Inflammatory Bowel Disease – Chron’s, Ulcerative Colitis, and Microscopic Disease
By Jillian Foglesong Stabile. MD
Inflammatory bowel diseases are a relatively common group of diseases that affect up to 3 million people in the United States. These diseases frequently cause diarrhea, abdominal pain, and sometimes blood in the stool. There are 3 common types of inflammatory bowel disease: Chron’s disease, ulcerative colitis, and microscopic colitis.
Chron’s disease
One of the common types of inflammatory bowel disease is Chron’s disease. Chron’s can occur anywhere along the gastrointestinal tract, from mouth to anus. Chron’s disease causes abdominal pain, diarrhea (sometimes severe), blood in the stool, and fatigue. Poor absorption of vitamins and minerals because of gut inflammation can lead to malnutrition and weight loss. Symptoms can vary based on where in the gastrointestinal tract can occur.
Who gets Crohn’s disease?
Crohn’s disease can occur at any age, but it is most commonly diagnosed in people between the ages of 20 and 30. There may be a genetic component to Chron’s disease because it is also more common in people who have a family member, especially a first-degree family member such as a child, sibling, or parent, who has inflammatory bowel disease. Chron’s disease also seems to be more common in people who smoke.
How is Crohn’s disease diagnosed?
The first step to the diagnosis of any inflammatory disease is a thorough history and physical exam. Chron’s disease shares many similarities to other diseases including other inflammatory bowel diseases, celiac disease, chronic pancreatitis, colon cancer, diverticulitis, irritable bowel syndrome, ischemic colitis, lymphoma, and sarcoidosis.
Laboratory tests can help your healthcare provider make the diagnosis of Chron’s disease or at least rule out other conditions. Fecal calprotectin is one test that is used to rule out Chron’s disease in both children and adults. This test is performed on the stool. Additional tests may be performed on stool to rule out infections as a source of symptoms. Blood tests that may be helpful include blood counts, a metabolic panel, and inflammatory markers. In patients who have been diagnosed with inflammatory bowel disease, bloodwork may be monitored routinely to evaluate how treatment is affecting the disease.
Imaging studies and procedures are frequently used to diagnose Crohn’s disease. Colonoscopy is a procedure where a lighted tube with a camera is inserted in the rectum and advanced to the end of the colon. Biopsies can be taken to confirm the diagnosis of Chron’s disease. To evaluate the upper GI tract and the small intestine, an upper endoscopy or capsule endoscopy is frequently performed. X-rays and CT scans are sometimes used to help to help clarify the diagnosis as well.
What are the complications of Crohn’s disease?
Crohn’s disease can cause symptoms in other parts of the body besides the gastrointestinal tract. It can cause joint pain, eye problems, fever, kidney stones, and skin changes. In children, Chron’s disease can affect growth and development. Complications of Chron’s disease include bowel obstruction due to scarring, ulcers anywhere in the GI tract, fistulations (tunnels between the colon and other parts of the body), anal fissures, osteoporosis due to malnutrition, arthritis, colon cancer, and hidradenitis suppurativa (a painful skin condition). Chron’s disease also increases the risk of developing blood clots.
How is Crohn’s disease treated?
Crohn’s disease can be treated with medications such as steroids, medications that suppress the immune system, or even newer biological treatments. In some cases, surgery may be necessary to remove parts of the colon.
Medications for Chron’s disease can have potentially serious side effects and may require routine monitoring. In some cases, medications can be dangerous during pregnancy, so you should talk with your healthcare provider if you are considering pregnancy.
Ulcerative colitis
Ulcerative colitis is the other well-known form of inflammatory bowel disease. Unlike Crohn’s disease, ulcerative colitis generally affects only the colon and spares other parts of the gastrointestinal tract. Ulcerative colitis is associated with symptoms including diarrhea (bloody or not), increased stool frequency, fecal urgency, feeling of needing to have bowel movement but not being able to pass it, abdominal cramping or tenderness, weight loss, fatigue, nausea, or sometimes fever.
Who gets ulcerative colitis?
Ulcerative colitis is more common in people aged 15-30, though it can occur at any age. It is also more common in people with a first-degree relative of someone with the condition. Ulcerative colitis also appears to be more common in people of Jewish ancestry.
