Inflammatory Bowel Disease

Inflammatory bowel disease consists of the major conditions of Crohn's disease and Ulcerative Colitis. There are some people with colonic inflammation which is difficult to fit to a particular pattern, and we call this indeterminate colitis.

Crohn's Disease
Crohn's disease is due to inflammation of the wall of the bowel. It can affect any part of your digestive system, from your mouth down through your stomach and bowel to your anus. However, it's most common in your small bowel or the first part of your large bowel. It may affect more than one section leaving unaffected areas in-between.

If you have Crohn's disease, you will have inflammation and swelling in affected areas of your bowel and ulcers may form. These are raw areas of the bowel lining which can bleed. Your bowel wall will be thickened and this may cause blockages.

Crohn's disease is a chronic condition. This means that it lasts a long time, sometimes for the rest of the affected person's life. Crohn's disease is characterised by flare-ups of symptoms. These alternate with periods of no symptoms at all - this is called remission. Symptoms include:

- diarrhoea - it may contain blood, pus or mucus
- a painful and swollen abdomen (tummy)
- loss of appetite
- weight loss
- fever
- rectal bleeding - this may lead to anaemia (a condition when you have too few red blood cells or not enough haemoglobin in your blood)
- tears, ulcers or abscesses (pus-filled areas) around your anus

Treatment
Medicines Many people with Crohn's disease find that treatment with medicines is effective. Medicines used to treat Crohn's disease include:

- corticosteroids (eg prednisolone) to reduce inflammation
- medicines to suppress your immune system (eg methotrexate or azathioprine)
- a medicine called infliximab

Surgery
Surgery may be needed to treat complications or if medicines aren't controlling the disease. The surgeon will aim to remove as little of your bowel as possible and expand any parts that have become narrowed. Most Crohn's disease patients will need surgery at some time (97%).

Ulcerative Colitis
Ulcerative colitis is an inflammatory bowel disease that affects about one in every 500 people in the UK. It is a chronic (long-lasting) condition that causes inflammation and ulcers to develop in the lining of your large intestine (colon) and rectum. If you have ulcerative colitis you may have inflammation problems in other areas of your body, such as arthritis or red and painful skin or eyes. Ulcerative colitis can occur at any age and affects men and women equally.

Ulcerative colitis is known as a "relapsing and remitting" condition. This means that your symptoms can disappear and then flare up again from time to time. You may have weeks or even months with few or no symptoms at all.

Symptoms
The main symptom of ulcerative colitis is frequent, watery diarrhoea that sometimes has blood and/or mucus in it. You may also have abdominal cramping during bowel movements. Other symptoms include:

- feeling like you haven't finished on the toilet
- nausea
- loss of appetite
- weight loss
- tiredness
- inflammation (redness or pain) in the eyes, skin or joints.

Having ulcerative colitis increases your risk of developing colon cancer. The risk depends on how long you have it for, and how extensive it is. Because of this, if you have ulcerative colitis you should have regular colonoscopies to check for any signs of cancer developing. If these are present you may need surgery to remove the affected area of colon.

Medicines
The most common treatments for ulcerative colitis are either steroids or a type of medicine called 5-aminosalicylate (5-ASA). You may also be given medicines to suppress your immune system (immunosuppressants) if these treatments don't work.

5-ASA medicines work well for reducing moderate flare-ups or relapses. Some people need to switch to steroids if the 5-ASA treatment isn't working or if the flare-up is severe. You take these medicines as tablets, suppositories or as enemas.

Surgery
In most people, the symptoms of ulcerative colitis can be controlled using medication. However, occasionally the colon needs to be surgically removed. This could be because the inflammation and ulceration continue despite treatment. Sometimes the bowel can become severely swollen - a condition known as megacolon. This is very serious and usually means that the colon needs to be removed.

Alternatively, you may choose to have surgery if your symptoms aren't controlled or you are getting severe side effects from your medication.

Surgery for ulcerative colitis can greatly improve your quality of life: removing the colon can effectively get rid of the disease.