomodulators.

 

It should be remembered that this is a chronic disease that is not curable and leads patients to take medication for life, with alternating phases of well-being and discomfort.

 

Surgical treatment

In the last 20 years, surgical therapies have been developed that provide for the removal of the entire colon and rectum and the reconstruction of intestinal continuity with the creation of a pouch (made from the small intestine) that allows the patient to completely recover from the disease.

In the postoperative period, the patient must then undergo periodic check-ups by the treating gastroenterologist and, if necessary, endoscopies of the pouch (a kind of rectal pouch) to check that no inflammatory condition recurs.

 

Intestinal diseases are increasingly prevalent

Presenting a study of more than nine million British citizens over 17 years, British researchers were able to document the significant increase in the total number of patients (prevalence) between 2000 and 2017. The number of people suffering from inflammatory bowel disease increased by 55% (ulcerative colitis) and 83% (Crohn's disease), respectively. A figure that can be explained in two ways: on the one hand by the improvement in diagnostic techniques and on the other hand by the arrival over the years of new biological drugs that have changed the way the two conditions are treated. Based on this trend, researchers estimated that cases will increase by a quarter by 2025. This means that if, two years ago, Europe had about three million people with this disease, in a little over five years, there could be almost a million more. All this assuming that the incidence, i.e. the number of new diagnoses, remains constant.

 

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