About Crohn's Disease and Ulcerative Colitis 

• Crohn's disease and ulcerative colitis are chronic digestive disorders of the intestines. These illnesses are collectively known as inflammatory bowel diseases, or IBD, because many of their symptoms and complications are similar. However, recent evidence suggests that they are separate disorders.
  
  
• It is estimated that some 1.4 million Americans suffer from IBD, with approximately 30,000 new cases diagnosed each year.
  
  
• Anyone can get IBD, but adolescents and young adults between the ages of 15 and 35 are most susceptible. (Ten to 20 percent of those afflicted develop symptoms before the age of 18.)
  
  
• The cause of IBD is unknown. There is no medical cure for these conditions, which can flare up without warning. Colectomy (surgical removal of the colon) cures ulcerative colitis. Crohn's disease is incurable; its relapse rate is 75-80 percent.
  
  
• Approximately 20 percent of patients have another family member with IBD, and families frequently share a similar pattern of disease.
  
  
• According to a 1990 study, the medical costs of IBD in the U.S. totaled $1.4-$1.8 billion annually. Surgery and inpatient care were estimated to account for roughly one-half of this amount. The disability costs of illness (lost labor productivity) were estimated to be $0.4-$0.8 billion, making the total estimated annual cost of IBD $1.8-$2.6 billion.

Symptoms & Complications

• Ulcerative colitis involves the inner lining of the colon, while Crohn's disease involves all layers of the intestine and can occur in both the small intestine and colon.
  
  
• Symptoms range from mild to severe and life-threatening, and include any or all of the following:
  • persistent diarrhea
  • abdominal pain or cramps
  • blood passing through the rectum
  • fever and weight loss
  • joint, skin, or eye irritations
  • delayed growth and retarded sexual maturation in children
    
    
• Crohn's disease and ulcerative colitis are unpredictable illnesses. Some patients recover after a single attack or are in remission for years. Others require frequent hospitalizations and surgery. Symptoms may vary in nature, frequency, and intensity.
  
  
• Without proper treatment, symptoms may worsen considerably and complications, such as abscesses, obstruction, malnutrition, and anemia, are frequent.
  
  
• Colon cancer may be a serious complication of long-term ulcerative colitis or Crohn's disease involving the whole colon, even in a patient who is in remission.

Treatment

• Medications currently available alleviate inflammation and reduce symptoms, but do not provide a cure or prevent long-term complications. The principal drugs used to treat both Crohn's disease and ulcerative colitis are 5-ASA preparations, corticosteroids (e.g., prednisone, budesonide), and immunosuppressants. Antibiotics are useful in Crohn's disease of the colon.
  
  
• 5-ASA is the active ingredient of sulfasalazine, which was widely prescribed to treat IBD for many years. Today, other 5-ASA preparations, which have fewer side effects than sulfasalazine, are FDA-approved for treatment of ulcerative colitis: Asacol®, Rowasa®, Dipentum®, and Pentasa®. Though they have not been approved for this indication, Asacol and Pentasa are useful in Crohn's disease because they are delivered to the small intestine.
  
  
• Immunosuppressive agents, such as azathioprine (Imuran®) and 6-mercaptopurine (6-MP, Purinethol®), are helpful in persons who do not respond to 5-ASA and corticosteroids, or who have recurrent flare-ups of disease when steroids are tapered.
  
  
• New treatments are being developed, based on research of the immune system's role in the symptoms of IBD. The first of these, Remicade®, has been approved by the FDA for treatment of patients with moderate to severe Crohn's disease who have not responded to conventional therapy. Remicade targets TNF-alpha. This chemical, which is secreted by cells in the immune system, plays a key role in causing inflammation in people with IBD.

Surgery

• Surgery is sometimes recommended when medications can no longer control symptoms, when there are intestinal obstructions, or when other complications arise.
  
  
• An estimated two-thirds to three-quarters of persons with Crohn's disease will have one or more operations in the course of their lifetime. The surgery for Crohn's disease, however, is not considered a permanent cure, because the disease usually recurs. For ulcerative colitis, surgical removal of the entire colon and rectum (colectomy) is a permanent cure. Approximately 20 percent of ulcerative colitis patients have to undergo colectomy eventually. The risk for surgery for ulcerative colitis may be higher if the disease begins in childhood.

Emotional Factors

• IBD is not a psychosomatic illness--there is no evidence to suggest that emotions play a causative role. Flare-ups of disease may occur, however, during times of emotional or physical stress.

Diet

• There is no link between eating certain kinds of foods and IBD, but dietary modifications, especially during severe flare-ups, can help reduce disease symptoms and replace lost nutrients. People with IBD may suffer uncomfortable symptoms when they drink milk or eat dairy products, as approximately 20 percent of the Caucasian population, and the majority of non-Caucasians, have lactose intolerance.

Effects on the Person With IBD

• The economic and social burden on patients and their families can be enormous. Children and adults may have to interrupt school and work for repeated hospital stays, and medical and disability insurance often are unavailable.