Introduction
Ulcerative colitis (UC) and Crohn’s disease (CD) are the forms of Inflammatory Bowel Disease (IBD) that affects gastrointestinal track. A big number of researches is being carried out to understand and find solutions to the disease and the causes of the disease related. However, it is postulated that the two diseases are a result of challenges in the immune system. It is also thought that virus or bacteria cause the two diseases. Stress and diet are not considered to be the cause of IBD. Although, definitive treatment are yet to be found, medical, surgical and dietary management can allow the patient to have full lifespan while the quality of life is greatly affected.
Pathophysiology of Ulcerative Colitis and Crohn’s Disease
There are several concerns that are yet to be addressed regarding to the etiology of the disease. There are many unanswered questions about the etiology of the IB. However, studies in the laboratory and clinical trials show that genetics and environmental issues are the main players in the pathophysiology. Theories about the pathophysiology of IBD have been postulated. Among these are a dysfunctional immune response to a commensal bacterium, an auto-immune response to a luminal or mucosal antigen and an infection with a pathogenic organism remaining in the tissues of the intestine that often causes inflammatory severe responses.
The hypothesis that implicates auto-immune response to luminal or mucosal antigen is associated with the findings of neutrophils and antibodies against tropomysin isoform that is activated by complement factors (Rampton & Sladen, 1981). Interference of immune resistance to self-cut antigens is thought to result from exposure to microbial peptides sharing immunogenic and endogenic antigens (Jani & Regueiro, 2002). The role of a bacterium and chronic inflammatory response resulted from the findings indicating resemblance of clinical case and histological appearance to many pathogens that have been identified to be affecting the gastrointestinal track. Falling in this category are: Yersinia, M. tuberculosis, Shigella and Campylobacter (Macpherson et al., 1996). However, immunohistochemical studies are yet to reveal scientific evidence on the significant role of microorganisms in the pathophysiology of IBD (Macpherson et al., 1996).
Disease-producing bacteria and fungi may spread their toxic humors in the intestine in cases where the normal balance is tampered (Hoffman, 1995). This results from “shortened breastfeeding period, over-reliance on antacids, inadequate breast-feeding, a diet high in sugar or starch, use of antibiotics, parasites or harmful bacteria or yeast from food or water, immunosuppressant from infections, problems with malnutrition, poisonous substances that come into contact with the body” (Hoffman, 1995). Some of the drugs used may cause complications in the wall of the intestine. In such cases, harmful organisms obtain favorable environment to penetrate due to cause irritation in the intestine. This causes disruption of digestion process and impairment to the immunity of an individual, and eventually, increases degradation of the bowel mucosa.
On the other hand, the role of commensal bacteria has been found to be quite significant. Even though their direct role in the initiation of IBD is not clear, their role of post mucosal and epithelial disruption is significant since they aid further destruction of the epithelial and endothelial layer. Hence, the clinical response to the patients treated with antibiotics can explain the involvement of bacteria in the IBD pathogenesis. The commensal bacteria implicated here are mainly Clostridium and E.coli types (Kanauchi et al., 1999).
Clinical Manifestation of Ulcerative Colitis and Crohn’s Disease
Both ulcerative colitis and Crohn’s diseases cause severe digestive afflictions with impairing symptoms. This makes long-term dependence on powerful drugs necessary. In turn, debilitating surgery may be needed adding mortality risks (Hoffman, 1995). The common initial early indicators of ulcerative colitis are constipation with patients passing blood in mucus and stools. Occasionally, there may be an urge to relieve oneself with difficulty in functioning of bowel muscles. A patient may take a long period before experiencing diarrhea-related symptoms. However, there may be feelings of pain in the abdomen. In these circumstances, the patient may develop severe fatigue, weight loss, loss of appetite, fever and occasional painful joints.
The onset of Crohn’s disease, unlike ulcerative colitis, may be insidious in nature (Hoffman, 1995). There is also the problem of abdominal pain that gnaws weight loss and stunted growth in children. Symptoms of bloody diarrhea are less common. The most enduring feature of chronic levels of Crohn’s disease is occasional obstruction of the intestine, recurrent vomiting and in extreme cases; fistulous tract may appear between the intestines and the patient’s bladder. This may permit infiltration of stool into the urine (Hoffman, 1995). Patients who suffer from this infection always complain about dizziness, lousiness and tiredness. Physicians must, thus, determine whether the symptoms being manifested are equivalent to the infection.
