Inflammatory Bowel Diseases: Ulcerative Colitis vs. Crohn’s Disease

Management of ulcerative colitis

• Medical :

1. Steroids
2. Sulphasalazine
3. Steroid/5-ASA enema

Surgical :

1. 20-30% require surgery
2. Colectomy is curative
3. 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

1. Steroids
2. Azathioprine
3. Sulphasalazine (5-ASA)

• Surgical

1. 80% of pts need surgery at some point
2. 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