Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
Are the intestinal complications of ulcerative colitis and Crohn's disease different?
Some intestinal complications of
IBD occur in both ulcerative colitis and Crohn's disease. For example, ulceration of the inflamed inner
intestinal lining (mucosa), which causes
abdominal pain and intestinal bleeding,
may complicate both diseases. Since both ulcerative colitis and Crohn's disease involve the colon,
complications that are associated with the colon, such as toxic megacolon and
colon cancer, occur in both diseases. Additionally,
there are no intestinal complications that occur only in ulcerative colitis and not in
Crohn's disease. On
the other hand, certain intestinal complications of IBD occur predominantly in
Crohn's disease (for example, fistulas) or exclusively in Crohn's disease and not in
ulcerative colitis (for example,
malabsorption and SIBO).
The differences in intestinal complications between ulcerative colitis
and Crohn's disease depend on the characteristically dissimilar behaviors of the inflammation
associated with these diseases. In Crohn's disease, the inflammation usually extends from the
inner lining (mucosa) through the entire thickness of the bowel wall. This
spreading inflammatory process may thereby lead to fistulas, abscesses, or
strictures of the bowel. By contrast, the inflammation in ulcerative colitis is limited to the
inner lining of the colon. The development of these particular complications is,
therefore, much less common in ulcerative colitis. Also, Crohn's disease can affect any area of the GI tract
from the mouth to the anus, whereas ulcerative colitis is limited to the colon. Therefore,
complications involving the small intestine, such as malabsorption and SIBO, as
previously noted, occur only in Crohn's disease and not in ulcerative colitis.
Do intestinal ulcers occur in IBD?
When the inflammation in the inner lining of the intestine becomes severe, it
can break through the inner lining to form ulcers. The ulcers associated with
ulcerative colitis
are located in the colon, whereas ulcers in Crohn's disease may be found anywhere in the gut
from the mouth (aphthous ulcers) to the anus. Ulcerative colitis ulcers are typically shallow
and more numerous, while Crohn's disease ulcers are usually deeper and with more distinct
borders.
What are the symptoms of intestinal ulcers?
The symptoms caused by intestinal ulcers are predominantly abdominal
pain, cramps, and bleeding. Sometimes, however, ulcers may be present in IBD but
are not associated with any symptoms (asymptomatic).
In Crohn's disease, the inflammation and
accompanying ulcers occur most commonly in the ileum, jejunum, and colon, but
can occasionally occur in the duodenum. Note, however, that these ulcers are
entirely different from the far more common acid-related
peptic ulcers in the
duodenum.
How are ulcers in IBD diagnosed and treated?
Ulcers in IBD diagnosis
Intestinal ulcers can be diagnosed by directly viewing the lining of the
intestines. Various procedures, utilizing viewing instruments called endoscopes,
are available. Endoscopes are flexible, thin, tubular instruments that are
inserted into the gastrointestinal (GI) tract through either the mouth or
rectum, depending on the procedure. Which procedure is done depends on the part
of the GI tract that is being examined. Endoscopy can be done for either the
upper or lower GI tracts. The endoscope is inserted through the mouth for upper
endoscopy or through the rectum for lower endoscopy. The colon is examined
either by sigmoidoscopy (using sigmoidoscopes) for the lower (sigmoid) part of
the colon or by colonoscopy
(using a colonoscope) for the entire colon.
The upper GI tract is examined by a procedure called
esophago-gastro-duodenoscopy
(EGD). An upper GI endoscope is used for this procedure. EGD is useful in detecting
Crohn's disease ulcers in the esophagus, stomach, and the duodenum.
Crohn's disease ulcers in the small intestine may be seen by a procedure
called enteroscopy, in which a special endoscope (called an enteroscope) is
used. But enteroscopies need special equipments and are not widely available.
