JANUARY 2019

the DOCTOR is in
Crohns and Ulcerative Colitis
This brief summary of
Inflammatory Bowel
Disease is designed
to help you understand the
basics of Crohn’s and Ulcerative
colitis and highlight key
differences between the two
and hopefully help you seek
out a doctor if necessary.
Ulcerative colitis is an inflammatory
condition limited
strictly to the large intestine
(colon). The colon is the
part of the GI tract that reabsorbs
water and where stool is created.
The inflammation here is localized
to the superficial layers of the
colon. The most common symptoms
are diarrhea with mucus and/
or blood but the pain is typically
less severe. During a colonoscopy,
inflammation is typically continuous
with a clear start and end with
sparing of the anus. Removing the
large intestine is curative.
Crohn’s is also an inflammatory
disorder which can manifest anywhere
in the gastrointestinal tract.
The inflammation here is transmural,
essentially meaning that it is
deeper. Thus, inflammation, strictures,
and fistulae can occur from
the mouth to the anus. The most
commonly affected area is the terminal
ileum, the last part of the
small intestine prior to transitioning
to the large intestine. The diarrhea
here is typically more “porridge
like” and associated with significant
pain. Crohn’s is also more commonly
associated with anal disorders
including abscesses and fissures.
On a colonoscopy the inflammation
is occurs sporadically and at times
impairs passage of the
camera. Surgery is reserved
for removing narrowed
segments of bowel
but unfortunately is not
curative.
The diarrhea can be
loose, watery, or bloody
and occurs over several
weeks. They can be associated
with urgency
(feeling the need to go),
frequency, pain, weight
loss, fatigue, anemia, and
the diarrhea can wake you up from
sleep. Many patients at the time of
diagnosis have over 20 bowel movements
per day! These symptoms
should prompt you to see a doctor
as soon as possible. There is a significant
overlap with irritable bowel
syndrome which at times can delay
the diagnosis as patients can have
both occurring at the same time.
It should be noted that waking up
from sleep for a bowel movement is
almost never considered normal.
Both of these conditions are
considered autoimmune disorders
where the immune system attacks
the body for unknown and unclear
reasons. There is a genetic and
environmental component but the
trigger has yet to be discovered and
this is an active area of research.
The disease can start at any age
but typically manifests between 15-
35. Patient with one autoimmune
disease are also at risk for another
autoimmune disease.
The treatment for these conditions
has progressed rapidly in the
past 20 years after an initial slow
start. In the 1950’s the only two
JOHNATHON
MARKUS M.D.
SPECIAL TO THE
CHALDEAN NEWS
These conditions
are life-long and
require an intimate
relationship between
you and your
gastroenterologist.
treatments were corticosteroids
and sulfasalazine. Corticosteroids
work quickly and effectively but
their long-term use has been associated
with diabetes and osteoporosis.
Sulfasalazine has been largely
replaced by the aminosalicylates
such as mesalamine. The 1960’s
brought us Azathioprine (Imuran)
and Methotraxate. As a side note,
if you are a woman on methotrexate,
you should NOT get pregnant
as this medication is known to
cause harm to the fetus.
The world of inflammatory bowel
disease changed in 1997 with approval
of the TNF-alpha inhibitors.
This one of the first medications
that was able to place patients in
deep remission without pain or diarrhea.
However, these medications
were not without flaws. Namely,
many patient’s lost response either
due to adaptation of the disease or
creation of antibodies which deactivated
the medication. There was
also an increased risk of infections
and lymphoma.
Two new medications have been
approved for the treatment of inflammatory
bowel disease. Vedolizumab
(Entyvio) was approved in
May of 2014 for the treatment of
both Crohn’s and Ulcerative colitis.
This medication blocks white
blood cells from entering the GI
tract. Ustekinumab (Stelara) was
approved for Crohn’s disease in
September of 2016 and is now one
of the most prescribed medications
for moderate-severe Crohn’s. This
works by inactivating proteins that
stimulate inflammation. There is
minimal cancer, infection, and antibody
formation with both of these
medications. Finally, Tofacitinib
(Xeljanz) was approved to treat UC
in May of 2018.
These conditions are life-long
and require an intimate relationship
between you and your gastroenterologist.
Goals of therapy have
changed over the years with more
emphasis on aggressively treating
any inflammation rather than
symptoms. These conditions are
associated with increased risks of
cancer, vitamin deficiencies, and
infections which further necessitate
open and clear dialogue between
you and your doctor. It can
be scary to think that these disease
are for life but there is a significant
amount of hope for those afflicted
with either of these diseases given
the vast amount of ongoing research.
With aggressive care and
a close relationship with your gastroenterologist
many of the symptoms
and complications can now be
avoided.
For further information visit the
Crohn’s and Colitis Foundation:
www.crohnscolitisfoundation.org
Going Green?
Read Chaldean News online at
www.chaldeannews.com
28 CHALDEAN NEWS JANUARY 2019