Posts Tagged ‘Ulcerative Colitis’

Ulcerated Colitis

06.05.10

Ulcerative colitis is a chronic disease in which the large intestine becomes inflamed and ulcerated (pitted or eroded), leading to flare-ups (bouts or attacks) of bloody diarrhea, abdominal cramps, and fever. The long-term risk of colon cancer is increased. Ulcerative colitis may start at any age but usually begins between the ages of 15 and 30.

A small group of people have their first attack between the ages of 50 and 70.Ulcerative colitis usually does not affect the full thickness of the wall of the large intestine and hardly ever affects the small intestine. The disease usually begins in the rectum or the rectum and the sigmoid colon (the lower end of the large intestine) but may eventually spread along part or all of the large intestine.

Ulcerative proctitis, which is confined to the rectum, is a very common and relatively benign form of ulcerative colitis. In some people, most of the large intestine is affected early on.

The cause of ulcerative colitis is not known for certain, but heredity and an overactive immune response in the intestine seem to be contributing factors. Cigarette smoking, which is detrimental in Crohns disease, seems to decrease the risk of ulcerative colitis.

However, smoking in order to reduce the risk of ulcerative colitis is ill-advised in light of the many health problems that smoking can cause. Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD).

Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon. The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset. Ulcerative colitis is, however, a systemic disease that affects many parts of the body outside the intestine.

Because of the name, IBD is often confused with irritable bowel syndrome (“IBS”), a troublesome, but much less serious condition. Ulcerative colitis has similarities to Crohns disease, another form of IBD. Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission.

Ulcerative colitis is a rare disease, with an incidence of about one person per 10,000 in North America. The disease tends to be more common in northern areas. Although ulcerative colitis has no known cause, there is a presumed genetic component to susceptibility.

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Pathophysiology of Crohns Disease

05.28.10

Crohns disease begins with crypt inflammation and abscesses, which progress to tiny focal aphthoid ulcers. These mucosal lesions may develop into deep longitudinal and transverse ulcers with intervening mucosal edema, creating a characteristic cobblestoned appearance to the bowel.

Transmural spread of inflammation leads to lymphedema and thickening of the bowel wall and mesentery. Mesenteric fat typically extends onto the serosal surface of the bowel. Mesenteric lymph nodes often enlarge.

Extensive inflammation may result in hypertrophy of the muscularis mucosae, fibrosis, and stricture formation, which can lead to bowel obstruction. Abscesses are common, and fistulas often penetrate into adjoining structures, including other loops of bowel, the bladder, or psoas muscle.

Fistulas may even extend to the skin of the anterior abdomen or flanks. Independently of intra-abdominal disease activity, perianal fistulas and abscesses occur in 25 to 33% of cases; these complications are frequently the most troublesome aspects of Crohns disease.

Noncaseating granulomas can occur in lymph nodes, peritoneum, the liver, and all layers of the bowel wall. Although pathognomonic when present, granulomas are not detected in about half of patients with Crohns disease.

The presence of granulomas does not seem to be related to the clinical course.Segments of diseased bowel are sharply demarcated from adjacent normal bowel (“skip areas”); hence, the name regional enteritis. About 35% of Crohns disease cases involve the ileum alone (ileitis); about 45% involve the ileum and colon (ileocolitis), with a predilection for the right side of the colon; and about 20% involve the colon alone (granulomatous colitis), most of which, unlike ulcerative colitis (UC), spare the rectum.

Occasionally, the entire small bowel is involved (jejunoileitis). The stomach, duodenum, or esophagus is clinically involved only rarely, although microscopic evidence of disease is often detectable in the gastric antrum, especially in younger patients. In the absence of surgical intervention, the disease almost never extends into areas of small bowel that are not involved at first diagnosis.

There is an increased risk of cancer in affected small-bowel segments. Patients with colonic involvement have a long-term risk of colorectal cancer equal to that of UC, given the same extent and duration of disease.

