Ulcerative Colitis and Crohn's Disease
About the author:
is a practicing gastroenterologist and author of
"Natural Stomach Care: Treating and Preventing Digestive Disorders with
Best of Eastern and Western Therapies".
Read Daily Inflammatory Bowl Disease (IBD) and Digestive
Health News/Tips Here
Disease means inflammation of the bowel or gastrointestinal tract. It may occur due to a
variety of causes including infections, drugs, ischemia (lack of blood supply) etc.
However, unless specified, it generally implies chronic idiopathic inflammatory bowel
disease (IBD), the cause of which is unknown.
- Inflammatory Bowel Disease (IBD) can be classified into two types :
Ulcerative Colitis (UC) and Crohn's disease (CD). This classification may not be possible
in some cases (10-15%), and these are called indeterminate.
- Ulcerative Colitis as the name suggests involves only the
colon/rectum although some "backwash ileitis" may be seen. In addition, it
involves the mucosa or the innermost lining of the colon wall. In contrast, Crohn's
Disease is a transmural disease (involving all layers of bowel) and may involve any part
of the gut, from mouth to anus.
- A variety of factors have been implicated in the causation of
Inflammatory Bowel Disease (IBD) including genetics, race, diets etc. It is
generally believed to be an autoimmune disorder, i.e. the person's immune system is the
source of the problem. Stress does not cause the disease although it may exacerbate the
Inflammatory Bowel Disease may present with a variety of
symptoms depending in part on the location of the disease. Symptoms include, abdominal
pain, diarrhea, bleeding and malnutrition. Ulcerative Colitis generally manifests with
rectal bleeding while Crohn's may sometimes present with vague, non-specific symptoms.
Growth retardation may be seen in kids.
- Clinical history and physical exam along with the laboratory
abnormalities provide clues to the diagnosis. Endoscopy with biopsy usually clinches the
diagnosis. Diagnosis of Crohn's Disease, although not absolute, may sometimes be made by
the typical changes the small bowel seen on barium x rays.
- Medical treatment of Inflammatory Bowel Disease includes
aminosalicylates (ASA) and corticosteroids. Sulfasalazine is the prototype aminosalicylate
and newer 5-ASA preparations like Asacol, Pentasa, Dipentum are available. In addition,
ASA may be administered as rectal suppositories and enemas. Corticosteroids may be given
as intravenously, by mouth or as rectal enemas. Corticosteroids have substantial long-term
being increasingly used for IBD. Commonest is azathioprine and 6-MP but the
onset of action is slow. Monitoring of 6-TG levels is done to optimize the
therapy. Methotrexate is effective in Crohn's disease. Cyclosporine may be
used for short term in times of emergencies. Infliximab (Remicade) infusion
is an effective treatment for inflammatory as well as fistulous disease.
Many patients are turning
to alternative and complementary therapy. Role of probiotics appears
promising based on the results of various studies and are being increasingly
recommended by physicians. Of note, just like antibiotics, all probiotics
are not the same and effective for everything. It appears that combinations
of several probiotic bacteria may be superior to using them alone.
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ARTICLES ON RELATED ISSUES
RELATED PUBLICATIONS BY DR. MINOCHA
Minocha et al. Acute Sulfasalazine Overdose. Journal
of Toxicology Clinical Toxicolgy 1991.
Minocha et al. Small Bowel
Endometriosis Masquerading as Regional Enteritis. Digestive Diseases and Sciences 1994.
Minocha et al. Lack Of Crucial Role of
Mast Cells in Pathogenesis of Experimental Colitis in Mice. Digestive Diseases and
Minocha A et al.: Crohn's Disease
Complicating Male Genitourinary Tract Without Overlying Cutaneous Involvement. Am J
Minocha A et al.: Role of Appendectomy
and Tonsillectomy in Pathogenesis of Ulcerative Colitis. Digestive Diseases And
Sciences 1997. |
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