Intestinal inflammation caused by Crohn’s disease and ulcerative colitis

Definition of Crohn’s disease and ulcerative colitis

Crohn’s disease and ulcerative colitis are inflammatory diseases that cause ulcers in the lining of the intestinal wall. In English, the term IBD, Inflammatory Bowel Disease, is used. Ulcerative colitis and Crohn’s disease cause the same clinical picture. However, ulcerative colitis occurs only in the large intestine, whereas Crohn’s disease can also affect the small intestine. The inflammation in ulcerative colitis is also somewhat more superficial. In Crohn’s disease, a person may develop so-called fistulas. Fistulas are wounds in the intestinal wall that can even extend through the mucous membrane.

Crohn’s disease

In the Netherlands, approximately 20,000 people have Crohn’s disease. The disease is diagnosed in 1 in 1,000 people. Crohn’s disease can cause ulcers in both the large and small intestine. The disease usually manifests in people between the ages of 15 and 25, but it can also occur in young children. Crohn’s disease is slightly more common in women than in men.

Symptoms of Crohn’s disease and ulcerative colitis

Crohn’s disease and ulcerative colitis are chronic diseases with a number of clear symptoms. Both diseases have quiet and active periods. The consequences of both diseases can be serious and sometimes even life-threatening. Symptoms caused by these diseases include:

• Cramps
• Abdominal pain
• Mucous or bloody diarrhea
• Some people with ulcerative colitis experience:
• Poor appetite
• Fatigue
• Anemia

Joint pain

• Liver problems

Differences between Crohn’s disease and ulcerative colitis

The course of the disease is unpredictable; some people almost never have symptoms, while others are almost never symptom-free. The course of Crohn’s disease differs from person to person. There are several important differences between Crohn’s disease and ulcerative colitis:

• In Crohn’s disease, inflammation can occur throughout the entire gastrointestinal tract, from the mouth to the anus. In ulcerative colitis, inflammation occurs only in the large intestine and rectum.
• In Crohn’s disease, the small intestine may be affected. In that case, food absorption is reduced. This causes deficiencies in minerals and vitamins, which can result in weight loss and anemia. In children, this can lead to growth retardation.
• In Crohn’s disease, scar tissue and therefore narrowing are seen more often. Narrowing is almost never seen in ulcerative colitis.
• Fistulas and granulomas occur only in Crohn’s disease.
• In Crohn’s disease, ulcers are seen in different locations. In ulcerative colitis, often only the rectum is affected.
• In Crohn’s disease, the ulcers can be deep. In ulcerative colitis, they are more superficial and affect only the mucous membrane.
• In ulcerative colitis, a continuous section of the intestine is inflamed.

Available tests for Crohn’s disease and ulcerative colitis

To detect Crohn’s disease and ulcerative colitis, stool testing and internal examinations can be performed. Stool testing can examine:

• The amount of calprotectin, lactoferrin and transferrin in the stool.
• The presence of occult blood.
• The TNA-alpha levels in the stool. TNF-alpha plays a key role in regulating the immune system. In Crohn’s disease and ulcerative colitis, these inflammatory messengers may be elevated.
• The sIgA level in the stool. A higher sIgA level indicates an infection.
• Beta-defensin 2 levels. The intestinal wall plays an active role in defending our body against harmful bacteria and parasites. The intestinal wall therefore also contains special Paneth cells, which produce the substance defensin. The name ‘defensin’ says it all: defensin inhibits harmful bacteria and intestinal parasites by restricting their growth.

Internal examination for Crohn’s disease and ulcerative colitis can also be performed. This is done when inflammatory markers are elevated or when someone has persistent diarrhea. A tube with a camera is then inserted into the body through the mouth or anus. This makes it possible to examine the quality of the mucous membrane of the intestine(s). Small pieces of tissue, biopsies, can also be taken for later examination under a microscope.

Treatment

There is actually nothing you can do to prevent these diseases. However, there may be a number of ways to reduce the symptoms. The Crohn and Colitis Foundation of America states that diet does not play a role in the inflammatory process in people with Crohn’s disease or ulcerative colitis. However, many people with one of these diseases find that it is better to avoid the following products in particular:

• Large amounts of sugar
• Dairy products
• Dried beans, peas, legumes and dried fruit
• Foods containing sulfur or sulfate
• (Chili) sauce
• Peppers
• Meat and processed meat products
• Nuts and seeds
• Grains, soy
• Chocolate
• Caffeine
• Products containing sorbitol
• Alcohol
• Carbonated drinks

However, there are also nutrients with anti-inflammatory properties. Examples include:

• Turmeric
• Oily fish
• Foods rich in antioxidants

An anti-inflammatory diet should be established together with a nutrition professional. In addition, many researchers emphasize the importance of making the diagnosis at an early stage of intestinal symptoms. Patients with intestinal complaints have much less energy and less enjoyment of life. Stool testing has been shown to save costs, can shorten the course of illness and is non-invasive. Patients do not have to deal with waiting times, and the doctor can make a more targeted referral to a specialist. This speeds up the diagnostic process.

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