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Infectious Colitis

03.05.10

Infectious colitis: A variety of “bugs” may cause colitis. They have developed a variety of ways to overcome our natural defenses and ultimately cause colitis. The germs include these:

•    Bacteria: Commonly found in food or contaminated water, bacteria may produce toxins that trigger intestinal cells to secrete salt and water and interfere with their normal functions. Salmonella, Shigella species, Campylobacter jejuni, and Clostridium are examples of bacteria associated with infectious colitis.
•    Viruses: Viruses such as rotavirus or Norwalk can damage the mucous membrane lining your intestine and disturb fluid absorption.
•    Protozoa: People infected with these tiny organisms may show no symptoms (carrier state), or they may have chronic, mild, loose, bowel movements or acute severe dysentery. Colitis due to E histolytica, also known as amebiasis, has become an important sexually transmitted disease in homosexual men.

Types of colitis include ulcerative colitis, Crohn’s colitis, diversion colitis, ischemic colitis, infectious colitis, fulminant colitis, chemical colitis, microscopic colitis, lymphocytic colitis, and atypical colitis. The risk of developing infectious colitis varies considerably throughout the world and depends on local conditions. Populations in developing countries often live in ramshackle housing without good sanitation. Colon infections are readily transmitted in this setting.

However, in industrialised countries, most inhabitants live in a sanitary environment but other practices facilitate germ transmission such as large-scale food production, distribution retailing practice (fast-food chains…). Hospitalised patients, infants in day care centres, travellers also exhibit an increased susceptibility for infection. vIn most patients coming to the general practitioner or specialist with a history of acute (short history, less than one week) watery diarrhoea with blood or mucus (dysentery), it will be possible to make a diagnosis fairly easily.

Watery diarrhoea is more often of viral aetiology, and at routine bacteriological investigation, cultures will be negative. Watery diarrhoea is the result of a disturbed balance between intestinal secretion and absorption. Viruses can infect and kill villous tip enterocytes and by doing so disturb absorption. Diarrhoea with blood is more often of bacterial origin.

Production of bloody stools means a mucosal break caused by entero-invasive bacteria. Acute bloody diarrhoea however usually begins with watery diarrhoea. Some bacteria can also induce either acute diarrhoea or acute bloody diarrhoea. The differential diagnosis between infectious colitis and other types of colitis is sometimes difficult : in patients coming from tropical or subtropical countries where infections are more likely, a diagnosis of chronic idiopathic inflammatory bowel disease must be made cautiously ; whenever more than one person has been acutely ill at the same moment, a diagnosis of chronic inflammatory bowel disease is unlikely and food poisoning has to be considered; immuno-compromised patients ; elderly patients where one has to consider diverticular disease, ischaemia, malignancy, or a colitis — like picture due to drugs.

Drugs are indeed a common cause of diarrhoea and colitis.

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Crohns Disease in Children

10.31.09

In the last quarter century, it has become clear that Crohns disease and ulcerative colitis affect large numbers of children and young teens. Nutritional deficiency is a major issue in treatment of children with Crohns disease. Children are growing machines.

Inflammatory bowel disease may not cause great weight loss for youngsters at first, so failure to grow normally or backsliding on height and weight charts should be taken as signs that something is wrong and worth investigating. Children facing Crohns disease also have significant self-image issues to deal with.

The disease changes their routines, and its effects may separate them from the normal activities of childhood and adolescence. Therefore, these youngsters need sensitive support from family, friends, and physicians to help them maintain their social, as well as their physical, growth. Crohns disease is a serious, chronic disease affecting the digestive system. Chronic means that the disease is long-term and persistent, usually lifelong. Crohns disease causes inflammation, most often in the small intestine (which has three parts: duodenum, jejunum, and ileum).

The walls and lining of the affected areas become red and inflamed, leading to ulcers and bleeding. Crohns disease sometimes is named by referring to inflammation in the part of the intestine affected, such as jejunoileitis, ileitis, ileocolitis, or colitis (when it involves the large intestine, also called the colon).

Crohns disease can appear at any age, but it is most often diagnosed in adults in their 20s and 30s. However, approximately 30% of people with Crohns disease develop symptoms before 20 years of age. In the United States, about 100,000 teens and preteens have Crohns disease.Along with ulcerative colitis, a similar illness, Crohns disease is also called inflammatory bowel disease, or IBD.