Ulcerative colitis is known to mostly affect the large intestine called colon. However, it may also interfere with the last part of small intestine called ileum. In cases where there is sole involvement of the rectum, the condition may be referred to as ulcerative proctitis. However, in cases where the whole colon is involved, it is often known as pancolitis (AGA, 2006). The latter is always associated with pain in the left lower abdominal area. Patients may also bleed through the rectum especially during a bowel movement. Crohn’s disease, on the other hand, can occur anywhere along the digestive track between the mouth and anus (Hoffman, 1995).
Ulcerative colitis shows continuous inflammation throughout the colon. This may start from one’s rectum or sigmoid colon and affect the entire colon area. Upon colonoscopy or sigmoidoscopy, the wall of the colon becomes thinner and becomes continuously inflamed. This leaves all the healthy tissues in the affected area patched. Ulcerative colitis has no granulomas, but the large intestines have mucus lining the walls and are ulcerated. However, the ulcers do not extend into the inner lining (Hoffman, 1995).
The inflammation in CD may occur in patches in one or more organs in the digestive system. Upon colonoscopy or sigmoidoscopy, the colon wall is thickened with ‘cobble stone’ appearance (Hoffman, 1995). There are granulomas and deeper ulcerations which might spread onto other areas within the wall of the bowel. The occurrence of strictures, fissures and fistulas are very common complications in Crohn’s Disease (CD). In contrast with UC, smoking increases the risk of CD and complicates management of the disease due to high chances of relapse and repeated surgical treatments (Hoffman, 1995).
Diagnosis of Ulcerative Colitis and Crohn’s Disease
Diagnosing Crohn's disease and ulcerative colitis may be prolonged since the same symptoms may represent other infections. In such scenarios, it is essential for a physician to eliminate infections like bowel infections. Blood tests are essential in determining the level of severity of the inflammation caused. Additionally, they can also detect vitamin or mineral deficiencies. A feaces (bowel motion) specimen may be required to exclude infection. Physicians use sigmoidoscopy to diagnose ulcerative colitis. This enables them to see the area of the intestinal lining that has been inflamed. Tests can also be carried out to determine any cancerous infections in the colon area and gastro-intestinal linings.
Diagnosis of ulcerative colitis often involves taking blood tests aimed at determining anemic infections. The tests checks on antibodies are meant to diagnose the levels of inflammation in the patient’s bowels. The sample of the stool can also be taken to determine whether there are infections caused with bacteria or viruses. However, colonoscopy can be used in the analysis of tissues in the stool for laboratory examination.
Treatment of Ulcerative Colitis and Crohn’s Disease
The main drugs used are 5-Aminosalicylates (azulfidine or its newer chemical cousins) and corticosteroids. Severe cases require prednisone, but one must take into consideration the devastating side effects of the role of prednisolone in diabetes, osteoporosis, cataracts, and depression. Additionally, newer pharmacological approaches rely on immunosuppressive agents like Imuran, 6-MP or cyclosporin. These medications can reduce reliance on prednisone, but create their own impressive array of problems.
Cimcia and humira are not used here but are under study. During the remission stage, it is advisable for patients to use drugs that reduce probability of relapse. For example: Sulphasalazine (Salazopyrine), mesalazine (Mesasal) or olsalazine (Dipentum) are used (Jani & Regueiro, 2002). This entire procedure is referred to as maintenance therapy. The drugs used in such circumstances are also applicable to control mild level infections. Azathioprine which can greatly reduce the activity of the immune system can also be applied when colitis becomes drug-resistant and difficult to manage. Treatment in the hospital may be necessary especially in cases of severe and chronic levels of attacks. Such situation may also require the use of steroid injected straight into the vein of the patient (AGI, 2006).
On the other hand, because inflammation solely affects the large intestine in case of ulcerative colitis, removal of colectomy may be resorted to as a lasting solution. Once in a while, anti-diarrhoeal drugs, like loperamide can be recommended, especially for the management purposes (AGA, 2006). Therapy for Crohn's Disease is more complex than for ulcerative colitis. Most of the same drugs are used; 5-Aminosalicylates and corticosteroids. In contrast, Cimcia and Humira can be used here. Surgery may be applied in order to eliminate the infected parts of the bowel. However, the disease often recurs. 85% of patients suffering from Crohn's disease who undergo surgery often experience relapse and recurrence after 2 to 3 years. However, surgery may be required in cases when drugs treatment is ineffective. This method is also appropriate in cases where Crohn's disease leads blocked or leaking bowels. There are some herbs and nutrients that can be used to protect intestines from inflammation.
