Introduction
Chronic inflammatory bowel disease (also known as CED) is a disease of the bowel in which recurrent (recurrent) or constantly active inflammation of the bowel occurs. Chronic inflammatory bowel disease often first occurs at a young age (between the ages of 15 and 35) and is often a family history. Crohn’s disease and ulcerative colitis are among the most common chronic inflammatory bowel diseases.
They differ in their spread in the gastrointestinal tract and how deeply the tissue is affected by the inflammation. Thus the entire gastrointestinal tract can be affected in Crohn’s disease. The inflammation affects all layers of the intestinal wall.
In ulcerative colitis, on the other hand, often only the large intestine is affected and the inflammation usually does not spread to all layers of the colon mucosa. If it is not possible to distinguish completely between the two diseases, this intermediate stage is called colitis indeterminata. The chronic inflammatory bowel disease is triggered by an excessive immune response of the body against components of the bowel wall.
However, the exact cause has not yet been clarified. In addition to the inflammation of the bowel, the stomach and oesophagus and other organs such as the bile ducts, skin, joints and eyes can also be affected by the inflammation. Patients with a chronic inflammatory bowel disease typically suffer not only from a general feeling of illness and fever, but also from severe abdominal pain and bloody diarrhoea.
Treatment is necessary in any case, as the inflammation can cause a rupture of the intestine (perforation) and thus a life-threatening condition. The treatment is carried out with drugs that suppress the immune system. If complications such as suppuration, fistula formation, degeneration or even narrowing of the intestinal lumen occur, surgery is necessary.
In contrast to Crohn’s disease, however, ulcerative colitis is curable. Since the chronic inflammatory bowel disease carries an increased risk of degeneration of the bowel cells to bowel cancer, regular check-ups should be carried out by the treating physician. The life expectancy of patients with both ulcerative colitis and Crohn’s disease is barely or not at all limited, provided that optimal therapy is given.
Symptoms
The chronic inflammatory bowel diseases ulcerative colitis and Crohn’s disease differ somewhat in their symptoms. Both diseases can lead to slightly elevated temperatures or even fever. In ulcerative colitis, the main symptom is bloody and mucous diarrhoea with a significantly increased stool frequency.
In addition, there is often abdominal pain in the left lower abdomen and painful urge to defecate (tenesmus). The causes are often flatulence. Extraintestinal complaints (symptoms outside the intestine) may also occur.
These complaints include primarily sclerosing cholangitis (inflammation of the bile ducts), arthritis (inflammation of the joints), skin rashes and inflammation of the eyes. Primary sclerosing cholangitis occurs in 75% of patients with ulcerative colitis. In general, complaints outside the bowel are rather rare in ulcerative colitis compared to Crohn’s disease.
Crohn’s disease is characterised by an intermittent course. There is a 30% probability of developing another relapse within a year. If the symptoms persist for more than half a year, the condition is called chronic.
In contrast to ulcerative colitis, Crohn’s disease tends to be characterized by watery, bloodless diarrhea with a usually only slightly elevated stool frequency. However, constipation (constipation) can also occur. In addition, pain in the right lower abdomen, anal fistulas, abscesses in the area of the anus and intestinal stenoses (constrictions) are to be expected as possible symptoms.
Since Crohn’s disease can occur in any section of the gastrointestinal tract, the symptoms depend primarily on the affected section of the intestine. Since it is mostly the small intestine that is affected and this is important for the absorption of nutrients, it can lead to the so-called malabsorption syndrome (disturbed absorption of substrates from the intestine) and consequently to deficiencies. These include weight loss, anaemia, steatorrhoea (fatty stools), lack of fat-soluble vitamins or kidney stones.
Crohn’s disease also causes extraintestinal symptoms, which are also relatively common in this disease. Here too, the joints are affected by arthritis (inflammation of the joints). This leads to inflammation of the eyes (iritis, episcleritis, uveitis), inflammation of the bile ducts and skin changes. Ulcers and aphthae in the oral cavity are also more frequent.