Ulcerative colitis attacks only the large intestine in a continuous manner and does not affect the entire thickness of the bowel wall. Crohns disease, on the other hand, can occur anywhere in the digestive tract, from mouth to the anus, attacks different sites in the intestine with areas of normal intestine in between (“skip lesions”), and affects the full thickness of the intestinal wall.

Both conditions wax and wane: there are times when symptoms reappear or get worse (exacerbations or “flares”) and other periods when symptoms get better or go away altogether (“remission”).While Crohns disease causes many problems for people of all ages, it can present special challenges for children and teens. In addition to bothersome and often painful symptoms, the disease can stunt growth, delay puberty, and weaken the bones. Crohns disease symptoms may sometimes prevent a child from participating in enjoyable activities.

The emotional and psychological issues of living with chronic disease can be especially difficult for young people. As many as 70% of children with the disease have inflammation of the lower part of the ileum. More than half of these children also have inflammation in variable segments of the colon.

•    About 10%-20% of children have inflammation in the colon only.
•    Another 10%-15% have inflammation scattered around the small bowel, mainly in the middle section (jejunum and upper ileum).
•    A very small number have inflammation only in the stomach and the uppermost section of the small intestine where the stomach empties into the bowel (duodenum).

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Crohns Disease Cause

09.15.09

Researchers have not yet identified the cause of Crohns disease, so it is described as an “idiopathic” disease. It is known that inflammation is part of the body’s immune response, and an immune response is usually triggered by something. But to date no specific “trigger” has been found to cause the inflammatory response seen in Crohns disease.

There is some evidence that Crohns disease has a genetic component. While there is no simple correlation from parent(s) to offspring, the disease tends to “run” in families. As many as 20 to 25 percent of patients with Crohns disease have a relative with CD or ulcerative colitis.

There is also a higher incidence among certain ethnic groups.In addition, some possible environmental factors have been linked to initial episodes or relapses. Crohns disease appears to be a disease that primarily affects those living in Western, industrialized societies. Whether this is due to some condition of the environment in which people live or their diet has not been determined.

The Role Of Heredity
Physicians classify Crohns disease as one of the “familial” or “complex” genetic diseases, as opposed to a “simple” genetic disease. In simple genetic diseases, such as sickle cell disease or cystic fibrosis, a person who inherits a copy of the defective gene from each parent is certain to get the disease. In Crohns disease, this is not the case. In fact, 75 to 80 percent of people with Crohns disease have no relative with either Crohns disease or ulcerative colitis.

But because there are fewer than 500,000 Americans with Crohns disease, the level of multiple incidence in families (20 to 25 percent of Crohn’s patients) means that the risk of being diagnosed with the disease is statistically somewhat higher in individuals who have a family member with either Crohns disease or ulcerative colitis.

Other evidence that suggests a genetic basis for Crohns disease is the fact that populations who have intermarried closely within their communities for many generations, such as Eastern European Jews, have a higher incidence of inflammatory bowel disease than do other groups.

Weakened Immune Response
In the healthy intestine, certain types of bacteria (enteric microflora) are present and necessary. In fact, between one billion and one trillion normal intestinal bacteria exist in every gram of intestinal content. These “normal” bacteria contribute to the process of digestion and keep abnormal bacteria, which can enter the GI tract in food, water, etc., from surviving and causing illness. If abnormal bacteria do survive and multiply, the body recognizes them as invading organisms, or “antigens.”

To a certain extent, these antigens are ignored in the GI tract – the immune system has a certain level of tolerance for them. But immunologic evidence shows that in the intestines of those with inflammatory bowel disease, some of this tolerance for bacteria is lost.

The TH1 cells, which are responsible for activating the immune response against invading organisms, do their job. But the TH2 cells, which are responsible for deactivating the immunologic response after invading organisms are destroyed, fail to perform theirs. The result is an inflammatory overreaction, resulting in pain, fever, and, sometimes, tissue damage.Some evidence also suggests that flare-ups of Crohns disease or ulcerative colitis are a heightened response to seasonal allergies, upper-respiratory infections, or other transient illnesses.