How is ulcerative colitis diagnosed?
Ulcerative colitis can be suggested by blood tests and stool studies, though these alone cannot make the diagnosis. Endoscopic procedures are also used to help make the diagnosis. Colonoscopy with biopsy is the diagnostic test of choice. Imaging studies are used to determine whether complications of the condition are present.
What are the complications of ulcerative colitis?
Ulcerative colitis can cause other conditions such as dehydration, anemia, and osteoporosis. Growth and developmental issues can be present in children. Some of the more serious potential complications include colon cancer, primary sclerosing cholangitis (a condition that causes scarring in the liver), perforation (a hole in your colon), toxic megacolon (a condition where your colon expands and stops functioning), and blood clots. These conditions can be life-threatening and require immediate medical intervention.
How is ulcerative colitis treated?
Like Crohn’s disease, ulcerative colitis can be treated with a combination of therapies such as medications or surgeries. The medications used to treat ulcerative colitis are frequently the same medications as the ones used in Crohn’s disease: steroids, immunosuppressants, and biologics. In addition, a class of medications that suppress the janus kinase is used to treat ulcerative colitis.
Surgery is used if the disease cannot be controlled with medications or if there are serious complications related to ulcerative colitis. Surgery may involve removing part or all of the colon and rectum.
Microscopic colitis
Microscopic colitis is an inflammatory bowel disease that cannot be seen by examination of the colon through a colonoscope. The reactions are only seen looking under a microscope.
What is microscopic colitis?
Microscopic colitis is considered to be an autoimmune condition. This type of inflammatory bowel disease usually causes chronic diarrhea, abdominal pain or bloating, weight loss, nausea, dehydration, or fecal incontinence. There are two primary forms of microscopic colitis: lymphocytic and collagenous colitis. They are defined by the types of cells that are seen in the microscope. Sometimes, the cell types are mixed, and the microscopic colitis cannot be fully defined. Both forms of microscopic colitis have the same symptoms and treatments.
Who gets microscopic colitis?
Microscopic colitis is more common in older adults. It is diagnosed at an average of 60-65, though it can be diagnosed at any age. It is more common in women than men and is more common in smokers. Having other autoimmune disorders such as celiac disease, psoriasis, rheumatoid arthritis, thyroid disease, or type 1 diabetes, or taking certain medications can also increase your risk of developing microscopic colitis.
How is microscopic colitis diagnosed?
History and physical are vital for diagnosing microscopic colitis. The diarrhea associated with microscopic colitis is usually watery and lasts for more than 3-4 weeks. Microscopic colitis isn’t visible in imaging studies or a colonoscopy. The only way to diagnose this condition is by colonoscopy with biopsy even if the tissue looks normal.
What are the complications of microscopic colitis?
The complications associated with microscopic colitis are typically dehydration and weight loss. It is less likely to cause some of the other more severe complications associated with inflammatory bowel diseases. In rare cases, ulcerations or perforation can occur.
How is microscopic colitis treated?
Microscopic colitis can be controlled but not cured. Treatment is generally aimed at controlling the symptoms. Antidiarrheals are frequently used and may be enough to control symptoms for some patients. If these medications are not enough to control the symptoms, then the next step is generally to add a medication such as cholestyramine or bismuth sulfate. Other therapies such as steroids, such as budesonide, are used in situations where other medications aren’t effective at controlling the symptoms.
Monitoring symptoms and discussing your concerns with your healthcare provider is one of the most important things that you can do. Inflammatory bowel disease can be very serious and have potential long-term health problems. Bloody diarrhea is a reason to seek medical care immediately, and diarrhea for more than three to four weeks should be evaluated by a healthcare provider.
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Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.
References:
https://my.clevelandclinic.org/health/diseases/15587-inflammatory-bowel-disease-overview
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325380/
https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/definition-facts
https://www.aafp.org/pubs/afp/issues/2018/1201/p661.html
https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/diagnosis
https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/symptoms-causes
https://www.aafp.org/pubs/afp/issues/2018/1201/p661.html
https://my.clevelandclinic.org/health/diseases/10351-ulcerative-colitis
https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis/definition-facts
https://www.mayoclinic.org/diseases-conditions/microscopic-colitis/symptoms-causes/syc-20351478