Ulcerative Colitis / Crohn’s Disease
What is Ulcerative Colitis / Crohn’s Disease?
Ulcerative Colitis and Crohn’s Disease are both classified as “Inflammatory Bowel Disease,” which is defined as chronic inflammation of the intestines caused by a defective immune system.
What is the difference between Ulcerative Colitis / Crohn’s Disease?
Both Ulcerative Colitis / Crohn’s Disease causes inflammation of the intestine. This leads to abdominal pain, diarrhea, bleeding in stools, mucus discharge, weight loss, and loss of appetite.
While there are several similarities between Crohn’s and ulcerative colitis, key differences set these conditions apart – and call for different treatment approaches. The following are the distinctions between the two conditions:
- Ulcerative colitis exclusively affects the colon, but Crohn’s disease may affect any part of the digestive system.
- Depth of inflammation – Ulcerative colitis causes inflammation of the lining of the intestine, as opposed to Crohn’s disease, which causes inflammation of the entire thickness of the bowel.
- Unique symptoms – Individuals with ulcerative colitis, may suffer rectal bleeding or blood in their feces more often than those with Crohn’s disease. Additional and unique symptoms of Crohn’s disease include mouth sores, anal tears, ulcers, infections, and narrowing of the intestine.
Diagnosis and treatment of Ulcerative Colitis/ Crohn’s Disease:
- Diagnosis is established by endoscopy and biopsy of the affected segment of the intestine. This may need an upper GI scopy or a colonoscopy depending on the part of the intestine that is involved.
- Treatment of Ulcerative Colitis and Crohn’s disease is mainly medical.
A number of drugs are used such as mesalazine, steroids, antibiotics, and azathioprine
- Immunomodulators like Infliximab, Adalimumab, or Vedolizumab are used in severe cases
When is Surgery needed for Ulcerative Colitis and Crohn’s disease?
- Failure or poor response to medical treatment
- Medical treatment can fail or result in inadequate relief. This needs to be treated with surgery.
- Acute colitis presents as an emergency
- Acute colitis can present as severe diarrhea with bleeding. This may need surgery if medical treatment does not treat it
- Perforation of the colon
- Severe colitis can lead to perforation which has to be treated with emergency surgery
- Development of Colon cancer
- Ulcerative Colitis and Crohn’s disease increase the risk of colon cancer. This has to be treated with surgery.
Types of Surgery for Ulcerative Colitis and Crohn’s disease:
- Surgery on the Small intestine
- Resection and anastomosis – In this procedure, the affected segment of the small intestine is removed and the two ends are joined back together. This can be done by stitches or by intestinal staplers.
- Strictureplasty – Stricture is a narrowing developed in the small intestine, which is seen in Crohn’s disease. This leads to intestinal obstruction and needs surgery. Strictureplasty is a type of operation that opens up the narrow segment of the intestine without its removal. Patients with Crohn’s disease often have multiple strictures. These are best treated by strictureplasty rather than resection. This leads to the preservation of bowel length.
- Surgery on the Large intestine
- Total colectomy – Removal of the entire colon. This procedure is needed in cases with severe colitis which does not respond to medical treatment.
- Total colectomy, proctectomy, and Ileal pouch formation – Removal of the entire colon and rectum may be necessary in severe colitis or if there is the development of colon cancer. In such a case a pouch can be created from the small intestine which is joined to the anus. In this manner, the patient can still pass stools the normal way, without needing a permanent stoma.
Can Surgery for Ulcerative Colitis and Crohn’s disease be done Laparoscopically?
- Yes, Surgery for Ulcerative Colitis and Crohn’s disease can be done Laparoscopically in most cases.
- Robotic Surgery also has benefits when the removal of rectum is needed.
- Laparoscopic or Robotic Surgery leads to small incisions, lesser pain, and faster recovery.
Is stoma formation necessary?
- Ulcerative colitis and Crohn’s disease lead to poor healing.
- Therefore after surgery, at times it is necessary to protect the operated intestine by creating a stoma.
- A stoma is a part of the intestine that is brought out, opened, and attached to the skin. This produces stools which get collected in a bag.
- A stoma can protect the operated part of the intestine and help in its healing by bypassing or diverting stools away from it.
- Once healing has occurred, the stoma can be closed by a smaller operation a few weeks later.
What is the usual recovery time after Surgery?
- Following surgery for Ulcerative colitis and Crohn’s disease, patients stay in the hospital for 5-7 days. Once the patient passes stools and can have a normal diet, he or she is discharged
What is the long-term prospect for patients?
- Ulcerative colitis and Crohn’s disease are unfortunately chronic diseases with relapses and remission
- They are best managed by Multidisciplinary team
- This team should include a Medical Gastroenterologist, GI Surgeon, Dietitian and Stoma nurse (if stoma made)
- Patients need long term follow up and with Multidisciplinary treatment, good outcomes are possible.
For more information & consultation on Ulcerative Colitis/ Crohn’s Disease
Treatment in Mumbai, contact us on 84518 65944 or simply fill in your name and number & one of our team member will get in touch with you soon. Our team of experts along with Dr. Chintamani Godbole, MS, DNB (Surgical Gastroenterology), FRCS (Edinburgh, UK), and Gastrointestinal surgeon will help you out in understanding your problem and guide you through every stage of your treatment.