Hello everyone. My name is Todd Eisner, and I am a gastroenterologist in private practice in Boca Raton, Florida. Twice a month, we will be discussing topics involving different issues in Inflammatory Bowel Disease.
Issues that will be encountered include symptoms, diagnosis, treatment options and complications such as colon cancer. In addition to standard, old-time treatments of Inflammatory Bowel Disease such as aminosalicylates, antibiotics, immunosuppressive agents and steroids, new treatments with biologic agents such as Remicade and Humira will be discussed.
As a start, we will discuss the two major subgroups of Inflammatory Bowel Disease, Ulcerative Colitis and Crohn's Disease. Ulcerative Colitis and Crohn's Disease may be difficult to distinguish from each other. Ulcerative Colitis is an inflammatory disease affecting the colon. It almost always involves the rectum, and when it only involves the rectum it is called proctitis. The inflammation is continuous, and may involve the entire left side of the colon, or at times, the entire colon (pancolitis). Typical symptoms of ulcerative colitis are diarrhea, rectal bleeding and abdominal cramping. The diagnosis is best made by sigmoidoscopy or colonoscopy with biopsy. Crohn's disease is also an inflammatory disease affecting the gastrointestinal tract, but unlike Ulcerative Colitis, Crohn's disease can affect the entire gastrointestinal tract. One third of the time, Crohn's involves only the colon (Crohn's colitis), one third of the time it involves only the small bowel, typically the distal ileum (ileitis), and the remaining third it involves both the colon and small bowel. Rare cases of Crohn's can involve the stomach and even esophagus. When Crohn's disease only involves the colon, the symptoms are similar to that of Ulcerative Colitis. When the small bowel is involved, bleeding is rare, with the predominant symptoms being abdominal pain, diarrhea and weight loss. In addition to colonoscopy, other diagnostic modalities to diagnose Crohn's disease include small bowel barium X-ray and capsule endoscopy.
While we will go into specific treatment options in future blogs, the medical treatment of the two disorders are similar. The approach to surgery however, is different. Since Ulcerative Colitis only involves the colon, removal of the colon is curative. Recent advances in medicine now usually alllow removal of the colon without the need for a colostomy bag. Crohn's disease, on the other hand, is not cured by surgery. The reason for that is that since Crohn's disease can involve the entire gastrointestinal tract from the mouth down to the anus, if an area is resected, the disease commonly will go on to involve other areas of the gastrointestinal tract. Because of that, surgery for Crohn's disease is usually reserved for those with obstruction, bleeding, perforation or refractory abdominal pain.
The general classes of medical treatment for Ulcerative Colitis and Crohn's disease include: 1) Aminosalicylate agents such as Pentasa, Asacol and Colazol; 2) Antibiotics such as Cipro, Levaquin, Flagyl and Xifaxan; 3) Steroids such as Prednisone and Entocort; 4) Immunosuppressive agents such as Imuran and 6-mercaptopurine; and 5) Biologic agents such as Remicade and Humira.