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Understanding Crohn’s and Colitis

Written by Mariya Rizwan, PharmD

According to the Centers for Disease Control and Prevention (CDC), in 2015, around 1.3% of Americans, which accounts for approximately three million people, were diagnosed with some form of inflammatory bowel disease, either Crohn’s disease or ulcerative colitis.

Let’s talk about them and understand the difference between the two.

Crohn’s disease and colitis are inflammatory bowel diseases. They are often mistaken for each other due to some similar symptoms they cause, such as abdominal pain, rectal bleeding, urgency to defecate, and diarrhea. However, they can be well differentiated because of some other characteristic symptoms.

What Are the Differences Between Crohn’s Disease and Ulcerative Colitis?

The symptoms of Crohn’s disease and ulcerative colitis are quite similar, which makes it difficult to diagnose. However, they have subtle differences, such as:

Patients with ulcerative colitis typically experience pain in the lower left side of the abdomen, whereas in Crohn’s disease, the pain is usually on the right side. However, it's important to note that this may not always be the case. In some instances, Crohn's disease can also cause pain in the lower left side of the abdomen. Additionally, bleeding from the rectum during bowel movements is a common symptom of ulcerative colitis but not as common in Crohn's disease.

In ulcerative colitis, the main affected part of the digestive tract is the large intestine or sometimes the ileum. But in Crohn’s disease, inflammation can occur at any part of the digestive tract, from the mouth to the anus. The patterns of inflammation of Crohn’s disease and colitis differ and are distinct. The inflammation because of ulcerative colitis is continuous. It usually starts in the rectum or sigmoid colon and spreads through the colon as the disease progresses. However, in Crohn’s disease, there are inflammatory patches in one or more parts of the digestive tract. It may appear as two separate patches between a healthy part.

In a colonoscopy or a sigmoidoscopy, there are differences that the physician can observe with Crohn’s or colitis. In ulcerative colitis, the wall is thinner with continuous inflammation and no patches of healthy tissues in the diseased section. However, in the intestine with Crohn’s disease, the colon may appear thickened, and because of intermittent diseased patterns, it may appear like a cobblestone pattern. The presence of granulomas helps in differentiating between Crohn’s disease and colitis. Granulomas are inflamed cells lumped together and present in Crohn’s disease, whereas in colitis, they are missing. Therefore, when the healthcare provider finds granulomas in the inflamed tissue section of the digestive tract, it is confirmed as Crohn’s disease.

In ulcerative colitis, the ulcers do not extend beyond the inner lining. Meanwhile, in Crohn’s disease, the ulcers are deep, extending into all layers of the bowel.

Management and Treatment of Crohn's Disease or Ulcerative Colitis

Along with medications, bowel rest is also essential in acute exacerbations. It helps in healing. To achieve bowel rest, place the patient on nothing by mouth (NPO) status and administer parenteral nutrition to supply the required fluids, electrolytes, and nutrients.

Once the acute episode subsides and the symptoms get relieved, give them a diet high in protein, vitamins, and calories. However, the diet consumed should be balanced. You can also prescribe fiber supplements as they benefit colonic diseases. A low-roughage diet is usually indicated for patients with obstructive symptoms. Moreover, a low-residue, milk-free diet is also well tolerated.

Generally, the treatment for Crohn’s disease and colitis is similar. However, certain medicines can be more effective in one form of inflammatory bowel disease than others.

In most cases, the mainstay choice to treat ulcerative colitis is 5-acetylsalicylic acid (ASA) medications and corticosteroids. However, the 5-ASA medications do not treat Crohn’s disease when it involves the small colon. In that case, corticosteroids are used.

Certolizumab pegol is only approved for Crohn’s disease, and balsalazide disodium is for ulcerative colitis. However, new biologics and other drugs, such as adalimumab and vedolizumab, are given for both conditions.

For patients with Crohn’s disease, surgery to remove the diseased part can help alleviate its symptoms. But the disease tends to recur.

In ulcerative colitis, the large intestine tends to get diseased. Therefore, colectomy is referred to as its cure. After that, a patient may also need to undergo an ileostomy because in ulcerative colitis, removing the diseased part does not help as it recurs.

Role of Nurses in Crohn's Disease or Ulcerative Colitis

Nursing care can help lower the symptoms of exacerbations during the acute attack of Crohn’s disease or colitis. It can help reduce acute episodes of inflammation and teach measures to prevent future attacks. Encourage the patient to maintain fluid intake. Ensure they drink at least 3000 milliliters of fluid daily unless restricted. Implement measures to prevent skin breakdown of the perianal area.

Ask the patient to rest well and maintain adequate nutritional intake with calorie counting. Moreover, assist them in maintaining oral hygiene, provide small and frequent meals throughout the day, monitor intravenous fluids and total parenteral nutrition as prescribed, and monitor the patient’s serum albumin levels.

With Crohn’s disease and ulcerative colitis, the patient may become mentally exhausted. Therefore, encourage them to express their feelings and refer them for more extensive counseling. Also, discuss measures to diminish stressful situations with the patient and family.

The Bottom Line

Living with Crohn’s disease or ulcerative colitis can be challenging. Therefore, your patients need appropriate management with medications, dietary restrictions, and counseling. Give them emotional support, especially during the time of acute exacerbation, as they may feel low and depressed. Healthcare providers can play an essential role in controlling the symptoms of acute attacks of inflammatory bowel disease by efficient management.

Compel your patients to attend follow-up visits, especially when the disease flares up.

About the Author:

Mariya Rizwan is an experienced pharmacist who has been working as a medical writer for four years. Her passion lies in crafting articles on topics ranging from Pharmacology, General Medicine, Pathology to Pharmacognosy.

Mariya is an independent contributor to CEUfast’s Nursing Blog Program.

Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.

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