Inflammatory bowel disease is summarized by the collective name “colitis”. Depending on the type of flow, localization, clinic, etiology, there are many variants of colitis: acute and chronic; infectious, radiation, ischemic, drug, toxic; catarrhal, erosive, ulcerative, atrophic, spastic; sigmoiditis, proctitis, transversitis, typhlitis, pancolitis, as well as gastroenterocolitis common to the stomach and small intestine.
Nonspecific ulcerative colitis (NUC) and Crohn’s disease (CD) are different diseases, and the differences between them are fundamental. For example, Crohn’s disease cannot rightfully be called colitis, since it does not fit into the framework of this diagnosis according to the criterion of localization. However, today NUC and CD are increasingly considered as a pair, since not only the differences, but also their common features are quite significant and obvious.
Both diseases are inflammatory and affect the gastrointestinal tract. Both present with similar or similar symptoms. Both remain etiologically unclear. Both are somehow connected with anthropogenic factors (technogenic, ecological, alimentary, etc.). And in just a few decades, both of them have moved from the category of rare diseases known mainly to academic medicine into the category of “humanity problems”, and these problems continue to worsen in the epidemiological aspect and “get younger” in terms of the average age of manifestation. To some extent, far from decisive, this is due to the fact that modern coloproctologists and gastroenterologists are much better prepared for the recognition and evidence-based diagnosis of UC and CD (both nosological and differential) than it was, say, another fifty years back, and have qualitatively different diagnostic tools. In other words, it is reasonable to assume that today these diseases are simply diagnosed more often. However, both the annual incidence and, accordingly, the prevalence in the general population are indeed growing at a rapid pace.
Taken together, all this attracts the close attention of specialists and all those who are interested in issues of modern medicine to the problem.
The reasons
As stated above, the causes of both inflammatory processes are the subject of ongoing research and heated debate. It is known that Caucasians suffer from UC and CD more often than representatives of other races, and that this especially applies to Jews: compared to other nations, the incidence among Semitic tribes is up to six times higher (which would give reason to assume the influence of, say, national cuisine, don’t be Jewish cuisine one of the most dietary in the world). The regions of the highest prevalence are the large cities of North America, Western and Northern Europe: 70-150 patients per 100 thousand of the population. A lot of? Few? If we imagine a large square courtyard, bounded along the perimeter by large multi-storey residential buildings, then at least one person in each of these houses suffers from ulcerative colitis or Crohn’s disease. Diseases are severe, they reduce the average life expectancy of patients significantly. In other words, even one case in a thousand, or four cases in a similar St. Petersburg court, is very, very much …
In terms of per capita, UC is still more widespread, but the incidence rate is several times higher in CD.
Among the alleged causes of both diseases, infectious (bacterial and viral), hereditary, autoimmune, psycho-emotional, toxic factors are considered; the polyetiological hypothesis is also discussed. All of them find their confirmations, and none of the confirmations is sufficient.
Nonspecific ulcerative colitis is more often associated with harmful environmental influences, nutritional factors (nutrition), long-term medication, and self-destructive habits.
Crohn’s disease is more “suspicious” in terms of autoimmunity: a number of signs indicate that the aggressor in relation to the gastrointestinal tract is the patient’s own immune system.
Symptoms
The clinical picture of both diseases is extremely variable and polymorphic. The most common and common symptoms include frequent diarrhea and other dyspeptic manifestations, emaciation, asthenic syndrome, abdominal pain, appetite disorders, fever-like malaise. Loose stools and / or blood in the feces are more common in UC; constipation, belching, heartburn, and extraintestinal manifestations (eg, arthritis, osteoporosis, various eye inflammations, urolithiasis, and many others) are found somewhat more often in the CD clinic, which is one of the main arguments in favor of the autoimmune hypothesis.
However, it should be understood that both the listed and many other symptoms are found in both ulcerative colitis and Crohn’s disease, and in a variety of combinations. In addition, each disease significantly increases the oncological risk and leads to severe complications (eg, intestinal fistulas and perforations, peritonitis, obstruction, paraproctitis, etc.).
Differential Diagnosis
The main differences between NJC and BC are as follows. By definition, ulcerative colitis is characterized by ulceration of the intestinal mucosa (recall, an ulcer is a long-term non-healing inflamed wound area that penetrates into the underlying layers, unlike superficial erosion, and causes the irreversible loss of one or another volume of tissues “corroded” by the ulcer. In contrast, again, from erosion, an ulcer cannot heal without a trace, it always leaves a fibrous defect). Crohn’s disease is pathologically manifested by granulomas – concentrated foci of inflamed connective tissue.
An important differential diagnostic point is that granulomatosis never occurs in ulcerative colitis, while ulcers and granulomas are often found in Crohn’s disease. In other words, the presence of transmural (throughout the entire depth of the intestinal wall) granulomas is an evidence in favor of CD, and the presence of ulcers, etc. crypt abscesses can only partly serve as a differential diagnostic sign in favor of UC.
Next, the most important criterion is localization. If inflammation of the intestine is limited to its thick section, it can be both UC and CD, and ulcerative colitis is much more likely. If the inflammation spreads and / or is predominantly localized in other departments, this is definitely Crohn’s disease, which can affect absolutely any part of the gastrointestinal tract, from the oral cavity and the inner surfaces of the cheeks to the anus.
Rectal bleeding is twice as common in UC as in CD. Weight loss is more characteristic of Crohn’s disease in its small bowel localization. Malignancy (malignancy), on the contrary, is more common in ulcerative colitis, and in this case, the onset of the tumor process occurs, as a rule, with a shorter course than in the case of Crohn’s disease.
Fibrotic processes, thickening of the intestinal walls due to the growth of scar tissue in Crohn’s disease are always found, and occasionally in ulcerative colitis.
The final diagnosis is established by a thorough clinical, anamnestic, medical genetic, laboratory and instrumental examination. The most informative in this case are endoscopic methods (colonoscopy, FGDS, diagnostic laparoscopy), radiography with contrast enhancement, biopsy (histological analysis). Sometimes an ultrasound with rectal access, MRI or other studies are additionally prescribed.
Treatment
Therapy for both inflammatory processes necessarily includes a special diet and giving up bad habits, primarily smoking. In both cases, corticosteroid hormonal preparations are used. In a number of patients (more often with Crohn’s disease), a positive effect is caused by the appointment of immunosuppressants, which would be an important argument in favor of autoimmune etiology, if not for numerous other cases where immunotherapy does not bring results. Additionally, antibiotics, probiotics, enzymatic preparations, sorbents for detoxification, etc. are used, as in the treatment of other colitis.
At the beginning of treatment, it is a conservative approach that is preferable, however, the progression of the inflammatory process over time can lead to the development of life-threatening complications and conditions, so sooner or later the question of surgical intervention is raised (more often in CD, which recurs more often).
In conclusion, it should be noted that both subjective complaints, and objective morphological signs, and criteria for the differential diagnosis of UC and CD are in fact much more complex and extensive than can be reflected in a short popular science article. However, it is certainly worthwhile to get a general idea of these severe, largely incomprehensible, but increasingly common diseases.
At least in order to exclude those risk factors that we ourselves can eliminate without much difficulty.
