How common are Crohn's disease and ulcerative colitis?
There are about 10,000 new cases of IBD diagnosed each year in Canada. From the statistics to date, it would appear that the incidence of Crohn's disease is increasing. There are geographical and racial variations in the occurrence of both diseases for reasons that are not clear.
Are these diseases infectious?
Although the cause of IBD is unknown, neither Crohn's disease nor ulcerative colitis has been shown to be infectious. An infecting bacterium, virus, fungus, or parasite has never been demonstrated with any consistency. Thus, it is believed that these diseases cannot be 'caught' or 'given'.
Are these diseases inherited?
IBD is not hereditary in the classical definition of a hereditary disease. Thus, there is no predictability that a child of an affected parent will develop the disease. IBD is, however, a somewhat familial disease in that there is an increased occurrence among blood relatives. The chances are about one in twenty that some relative of a patient will also have IBD, either Crohn's disease or ulcerative colitis.
Do these diseases occur often in children and how does the course differ from that in adults?
About 10 percent of those affected have onset before age 16. Unfortunately, the outlook is worse than in adults in that the complication rate is higher and surgery is required more often. Delayed growth and development may occur if the onset of disease is before puberty, as nutrient absorption can be severely impaired.
Is anything known about possible causes?
The cause or causes are completely unknown at present. There is considerable evidence to suggest that in some persons with these diseases, allergic-like reactions (antigen-antibody) occur in the tissues of the intestinal tract. This means that the body's defence mechanisms are operating against some materials in the digestive tract that they recognize as foreign matter. Exactly what initiates this reaction in the body (e.g. viruses, bacteria, food substances or other kinds of toxic agents) remains a mystery. What starts out as a defence mechanism, may then become the disease.
Are these autoimmune diseases?
The term autoimmune disease refers to any one of many conditions where the body's defence mechanisms appear to be attacking its own tissues, almost as though the body had somehow become allergic to part of itself. There are a number of features of Crohn's and colitis that resemble this type of auto-allergic or autoimmune reaction.
These include:
the young age of patients affected
the appearance of the pathological changes in the intestinal tissues
the associated complications that sometimes involve the skin or joints or eyes
abnormalities that may occur in various blood tests, and
the favourable response to certain "anti-allergic" drugs such as cortisone.
It must be emphasized, however, that these so-called autoimmune features are really quite non-specific. The same features may be seen in a wide variety of inflammatory diseases, infections, and other conditions. To refer to Crohn's disease and ulcerative colitis as autoimmune should, therefore, in no way imply that the basic causes of these diseases are known or understood.
Do Crohn's disease and ulcerative colitis have the same cause?
This has been a source of debate for many years. Some feel that the cause is the same and that different types of inflammation are due to the different locations of the disease process. Others feel that they are two unrelated disease processes and share only the fact that they involve intestinal tissue. More research is required to clarify this important question.
To what extent are Crohn's disease and ulcerative colitis psychosomatic diseases?
Since no one knows the causes of these diseases, no one can say for sure what role psychological factors play. Most physicians today believe that emotional problems do not cause Crohn's disease or ulcerative colitis. On the other hand, most would also agree that emotional factors may influence the course of the disease - just as they influence the course of most other chronic diseases.
Can psychotherapy cure or at least help control these diseases?
Since no medical cure is known and the clinical course of these diseases can be so varied and unpredictable, it is not possible to make any categorical statement about whether psychotherapy does or does not help. Some patients seem to benefit from psychiatric treatment while others do not. Perhaps a general rule to adopt is that if patients have emotional problems that seem to be affecting their health or otherwise disturbing their lives, then psychiatric help should be considered. If the help is successful, then the course of the Crohn's disease or ulcerative colitis will often coincidentally be benefited. However, in no case should any patient receiving psychotherapy be deprived of medical care!
What affect has Crohn's disease and ulcerative colitis on pregnancy and conception?
The fertility rate among women who have Crohn's disease or ulcerative colitis is essentially normal. The rate of spontaneous abortion is similar to that in the average population. The chances of having a normal child are also no different. In some patients, the illness worsens during pregnancy, while in others the illness might remain unchanged or even improve.
What are fistulae?
These are abnormal passageways between the inflamed intestinal tissue and some adjoining tissue or another segment of intestine. These sinus tracts are characteristic of Crohn's disease, particularly when connecting two segments of intestine or burrowing from the ileum to areas within the abdominal cavity. Complicated fistulae occur around the anus and rectum in Crohn's disease. Fistulae are not characteristic of ulcerative colitis, although they occasionally occur in the rectal region or between the rectum and vagina.
Do people with Crohn's disease and ulcerative colitis develop cancer?
Cancer of the small intestine, where Crohn's disease usually occurs, is an exceedingly rare disease. However, after many years of involvement with Crohn's disease, the incidence of cancer in the small intestine may be slightly higher than in the average population.
More is known about the potential risk of cancer of the large intestine, or colon, as a complication of ulcerative colitis or Crohn's disease. The incidence is significantly greater than in the average population but usually occurs in those cases in which the entire colon has been involved for at least 10 years. This risk slowly rises above average after ten years of disease.
What can be done to recognize cancer of the colon at its earliest stage?
Those at increased risk (colitis of the entire colon for more than ten years) should have a colonoscopy examination of the colon that includes a biopsy, every two years, in search of early changes toward malignancy.
Are you taking prescription medication for any of the following stomach problems/symptoms:
Stomach pain or discomfort
Heartburn
Sour taste in mouth/acid regurgitation
Excessive burping/belching
Increased abdominal bloating
Nausea
Early satiety
If you answer yes to any one of the symptoms listed above then take this test to see if your current medication is adequately controlling your stomach symptoms.
The PASS Test
PPI* Acid Symptom Suppression Test
*PPI is short for proton pump inhibitor, a class of medication used to suppress the acid in your stomach. These include Losec®, Nexium®, Pantoloc®, Pariet™, and Prevacid®.
