Inflammatory Bowel Diseases: Ulcerative Colitis vs. Crohn’s Disease
Management of ulcerative colitis
- Medical :
- Steroids
- Sulphasalazine
- Steroid/5-ASA enema
Surgical :
- 20-30% require surgery
- Colectomy is curative
- Main indication is severe attack unresponsive to medical therapy
Complications
- Fistulas, fissures,abscess (esp Crohn’s)
- Toxic dilatation (megacolon)
- Perforation
- Massive haemorrhage (rare)
- Carcinoma of colon (UC after 10 years)
Management of Crohn’s disease
Ideally managed by an aggressive physician and a cautious surgeon
- Medical
- Steroids
- Azathioprine
- Sulphasalazine (5-ASA)
- Surgical
- 80% of pts need surgery at some point
- Recurrence almost inevitable so surgery avoided as much possible but there are certain indications such as failure of medical therapy, complications
Prognosis
- 50% of patients relapse
- In Crohn’s 15% unable to work after 5 years, mortality 2x general pop.
- In UC under 10% unable to work after 5 years, no increase in mortality
Conclusion
- Crohn’s disease and ulcerative colitis are the 2 major idiopathic inflammatory bowel diseases major idiopathic inflammatory bowel diseases
- Aetiology remains unclear
- Patient usually present with diarrhoea +/- blood and mucus, abdo pain and weight loss
- Patients sometimes have extra GI manifestations
- Treatment is initially medical. with surgery for patients who don’t improve or develop complications
