Do you know about Crohn's disease and ulcerative colitis – two diseases that can leave your gut aching?

by Dr. Remo Panaccione

(NC)—Dr. Remo Panaccione, internationally renowned Canadian gastroenterologist and inflammatory bowel disease specialist, affiliated with the University of Calgary, takes the time to answer some of the more common questions about Crohn's disease (CD) and ulcerative colitis (UC) also known as inflammatory bowel disease (IBD), two diseases that can leave your gut aching with pain.

Q. What is inflammatory bowel disease?

A. Ulcerative colitis and Crohn's disease fall under the umbrella of inflammatory bowel disease (IBD) – both affect the digestive system and cause the intestinal tissue to become inflamed, form sores or ulcers and bleed easily. The major difference is that UC affects only the inner layer of the colon or large intestine. CD is a transmural disease affecting all layers of the intestinal wall and can affect anywhere in the gastrointestinal (GI) tract, from the mouth to the anus, but is usually located in the lower part of the small bowel and the upper end of the colon.

Q. How many people in Canada suffer from IBD?

A. Canada has among the highest prevalence rate of IBD in the world with over 200,000 Canadians living with either Crohn's disease or ulcerative colitis. IBD can occur at any age, but usually starts when people are in their 20's and in about 10 per cent of cases in children under the age of 10.

Q. What are the causes of IBD?

A. We really don't know what causes ulcerative colitis and Crohn's disease. However, research suggests that it is an interaction between environmental factors (a triggering infection, smoking, stress, certain drug toxic effects) and genetic factors leading to a disruption in the body's normal immune balance but definite links have not been established.

Q. What are the common symptoms of IBD?

A. Symptoms of ulcerative colitis and Crohn's disease can be fairly similar but sometimes these diseases are difficult to differentiate. They both present with diarrhea and in the case of UC this is usually bloody. They both can present with abdominal pain and cramping and weight loss. Major differences are that patients with Crohn's disease tend to have more pain in the right lower quadrant of their abdomen and can develop complications such as disease around the anus such as abscesses or other sores. Both can be associated with features outside the intestine such as recurrent mouth ulcers, recurrent pink eye, and joint aches and pains.

Q. Is there a cure for IBD?

A. Unfortunately because we don't understand the disease completely especially the triggers of the disease there is no cure for CD or UC. However, the disease can be managed by proper lifestyle choices and medical or surgical therapy. Eating a healthy balanced diet is important but there are no IBD specific diets. Avoiding smoking is a key part of treating CD. Medical therapy can reduce symptoms and signs and improve intestinal health in both diseases. For UC patients, removing the colon can be a long-term option.

Q. What can be done to treat IBD?

A. Establishing a good working doctor-patient relationship is key to treating this disease. This involves proper education of the patient so they understand what to expect from the disease, why medical therapy is important in the short- and long-term and to let them know that the goals of therapy are to restore their normal quality of life. Working with patients to find the right treatment options is very important as this can significantly improve their quality of life by relieving the symptoms that they are experiencing. Biologics are the latest generation of medications that are an effective treatment option to help block or reduce inflammation without patients having to experience the potentially life-changing effects of surgery. More importantly, these medications allow people to continue with their daily lives and activities.

Q. Are these biologic medications available to all patients across the country?

A. For the most part these drugs are available through private drug plans and most provincial drug plans. However, although these medications have been proven to be effective, they are not reimbursed in all provinces especially in the case of UC. For example, the biologic medication Remicade is the only one that has been approved in Canada to induce and maintain remission in patients with ulcerative colitis and reduce the likelihood of surgery yet patients and physicians in certain provinces do not have access to it. This needs to change, as all patients should have the option of choosing with their physician the medication that is best for them.

Q. Where should I go for more information on IBD?

A. For more information on IBD, speak to your family physician or visit www.ihaveoptions.ca.

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