Crohns Disease and Pregnancy

09.07.09

Women with Crohns disease who are considering having children can be comforted to know that the vast majority of such pregnancies will result in normal children. Research has shown that the course of pregnancy and delivery is usually not impaired in women with Crohns disease.

Even so, women with Crohns disease should discuss the matter with their doctors before pregnancy. Most children born to women with Crohns disease are unaffected. Children who do get the disease are sometimes more severely affected than adults, with slowed growth and delayed sexual development in some cases. Women with ulcerative colitis have normal fertility.

In Crohns disease, fertility may be reduced when the disease is active. Sulphasalazine can cause men to become less fertile. Fertility usually returns to normal when the drug is stopped. If possible, women should try to get pregnant when the disease is in remission. Flare-ups can occur during pregnancy but they are usually mild and will respond to medical treatment. Clinical experience has shown that the risk from steroids and sulphasalazine to the baby is extremely low.

Some doctors advise women to avoid pregnancy while on azathioprine because of theoretical risks, though many successful pregnancies have been recorded while taking the drug. Some doctors would suggest that a woman with inactive Crohns disease should stop taking her medication(s) during pregnancy, resuming an appropriate regimen only if a flare-up occurs.

Others might have different advice. Any woman who has Crohns disease and wants to become pregnant should discuss the issue of treatment during pregnancy with her health-care providers, where her personal medical history and treatment requirements can be taken into account. Women with Crohns disease whose disease is in remission at the time they conceive may experience increased symptoms during their third trimester, if they have symptoms at all. Many women suffer flare-ups immediately after giving birth. Doctors believe this is due to the hormonal changes of the pregnancy and postpartum period. “If Crohns disease flares up during pregnancy, sulphasalazine and steroids are permitted. Azathioprine and metronidazole should be avoided unless advised by a specialist.

However, note that there is no convincing proof that azathioprine has been responsible for foetal abnormalities and many inflammatory bowel disease specialists now recommend continuing the drug for those patients in whom relapse would be a major problem.There is no predicatable pattern to inflammatory bowel disease in pregnancy. Patients with inflammatory bowel disease often seem to be healthier during pregnancy, but at a risk of a flare-up in the postpartum period. The chance of a flare-up is not increased by pregnancy however it is advised to wait until disease is inactive before conception.

If patients conceive during a flare of Crohns disease:
- about 1/3 get better, 1/3 get worse and 1/3 stay the same

Women with Crohns disease tend to have more preterm births and babies with lower birth weights ”

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Colitis Ulcerosa

07.13.09

Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD). Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon.

The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset. Ulcerative colitis is, however, a systemic disease that affects many parts of the body outside the intestine. Because of the name, IBD is often confused with irritable bowel syndrome (“IBS”), a troublesome, but much less serious condition. Ulcerative colitis has similarities to Crohns disease, another form of IBD.

Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission.Ulcerative colitis is a rare disease, with an incidence of about one person per 10,000 in North America.

The disease tends to be more common in northern areas. Although ulcerative colitis has no known cause, there is a presumed genetic component to susceptibility. The disease may be triggered in a susceptible person by environmental factors. Although dietary modification may reduce the discomfort of a person with the disease, ulcerative colitis is not thought to be caused by dietary factors. Although ulcerative colitis is treated as though it were an autoimmune disease, there is no consensus that it is such.

Treatment is with anti-inflammatory drugs, immunosuppression (suppressing the immune system), and biological therapy targeting specific components of the immune response. Colectomy (partial or total removal of the large bowel through surgery) is occasionally necessary, and is considered to be a cure for the disease. Ulcerative colitis is a relatively uncommon, chronic, recurrent inflammatory disease of the colon or rectal mucosa. Often a lifelong illness, the condition has profound emotional and social impact on the affected individual. Ulcerative colitis is defined as continuous idiopathic inflammation of the colonic or rectal mucosa.

