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What to Know About Crohn's & Colitis
December 3, 2020
Crohn’s & Colitis Awareness Week--from Dec. 1 to Dec. 7--is an opportunity to better understand the varied impact these autoimmune diseases can have on the more than one million Americans who suffer from them.
Randy Longman, MD, PhD, assistant professor of medicine at the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell Medicine (WCM), and Dana Lukin, MD, the center’s clinical director of translation research, offer an overview of the diseases, and the various treatments WCM clinicians use to treat them.
Inflammatory bowel disease is an umbrella term that describes a chronic inflammation disease that affects the intestine.
“That can include Crohn’s and ulcerative colitis, and patients may experience a wide range of symptoms,” Dr. Longman says. “It may be diarrhea, nausea, vomiting, abdominal pain, or rectal bleeding—all of which may be mild to severe.”
Patients should tell their physicians about all of the symptoms they experience, Dr. Longman adds.
Irritable bowel syndrome (IBS) is not the same as inflammatory bowel disease.
“Inflammatory bowel disease involves inflammation, which is an immune-mediated process in the bowels,”
Dr. Lukin explains. “Irritable bowel syndrome is sometimes referred to as a functional condition that is not due to inflammation.”
Some of the symptoms present in inflammatory bowel disease (as opposed to irritable bowel syndrome) is the presence of bleeding, as well as systemic symptoms, such as weight loss.
“It’s important to think about how to distinguish the two using objective testing and, of course, listening to our patients describe their symptoms,” Dr. Lukin says.
Sometimes, Dr. Longman adds, both conditions can be present in the same patient, although they are supported by different processes, and different medical therapies are used to treat each condition.
Genetics plays a role in Crohn’s disease and colitis.
“What we know and what we’ve known for many years, is that inflammatory bowel disease, Crohn’s disease, and ulcerative colitis frequently travel in families,” Dr. Longman says.
Some of the genes involved in these conditions are well known and well described, he explains—and sometimes physicians can help identify genetic mutations that indicate more aggressive disease.
“Sometimes people can develop complications associated with Crohn’s disease—abscesses, fistula (a communication between the intestine and another part of the body)—and these are very complicated issues and can make the disease more difficult to treat. So recognizing aggressive disease is important because it’s important to make sure we start therapy quickly to address that.”
Stress can lead to Crohn’s and colitis flare-ups.
“Stress is absolutely linked to exacerbations, or what is typically referred to as ‘flares’ of one’s inflammatory bowel disease,” Dr. Lukin says. “This can be emotional, stress, busy times at work, a major life transition like a breakup, or even a good life transition, such as a wedding.”
In our school-age patients, Dr. Lukin says, doctors will see flares around the times of exams, “So there is definitely a clear link.”
Patients should “try to find ways to deal with those stressors effectively to help minimize potentially the duration of flare-type symptoms,” he adds.
Treatment options for inflammatory bowel diseases have improved—and there are more treatments.
“We are continually expanding the arsenal of medical therapy used to treat inflammatory bowel disease,” Dr. Longman says.
Doctors prescribe different types of drugs used to treat Crohn’s disease. The medications may control symptoms, reduce flares, decrease inflammation in the lining of the gastrointestinal tract, suppress the entire immune system to reduce the body’s immune response, and treat infections. These medicines may be delivered orally, by injections, or intravenously.
Also notable is that the field is evolving from a very reactive approach, in which medical teams focused on treating symptoms, to one that has adopted a “target to treat” approach, Dr. Lukin says.
“Some of these newer molecules are able to treat the disease more systemically, in a more disease-modifying fashion to prevent complications down the line,” he adds. “There are more choices that make it much more complex decision making, and I think it just underscores the real importance of having a good relationship with your physician and care team.”