Dietary Management of Inflammatory Bowel’s Disease
Due to the roles played by malnutrition and fermentation of certain hard to digest carbohydrates, a dietary management can reduce the severity of IBD. Specific Carbohydrate Diet (SCD) is a balanced tried option. It comprises of mostly animal proteins, certain vegetables and fats from nuts. During the restricted diet, antibiotics can be administered to reduce the bacterial load within the bowel. However, long therapies with antibiotics disrupt the microflora which can further worsen the condition (Kanauchi et al., 1999). As a result, adjunctive therapy is employed to facilitate faster resolution of the signs associated with the infection help speed thus improving the probability of success.
The L-Glutamine has healing effects on gastrointestinal mucosa. Fish oil contains Omega 3 polyunsaturated fatty acid EPA and can be used to help break the inflammatory cycle in UC as it does in rheumatoid arthritis and psoriasis cases. Bromelain can be used as an anti-inflammatory means. Fatty acids with short chains like butyrate are also often effective in treatment of colitis, but they should be used orally or through enema.
Vitamins and minerals play a supportive role in the tissue repair of gastrointestinal tract. However, given that IBD may interfere with digestion and absorption, a significant proportion of IBD suffer from malnutrition. Out of this proportion, several may develop complications relating to incompatibility with their fat tolerance levels. Others may also suffer from deficiencies of iron in the body and bleeding, which cause weakness and paleness among other symtoms. Diarrhea promotes depletion of water-soluble vitamins and essential minerals like zinc and magnesium. Some people suffering from Crohn's disease may develop partial of full inassimilation of certain minerals. They need to keep to vitamin-rich diets and take mineral-rich pills. . Others might need to be injected with Vitamin B12 after three months duration. Some require regular injection of Vitamin B12 every three months. This is meant to help reduce the deficiencies of nutrients in the body although it is not very common among the patients with ulcerative colitis. However, loss of blood may render this group very vulnerable to anemia. Correcting this calls for great investment in iron-content drugs. Evidence that relates ulcerative colitis or Crohn's disease to food allergies has not been found yet, since it is possible that certain foods could be responsible for diarrhea in patients especially the foods is rich in fiber content. These include fruits, some vegetables, and nuts. The quantity of the food consumed by the patients can therefore be reduced in the diet of the patients.
Prognosis of Ulcerative Colitis and Crohn’s Disease
Ulcerative colitis is a chronic disease having an intermittent course with periods of disease inactivity alternating with a rise in infections. Patients with proctitis colitis often manifest significant benign course. This often rates at 15% that progress proximally as the disease develops up to 20 per cent. The rate can, however, be reduced through the alternative to therapeutic procedures mechanisms. Patients with symptoms of severe and acute infection will often manifest less sustainable remission levels. The remission is, thus, not a factor of the severity of infections. The risk of colorectal cancer after 10 years of the disease increases when the disease goes beyond the splenic flexure. However, patients with only proctitis or rectosigmoiditis do not have increased risk of the tumor. 5% of the patients may progress to primary sclerosing cholangitis (Olsson et al., 1991). The disease affects the quality of life but not the lifespan; hence, it is not practical to estimate its mortality rate.
Crohn's disease is also a chronic condition without curative treatment. It is characterized by durations of improvement followed by episodes when symptoms relapse. However, treated patients gain a healthy weight with a very low mortality rate. In the contrary, Crohn's disease has been linked to high levels of vulnerability to small bowel infections that could even develop further to become cancerous (Canavan et al., 2006).
Conclusion
Ulcerative colitis and Crohn’s disease causes are not well understood leading to several hypothesis of their pathophysiology. Due to huge immune involvement and bacterial effect associated with the diseases, it is postulated that these two factors may be involved in development of the above diseases. It is also not clear why ulcerative colitis involves mainly the colon while Crohn’s disease traverses the whole alimentary canal. Clinical presentations and immune complexes can be used to satisfactorily diagnose the disease when combined with both laboratory and scopic investigations of the location and content of the bowel. It is important to note that though there is no definitive treatment for the two conditions, the available medications, surgeries and dietary considerations can allow patients to live full lifespan as the disease is reduced to only affect the quality of life.
