Understanding the Differences Between Ulcerative Colitis ...
Transcript of Understanding the Differences Between Ulcerative Colitis ...
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Understanding the Differences Between Ulcerative Colitis and
Crohns Disease:
What Every Patient Needs to Know
Joseph B. Felder, M.D.
Lenox Hill Hospital
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Today’s Objectives
• Understand inflammatory bowel diseases (Ulcerative Colitis and Crohns Disease)
• Recognize symptoms and differences between the two
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What are Inflammatory BowelDiseases (IBD)?
• Comprises Crohn’s disease (CD) and ulcerative
colitis (UC)
– Overlapping symptoms and complications
• Crohn’s disease can affect any area of the gastrointestinal (GI)
tract, including the small intestine and colon
• Ulcerative colitis affects only the colon
• An estimated 1.4 million Americans live with IBD
• 30,000 new cases diagnosed each year
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The Gastrointestinal System
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What Are the Potential Causes of IBD?Can they help differentiate between UC and CD?
GeneticPredisposition(i.e. different
genes linked to each)
Environmental
Factors(i.e. cigarette
smoking, NSAID use, stress)
Immune System Abnormalities
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What Are the Potential Causes of IBD?
• Genetic Predisposition
– 20%–25% of patients have a close relative with IBD
– Research has led to identification of
• 32 genes linked to CD
• 6 genes linked to UC
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What Are the Potential Causes of IBD?Can they help differentiate between UC and CD?
GeneticPredisposition(i.e. different
genes linked to each)
Environmental
Factors(i.e. cigarette
smoking, NSAID use, stress)
Immune System Abnormalities
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Recognizing Symptoms ofCrohn’s Disease
• Persistent diarrhea
• Crampy abdominal pain
• Low-grade fever
• Rectal bleeding
• Loss of appetite/weight
loss
• Extraintestinalmanifestations
– Joint pain/swelling
– Eye inflammation
– Skin lesions
– Mouth ulcers
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Recognizing Symptoms of Ulcerative Colitis
• Progressive loosening of
the stool
• Bloody stool with pus and urgency to evacuate
• Abdominal cramping
• Loss of appetite/weight
loss
• Extraintestinalmanifestations
– Joint pain/swelling
– Eye inflammation
– Skin lesions
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Indeterminate colitis10%–15%
The Spectrum of IBD
CROHN’S DISEASE
– Patchy inflammation
– Mouth to anus involvement
– Full-thickness inflammation
– Variable involvement
– Fistulas
– Abscesses
– Strictures
– Extraintestinal
manifestations (erythemanodosum, iritis, uveitis, arthritis, apthous ulcers)
– Increased risk of Cancer
– Granulomas
ULCERATIVE COLITIS
– Continuous inflammation
– Colon only
– Superficial inflammation
– Variable involvement
– Extraintestinalmanifestations (pyoderma
gangrenosum, primary sclerosing cholangitis)
– Increased risk of cancer
– No Granulomas
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The Gastrointestinal System
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• Erythema nodosum
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• Pyoderma Gangrenosum
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Diagnosing IBD
Findings on physical exam can help differentiate between UC and CD
• Physical examination– Aphthous oral ulcers
– Skin lesions (nodules and ulcers)
– Abdominal mass (Crohn’sdisease)
– Perianal abnormalities (Crohn’s disease)
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Diagnosing IBD
Findings on Special Studies can help differentiate between UC and CD
• Special studies– Small bowel x-ray
– Barium enema
– CT/MRI scans
– Upper endoscopy
– Colonoscopy
– Tissue biopsy
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Endoscopic Appearance: IBD
Normal colon on colonoscopy UC on colonoscopy CD on colonoscopy
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Understanding Complications of Crohn’s Disease
• Intestinal obstruction
• Abscess
• Fistula
• Stricture
• Colorectal cancer
Obstruction
Fistula
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Understanding Complications of Ulcerative Colitis
• Anemia
• Perforation (rupture) ofthe bowel
• Colorectal cancer
• Toxic megacolon
Perforation
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Conclusion:The Major Differences between UC and CD
• Ulcerative Colitis
– can only affect the colon
– superficial inflammation
– continuous disease (no
skip lesions)
– no granulomas
• Crohns Disease
– can affect anywhere in the
GI tract (mouth to anus)
– transmural inflammation
(fistula, etc.)
– skip lesions
– granulomas
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