Inflammatory Bowel Diseases | Crohn's & Ulcerative Colitis
Is it IBS or IBD?
What are Inflammatory Bowel Diseases?
Inflammatory bowel disease (IBD) is a catchall phrase that encompasses a variety of conditions that are marked by inflammation and can occur anywhere from the lips to the anus. There are two main diseases that are commonly referred to as IBD, Crohn's disease and ulcerative colitis.
What is Crohn's disease?
Crohn's disease was first written about in the United States by Burrill B. Crohn, Leon Ginzburg and Gordon Oppenheimer, a team of doctors in New York City who noticed that 14 patients shared the same characteristics of a disease pattern affecting the last part of the small intestine known as the terminal ileum.
Their paper on the topic was published in the Journal of the American Medical Association in 1932. Later in the same year, the same doctors reported on 52 others who also shared some symptoms, specifically the formation of small lesions called granulomas that were found in the small intestine.
While Dr. Crohn was the one for whom the disease was named, he was in no way the first to find it. According to Dr. Joseph B. Kirsner, a leader in IBD research and treatment, a physician who performed an autopsy as early as 1612 on a boy who had symptoms like those of CD. Another physician, T. Kennedy Dalziel of Glasgow, Scotland, reported on nine cases of "chronic intestinal enteritis" he had seen as a surgeon in a hospital there in 1913.
What are fairly clear are the characteristic markers of the disease in the gastrointestinal tract. CD can affect any site along the entire gastrointestinal tract-the lips, the oral cavity, the esophagus, the stomach, the duodenum, the jejunem, the ileum, the ileocecal valve, the cecum, the ascending or right colon, the transverse colon, the descending or left colon, the sigmoid colon, the rectum and the anus.
Because of this, the disease may go by other names, which indicate exactly where the diseased portion of the intestines is located. For example, it is commonly located in the ileum where it is referred to as ileitis or Crohn's ileitis or regional enteritis or terminal ileitis; if it involves the ileum and the colon, it is ileocolitis. When it is in the stomach or first few loops of the intestine, it is known as gastroduodenal Crohn's disease. If it is in the next few loops of intestine, it is called jejunoileitis. If it resides in the colon, it is known as Crohn's colitis. Another term for the disease is granulomatous ileitis or enteritis.
Just as Juliet wondered whether a rose by any other name would smell as sweet, a form of Crohn's disease by any other name usually acts the same way. Sores or lesions appear on the surface of the mucosa, the innermost layer or lining of the intestines; the mucosa is assigned the job of absorbing salts, water and other substances while releasing mucous. The different layers of the bowel wall become inflamed, past the muscular layer of the intestines to a protective coating called the serosa. Also inflamed is the mesentery, semi-circular fold of the peritoneum that holds the blood vessels and lymph glands associated with the intestines and adheres to the intestines as a means of support.
Generally, the symptoms of the disease include abdominal pain that can range from cramps to sharp, localized pains; a change in bowel motility such as diarrhea or constipation; blood in the stool, the color of which depends upon where it is released in the intestines and ranges from bright red to black; vomiting; nausea; lack of appetite; fever; fatigue; painful abscesses and resulting fistulas; and weight loss.
The disease can also affect other areas of the body such as the eyes, the kidneys, the liver, the joints, the gall bladder and the skin through related conditions. Because of this, occurrences such as strange bumps on the skin, a reddened or itchy eye, kidney stones, gallstones, swollen and painful joints can at times be related to CD.
There are a number of medical treatments that are effective in reducing or controlling inflammation in CD patients and there are surgical options when the medical efforts fail, when abscesses or fistula occur or scar tissue threatens to block intestinal openings. However, there is presently no cure for CD.
What is Ulcerative Colitis?
Like CD, UC has a history that predates when it was actually named in a medical journal article. In fact, cases have been documented in medical literature greater than 200 years ago. However, with the greater presence of dysentery and other infectious diseases, it made it harder for physicians to definitively distinguish between infectious and non-infectious colitis.
One important invention that debuted in 1913, the electric sigmoidoscope, changed the course of the research on the subject of ulcerative colitis, a term that appears in an English doctor's paper in 1859 regarding an autopsy of a woman who suffered from diarrhea and fever.
The sigmoidoscope allowed physicians to literally shine a light upon this little known phenomenon.
Greater strides were made in the next few decades in separating the cases of ulcerative colitis from those of infectious origin. What is understood now about UC is that it strikes the large intestine or colon, unlike Crohn's which affects the entire GI tract. Found from the cecum to the rectum, UC tends to spread in areas that are close to where it begins, not skipping around as CD does at times. It also appears to affect primarily the mucosa and doesn't burrow through the bowel wall.
Named for the areas that it strikes, UC can go by other names such as ulcerative proctitis (affecting the rectum only) and proctosigmoiditis (the rectum and the sigmoid colon). As the disease reaches further up the descending colon to the splenic flexure (located at the corner of the transverse colon and the descending colon), the disease gains the name of left-sided colitis. When it takes over the entire colon, it is called panulcerative colitis or total colitis.
The disease manifests itself in the mucosa. Changes at that level lead to the inflammation and ulceration that in turn cause a disturbance in the absorption of salt and water. The malabsorption of the water leads to diarrhea; damage to the mucosa can also lead to excessive amounts of mucous in the fecal matter. The ulcerations cause bleeding, which can lead to anemia. Abdominal pain, fever, fatigue, loss of appetite and weight loss often accompany the disease as well.
Ulcerative colitis also can manifest itself in other areas of the body such as the liver, the eyes, the skin, the joints and the kidneys and can account for symptoms such as strange bumps on the skin, a reddened or itchy eye, kidney stones, gallstones, swollen and painful joints.
There are a number of medical treatments that are effective in reducing or controlling the inflammation process in UC patients and there are surgical options when the medical efforts fail, such as when scar tissue threatens to block intestinal openings. There is a cure for UC that involves removing the colon, rectum and anus, leaving the patient with a stoma opening in the abdomen.
Due to advancements in medicine and medical technology, both Crohn's Disease & Ulcerative Colitis now have extremely low mortality rates.
To learn more about Inflammatory Bowel Diseases, see The First Year: Crohn's Disease & Colitis, an essential guide to successfully managing the disorders. You can also find published medical studies on IBD in the IBS Research Library.
To learn about helpful ways to manage IBD symptoms through lifestyle changes, you can follow the explicit IBS/IBD diet guidelines and IBS/IBD safe recipes; learn stress management through yoga practice for digestive health; and come join the IBS/IBD community to ask questions on our patient-expert moderated message boards.
All IBD information is copyrighted by Jill Sklar, 2002, The First Year: Crohn's & Colitis. All rights reserved.