The rectum is involved in more than 95% of cases. Some authorities believe that the rectum is always involved in an untreated patient. Partial healing may occur in a patient treated with topical therapy, creating diagnostic confusion. Ulcerative colitis occurs more frequently in white people. The incidence of ulcerative colitis is reported to be 2-4 times higher in Jewish people. However, recent population studies in North America do not completely support this assertion. Ulcerative colitis seems to have a female preponderance. Ulcerative colitis affects 30% more females than males. The incidence of ulcerative colitis peaks in people aged 15-25 years and in people aged 55-65 years, although it can occur in people of any age.

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Colitis Treatment

07.07.09

Because the symptoms and progress of ulcerative colitis vary from person to person, treatments must be tailored to individuals. In most cases, however, drug therapy is the first line of treatment for ulcerative colitis.Drug therapy helps treat the symptoms of ulcerative colitis and prevent them from coming back. The four main categories of medication for ulcerative colitis all work by reducing inflammation. The drug categories are aminosalicylates, corticosteroids, immunomodulators and biologic therapies.

Aminosalicylates are called “5-ASA” drugs because they contain 5-aminosalicylic acid, which helps control inflammation. These drugs usually are the first treatment for people with mild or moderate colitis. Most are taken orally, though if inflammation is located low in the large intestine, they can be delivered in enemas or suppositories.

Azulfidine (sulfasalazine): a combination of 5-ASA and the sulfa drug sulfapyridine, sulfasalazine was the first aminosalicylate used widely to treat colitis. In this combination, the sulfapyridine prevents 5-ASA from being absorbed until it reaches the large intestine. But the sulfa drug can cause unpleasant side effects. Newer 5-ASA drugs, while they still have side effects, are easier for some people to tolerate. Also called steroids, these medications can relieve symptoms quickly, but they usually are not effective in preventing symptoms from returning. They also can have serious side effects. As a result, corticosteroids usually are used for short periods of time only. People with ulcerative colitis gradually taper off corticosteroids since an abrupt stop can bring on symptoms. The drugs can be taken orally, delivered in enemas, suppositories and foams, or given intravenously.

Immunomodulators reduce inflammation by suppressing the immune system. Immunomodulators are usually prescribed for people who:
•    Do not respond to other medications
•    Have become dependent on corticosteroids
•    Have active, severe cases of the disease

Because these drugs are “strong,” people must be monitored carefully for complications, including pancreatitis, hepatitis, reduced white blood cell count and infection. The drugs are taken orally, and it may take up to six months before they are fully effective.

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Colitis Diet

06.16.09

There is no diet for ulcerative colitis that is agreed upon by all healthcare professionals. Most eating plans that are advertised as an ulcerative colitis diet were designed by those who suffer from the disease or those who love them.

One man who sells a cookbook for his ulcerative colitis diet plan says that he was told by a doctor of “oriental medicine” (his words, not mine) that he should eat no meat, no fish, no egg yolks, no fruits and no nuts. While another diet for ulcerative colitis control, developed by a doctor and a biochemist recommends meat, fish, eggs, fruits and nuts. It may be wise and most effective to design your own ulcerative colitis diet, taking into account any known food allergies or sensitivities.

A symptoms and food diary may be helpful to use as you are designing your diet for ulcerative colitis control. Try to note not only what you ate, but what you drank. While there is little agreement about what foods should be included in an ulcerative colitis diet, there are certain products (like caffeine, alcohol, high fiber cereals, some fruits and some fruit juices) that are known to have a laxative effect, cause cramping and diarrhea, even in people who do not have an inflammatory bowel disease like ulcerative colitis.

Diet is important. A healthy diet is important for overall good health and sense of well being. For those who suffer from ulcerative colitis, diet is particularly important.Chronic diarrhea may lead to malnutrition, weight loss, weakness and dehydration. For these reasons a diet for ulcerative colitis control should be well-balanced, with adequate amounts of protein, carbohydrates and good fats. Including vitamin supplements, particularly D, B12 and iron is recommended.

