Dear Dr. Garner,
I am 19 and have severe colitis. I have cramps all the time and need to always be around a bathroom. I have no social life. My doctor said it might be ulcerative colitis or Crohn disease. He said the two were similar, and he didn’t know which one I have.
Could you please tell me what these two diseases are and which one you think I might have.
Colitis Problem in Canarsie
Dear Colitis Problem,
Before tackling your problem, I would like to offer my prayers for a speedy recovery to all those affected by the horrific hurricane that we experienced this past week.
Colitis, or inflammatory bowel disease, can be devastating. It can destroy lives and attack young adults in the prime of their life. Two common examples of inflammatory bowel disease are Crohn disease and ulcerative colitis.
It is important to diagnose which one is causing the problem as treatment is different for each. In both diseases, there is severe diarrhea (often bloody), stomach pain and even malnutrition.
When examined under a microscope, the two conditions are markedly different. Crohn disease is more likely to affect additional parts of the body’s digestive tract, whereas ulcerative colitis is usually confined to the colon and does not affect the bowel as deeply or thoroughly as Crohn disease.
Both have genetic predisposition as they are autoimmune diseases, which means the body attacks itself in error.
Ulcerative colitis has a much higher incidence of cancer associated with it. Both can also cause joint problems. Both represent lifelong disease, with surgery more likely to be successful for ulcerative colitis than Crohn disease. Surgery might even be detrimental for those with Crohn disease, so it is important to know which condition you have.
The medical treatment is similar for both diseases with anti-cancer drugs, immune system drugs, antibiotics and anti-inflammatory medication used.
To determine which disease you have, the following tests may be used:
1. Blood tests. The tests will search for certain antibodies and also bacteria, anemia and other infection.
2. Stool samples. This will help tell if your stool has white blood cells, an indication of bowel inflammation.
3. Colonoscopy. Your doctor will biopsy suspicious-looking areas and send it to a pathologist to examine under a microscope.
4. CT Scan. This will help determine the extent of the disease.
Ways to Distinguish Between the Two Diseases:
1. Location of inflammation
Crohn disease: anywhere along the digestive tract.
Ulcerative colitis: at the end of the tract in the rectum.
2. Pattern of inflammation
Crohn disease: skips areas so not all of the bowel is diseased.
Ulcerative colitis: disease along the entire colon.
3. Symptoms
Crohn disease: pain more on the right side of the abdomen.
Ulcerative colitis: tends to have pain on the left side.
4. Appearance
The colon wall may be thickened in Crohn disease with superficial ulceration present in ulcerative colitis.
5. Complications
Crohn disease: connections between loops of bowel are formed which can cause infection later in life.
Ulcerative colitis: marked increase of colon cancer later in life.
6. Smoking
For some reasons, smoking has a good effect on ulcerative colitis (but that’s not a reason to light up), yet it worsens Crohn disease.
7. Treatment
Surgery is much more effective for ulcerative colitis. Both are treated with medications to reduce inflammation.
Ask your doctor for a referral to a physician who specializes in inflammatory bowel disease. Management and treatment will be selected, and you’ll see marked improvement.
Dr. Steven Garner, M.D., is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.
