Massachusetts Medical Society's Physician Focus

February 2014

Crohn's and Colitis

PROGRAM HIGHLIGHTS:

  • Crohn’s disease and ulcerative colitis are part of a group of chronic conditions known as inflammatory bowel diseases.

  • Though their symptoms are similar, the two conditions affect different parts of the digestive system.

  • Crohn’s can affect any part of the gastrointestinal tract, while ulcerative colitis is a disease of the large intestine where the lining of the colon becomes inflamed.

  • Each of the conditions strikes about 700,000 people in the U.S., with men and women affected equally.

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Crohn’s disease and ulcerative colitis are two diseases of the body’s digestive system wrapped in some mystery. Their causes are unknown, they have no known risk factors, and no preventives measures can be taken to avoid them.

“One thing we often try to tell patients,” says Andrew Warner, M.D., “is that there’s nothing they have done to bring this on, and there’s nothing they could have done to prevent this. Unfortunately, it’s just something that happens.”

Dr. Warner is chief of gastroenterology at Lahey Health in Burlington, Massachusetts and the featured guest on the February episode of Physician Focus with the Massachusetts Medical Society. With program host Lynda Young, M.D., clinical professor of pediatrics at Children’s Medical Center at UMass Memorial Healthcare in Worcester and a past president of the Massachusetts Medical Society, he presents an introduction to these digestive conditions, discussing their symptoms, how they affect a person’s health and quality of life, and how they are diagnosed and treated.

Crohn’s (named after the American gastroenterologist Dr. Burrill B. Crohn who was one of the first to describe the disease in 1932) and colitis are both chronic inflammations of the intestinal tract. Specifically, Crohn’s can affect any part of the gastrointestinal tract – including the stomach, esophagus, small intestine, though 70 percent of cases occur in the small intestine. Ulcerative colitis attacks the large intestine (colon) or rectum. While the conditions primarily hit the intestinal tract, Dr. Warner points out that they can affect other parts of the body as well, including the skin, eyes, mouth, liver, and joints – what he describes as “extra-intestinal manifestations.”

Crohn’s and colitis affect men and women equally. They reach all populations, though they tend to occur in families. The disease may start in the late teenage years up to the early thirties, but it can arrive at any time in one’s life, and patients as young as 5 or as old as 80 can be afflicted. While the exact cause is unknown, physicians suspect that it might be an overreaction of the immune system to bacteria in the digestive tract that causes the inflammation.

The symptoms of both are similar– abdominal cramping, bloating, and diarrhea, though colitis can include rectal bleeding. With Crohn’s disease, however, patients often lose weight, as the disease tends to occur in the small intestine and disrupt the nutritional activity that occurs in that part of the body. And because the symptoms could occur as a result of other conditions and are therefore characterized as “non-specific” to the diseases, most cases of Crohn’s and colitis are diagnosed months to years after patients first experience the signs of the diseases.

Despite the fact that Crohn’s and colitis are chronic conditions and can affect patients intermittently over years, Dr. Warner offers good news for patients.

“These are lifelong diseases,” he says, “and they can be quite scary, but we really have very good treatments now that weren't around even five or ten years ago.”

A major concern of patients is how these diseases can affect daily living, but here again, Dr. Warner provides some reassurance.

“Most patients can have a perfectly normal life,” he adds. “Just like someone who has arthritis or asthma, you learn about the things that precipitate it, what to avoid, how to treat it, and most patients, as long as they’re under the care of a physician, can lead a normal, healthy life.”

Watch the video above for more discussion, including conversation on such topics as how these diseases are diagnosed; how they affect daily living; the “hygiene hypothesis” as a cause of the diseases; and the different ways they can be treated, with dietary plans, steroids, biologics, and surgery. For additional information on these conditions, patients may wish to read “100 Questions & Answers About Crohn’s Disease and Ulcerative Colitis,” co-authored by the show’s guest, Dr. Andrew Warner.

Text:
MMS/Richard Gulla

ADDITIONAL RESOURCES
Crohn’s and Colitis Foundation

American College of Gastroenterology Patient Education and Resource Center

American Gastroenterological Association

Centers for Disease Control and Prevention

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"Crohn's and Colitis" PSA


From left, Lynda Young, M.D., Andrew Warner, M.D.
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