Simple sugars and artificial sweeteners cause flare ups in some people. No matter what your food preferences, it is important when designing your ulcerative colitis diet to be honest with yourself. It may be hard to give up sodas, coffee, candy and muffins, but your goal should be to control your symptoms. Ulcerative colitis is considered a chronic disease that has a tendency to go into remission and then flare up again over time. Mild to moderate symptoms may be controlled with an ulcerative colitis diet, supplements, herbs and medications, but severe ulcerative colitis can only be cured with surgery. Since cases rarely begin as severe, keeping your symptoms under control decreases the likelihood that surgery will be necessary. One thing to consider when designing your ulcerative colitis diet is stress and anxiety.

While stress and anxiety are not believed to cause ulcerative colitis, it is believed that they can aggravate the condition. Many people who suffer from ulcerative colitis also suffer from anxiety. It may be that the condition causes people to be more anxious, never knowing when they may have to find a bathroom, always worrying about a flare up, etc. Symptoms of anxiety include rapid pulse, trembling, shaking, sweating and nausea or abdominal distress. If you experience symptoms of anxiety, in addition to symptoms of ulcerative colitis, diet considerations are similar, but there are other suggestions.

These include eating smaller meals more frequently, chewing thoroughly and eating slowly.Salt and preservatives are known to put additional stress on the body. These should be excluded or at least restricted from a healthy ulcerative colitis diet, particularly when symptoms of stress and anxiety are present. When designing your diet for ulcerative colitis control, try to include less pre-packaged foods which are full of salt and preservatives.
One more consideration for an ulcerative colitis diet is meat selection. Most companies that raise poultry, cattle and pigs for human consumption include hormones in the animal’s diets. While there is no conclusive evidence that these hormones are harmful to humans, many people believe that they can put additional stress on the human body, because they increase stress on the animal’s bodies. When you are selecting meat and fish for your ulcerative colitis diet, try to select products that do not contain hormones. For example, wild salmon, free range chicken and other organic products are better choices for a diet for ulcerative colitis control than pork and beef.

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Colitis and Crohns

06.07.09

Inflammatory bowel disease, or IBD, describes two similar yet distinct conditions called Crohns disease and ulcerative colitis. These diseases affect the digestive system and cause the intestinal tissue to become inflamed, form sores and bleed easily. Symptoms include abdominal pain, cramping, fatigue and diarrhea.Crohns disease can affect any part of the gastrointestinal tract, from the mouth to the anus. Patches of inflammation occur, with healthy tissue between the diseased areas.

The inflammation can extend through every layer of affected bowel tissue. Crohns disease can not be cured by drugs or surgery, although either or both can help relieve symptoms.Ulcerative colitis affects only the inner layer of the colon, or large bowel. It always starts in the rectum and may extend as a continuous inflammation from there into the rest of the colon. Usually ulcerative colitis can be controlled with medication. The disease can be completely eliminated by surgically removing the colon, but afterward, waste material may have to be stored and expelled through an external appliance.

While ulcerative colitis causes inflammation only in the colon (colitis) and/or the rectum (proctitis), Crohns disease may cause inflammation in the colon, rectum, small intestine (jejunum and ileum), and, occasionally, even the stomach, mouth, and esophagus.The patterns of inflammation in Crohns disease are different from ulcerative colitis. Except in the most severe cases, the inflammation of ulcerative colitis tends to involve the superficial layers of the inner lining of the bowel. The inflammation also tends to be diffuse and uniform. (All of the lining in the affected segment of the intestine is inflamed.) Unlike ulcerative colitis, the inflammation of Crohns disease is concentrated in some areas more than others and involves layers of the bowel that are deeper than the superficial inner layers. Therefore, the affected segment(s) of bowel in Crohns disease often is studded with deeper ulcers with normal lining between these ulcers.

The most common disease that mimics the symptoms of Crohns disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.

Currently there is no cure for Crohns disease and remission may not be possible or prolonged if achieved; in cases where remission is possible, relapse can be prevented and symptoms controlled with medication, lifestyle changes and in some cases, surgery. Adequately controlled, Crohns disease may not significantly restrict daily living. Treatment for Crohns disease is only when symptoms are active and involve first treating the acute problem, then maintaining remission.

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