Ulcers in the small intestine, however, are more often diagnosed with an X-ray
study called a "small bowel follow-through" (SBFT). In this test, the patient
swallows a few cups of barium, which coats the lining of the small intestine. On
the X-ray, the barium may show the presence of ulcers. However, SBFT
may not be accurate, and may not detect small ulcers in the small bowel. In
patients suspected of having small bowel Crohn's disease ulcers and yet
have normal SBFT studies, CT (computerized tomography) of the small
bowel and capsule enteroscopy may be helpful in diagnosis.
Capsule enteroscopy is a procedure where a patient swallows a small camera
the size of a pill. The pill camera takes multiple images of the
inside of the small bowel and transmits these images wirelessly onto a
recorder worn around the patient's waist. The recorded images are later reviewd
by a doctor. Both CT of the small bowel and capsule enteroscopy in some studies
have been found to be more accurate than the traditional SBFT in diagnosing
Crohn's disease of the small bowel.
Ulcers in IBD treatment
The treatment of ulcers in IBD is aimed at
decreasing the underlying inflammation with various medications. These
medications include mesalamine (Asacol, Pentasa, or Rowasa), corticosteroids,
antibiotics, or immunosuppressives such as 6-MP (6-mercaptopurine, Purinethol) or
azathioprine (Imuran). In some cases, ulcers can be very resistant to these
treatments and the use of stronger drugs may be required. These drugs include an
immunosuppressive medication, cyclosporine (Neoral or Sandimmune), or the new
drug, infliximab (Remicade), which is an antibody to one of the body's
inflammation-inducing chemicals called tumor necrosis factor (TNFa).
Occasionally, medical therapy fails to heal IBD ulcers and surgical treatment is
needed.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
One in every 20 people develop a kidney stone at some point in their life. A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones symptoms and signs are, blood in the urine and pain in the abdomen, flank (lower back), or groin. A number of different conditions can lead to kidney stones including: gout, hypercalciuria, people with inflammatory bowel disease, kidney disease, and hypoparathyroidism. Some medications also increase the risk of kidney stones.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Pink eye, also called conjunctivitis, is redness or irritation of the conjunctivae, the membranes on the inner part of the eyelids and the membranes covering the whites of the eyes. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Pernicious anemia is a blood disorder in which the body does not make enough red blood cells due to a lack of vitamin B12 in the blood. Pernicious anemia can develop from a lack of a protein that helps the body absorb vitamin B12, not getting enough B12 in the diet, and certain intestinal conditions that interfere with the absorption of vitamin B12 such as Crohn's disease, celiac sprue, or ulcerative colitis. There is no cure for pernicious anemia, thus treatment is life-long.
Corticosteroid drugs such as prednisone and prednisolone are commonly used to treat asthma, allergic reactions, RA, and IBD. Steroids such as these do have serious drawbacks such as steroid withdrawal symptoms such as: fatigue, weakness, decreased appetite, weight loss, nausea, vomiting, abdominal pain, and diarrhea. Speak with your healthcare provider prior to tapering off steroid medications.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Bronchiectasis is a condition in which the bronchial tubes of the lung become damaged. Inflammation from infection or other causes destroys the smooth muscles of the bronchial tubes. Bronchiectasis is a form of COPD (which includes emphysema and chronic bronchitis). There are three primary types of bronchiectasis: 1) cylindrical bronchiectasis; 2) saccular bronchiectasis; and 3) cystic bronchiectasis. Bronchiectasis may also be acquired or congenital. The most common symptoms of bronchiectasis are recurrent cough and sputum production. There is no cure for bronchiectasis. Treatment is often geared toward controlling the symptoms of bronchiectasis.
Brain lesions (lesions on the brain) are caused by trauma, inflammation, autoimmune diseases, cancers, other diseases, stroke, bleeding, pituitary adenomas, and cerebral palsy. Symptoms of brain lesions include headache, nausea, fever, neck pain and stiffness, affected vision and speech, weakness or paralysis to one side of the body. Diagnosis of brain lesions is generally with imaging studies like CT or MRI scans. Treatment and prognosis of brain lesions depends on the cause of the lesion.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
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