This blog post is based on the Healthful Woman Podcast episode entitled “Crohn’s and Ulcerative Colitis, Part One: Overview” In this episode, Dr. Nathan Fox spoke with Dr. Asher Kornbuth, a clinical professor of medicine in gastroenterology at Mount Sinai about the two types of inflammatory bowel disease (IBD), Crohn’s Disease and Ulcerative Colitis. They covered who is most commonly diagnosed, the differences between the two types of IBD, treatment options, and more.
What is Inflammatory Bowel Disease?
Inflammatory bowel disease (IBD) is a term used to describe disorders that involve chronic inflammation of the tissues in the digestive tract. It is not to be confused with the more common irritable bowel syndrome (IBS). “It’s very important when you hear those initials, IBD, you recognize that it’s inflammatory bowel disease, far less common than the far more common irritable bowel syndrome, which is IBS,” explained Dr. Kornbuth.
IBD can be broken down into two categories including Crohn’s Disease and Ulcerative Colitis (UC).
Crohn’s Disease
Crohn’s disease is characterized by inflammation of the lining of the digestive tract. It most commonly affects the small intestine, though it can sometimes also affect the large intestine and the upper gastrointestinal tract.
Common symptoms of Crohn’s disease may include diarrhea, abdominal pain (most typically in the right lower part of the abdomen), blood stool, weight loss, reduced appetite, fatigue, and more.
Ulcerative Colitis (UC)
Ulcerative colitis, sometimes called UC, is characterized by inflammation and ulcers along the lining of the large intestine and rectum.
Common symptoms of UC may include blood stool, rectal bleeding, diarrhea, weight loss, fatigue, abdominal pain, and more.
Diagnosing IBD
When patients are experiencing symptoms associated with IBD, physicians can perform lab tests, endoscopic procedures, and imaging tests for effective diagnosis. Depending on the gastroenterologist and your symptoms, these tests may include colonoscopy, upper endoscopy, X-ray, CT scan, and more.
“With two tests you can evaluate the entire gastrointestinal tract literally from mouth to anus, as we say,” explained Dr. Kornbuth. “So, with a CT scan and a colonoscopy, boom, you’ve seen the entire GI tract. By the time you have symptoms severe enough to seek a gastroenterologist, there’s going to be something visible on those two simple imaging tests.”
Who is at Risk for IBD?
One question patients often ask is “Who can get IBD?” Dr. Kornbuth says “Basically, anybody could get it, but it is far more frequent in people in their teens, 20s, and 30s, and unfortunately, we even have younger children with it.”
However, there is believed to be a genetic factor involved. For example, The Ashkenazi Jewish population has a high IBD susceptibility. Having said that, most patients with Crohn’s disease don’t have a family history at all of Crohn’s and Colitis.
“So, why do I say it’s in part a genetic disease?” Dr. Korbuth said. “There have already been discovered 180 susceptibility genes, to either Crohn’s disease or ulcerative colitis, and a lot of them overlap. So, although no one in your family may ever have had Crohn’s disease or ulcerative colitis, some of them carry the genes, and the unfortunate patient who got the disease inherited some combination that predisposed them to the disease. So, yes, there is a genetic component.”
IBD Treatment Options
When it comes to IBD, the possible treatment options are many. Several categories of medications may be effective in treating Crohn’s disease or Ulcerative Colitis, including the following:
Anti-Inflammatory Medications: These are often the first step in the treatment of mild to moderate UC. These can include drugs in the mesalamine family, which are known as Asacol, Pentasa, Lialda, mesalamine, etc. In cases where the disease is located at the bottom of the colon, the same kind of medication may be given in enema form.
Immune System Suppressors: These medications work to suppress the immune response that releases inflammation-inducing chemicals in the body. Some examples of immunosuppressant drugs include azathioprine (Imura, Azasan), methotrexate (Trexall), and mercaptopurine (Purinethol, Purixan).
Biologics: These medications work by neutralizing proteins in the body that cause inflammation and include Remicade, Humira, Simponi, Cimzia, Entyvio, Stelara, and Skyrizi.
Sometimes, patients with IBD will be placed on steroids (most commonly Prednisone) which work to treat inflammation on a short-term basis like during a “flare”. Patients mustn’t be prescribed steroids for long periods due to the myriad of irreversible side effects.
Schedule a Consultation
At Carnegie Women’s Health, we work closely with maternal-fetal medicine specialists who are skilled in treating and monitoring women with IBD who wish to become or are, pregnant. If you are seeking IBD diagnosis or care, we would be happy to direct you to the correct specialists. Contact us today to learn more.
