July 11, 2024 • 13 mins
Crohn’s disease and ulcerative colitis: What are they? What are the symptoms, and how do they differ? In this episode, we will explore the historical background, our current understanding of these conditions, and their treatments. Tune in to learn more.
Check out our website: https://anatomyofillness.com/
Crohn’s and Colitis Foundation (US): https://www.crohnscolitisfoundation.org/
Crohn’s and Colitis UK: https://crohnsandcolitis.org.uk/
Crohn’s and Colitis Australia: https://crohnsandcolitis.org.au/
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912289/
https://www.crohnscolitisfoundation.org/about/our-beginning
https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf
https://my.clevelandclinic.org/health/diseases/15587-inflammatory-bowel-disease-overview
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773614/
https://nyulangone.org/conditions/inflammatory-bowel-disease/diagnosis
https://www.webmd.com/digestive-disorders/ss/slideshow-celebrities-crohns-disease
https://academic.oup.com/ecco-jcc/article/8/5/341/616781
*This podcast is for entertainment purposes only. If you suspect you have a medical condition, please seek out an opinion of a medical professional.*
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Recently, you've been feeling really tired and have lost weight without even trying.
(00:03):
Additionally, you've been suffering from abdominal pain and now get urgent sensations to go to the
bathroom without much warning. After visiting the restroom, you notice there is blood on the toilet
paper. Concerned about your health, you decide to see a doctor.
(00:29):
Hello and welcome to Anatomy of Illness. Today's episode is about Crohn's disease and ulcerative
colitis. Before we get into the condition, we are going to start with the history.
So why do we know Crohn's disease and ulcerative colitis exists?
To make things easier, I may refer to this as inflammatory bowel disease or IBD.
We begin around 460-370 BCE with Hippocrates. He had discussed many potential causes for chronic
(00:50):
diarrhoea during his time. The earliest potential complete description of Crohn's disease is likely
from 1769 by Giovanni Battista Mogagni. There was a case report in his treatise,
‘The Seats and Causes of Diseases’. In this he describes a 20-year-old male who had a
long-standing illness causing fever, abdominal pain and bloody diarrhoea. On autopsy, there were
perforations and transmural inflammation with ulcerations stretching from the terminal ileum
(01:13):
to the start of the colon. In 1793, with Matthew Bailey, he described a deadly bowel disease.
The symptoms and observations of this correspond to the current day description of ulcerative
colitis. In 1859, the term ulcerative colitis was coined by Samuel Wilkes, describing a patient with
bowel disease. However, based on the symptom description, this was more likely to be a
presentation of Crohn's disease. In 1907, John Percy Lockhart-Mummery used the first ever
(01:37):
electronically illuminated endoscope. This endoscope was designed to reach the sigmoid colon.
He reported malignancy in 7 out of the 36 ulcerative colitis patients examined.
The sigmoid colon is the part above the rectum. This is the terminal part of the colon before
reaching the rectum. Malignancy means an abnormal cell growth, normally cancer. After this, there
was an increase in studies to determine the transmissible agents causing the condition,
(02:01):
as they were trying to explain a breakout of inflammatory bowel disease. This included a case
series that reported inter-spouse Crohn's disease transmission. The primary bacteria being researched
at the time was Mycobacterium tuberculosis. Yes, that is right, tuberculosis is not just for the
lungs. This was due to the granulomatous lesions and surprising response to anti-tuberculosis
therapies, justifying the research. In 1913, Thomas Kennedy Dalziel describes 9 cases of
(02:26):
potential Crohn's disease. He described the bowel as having the "consistence and smoothness of an
eel in rigour mortis." Jacob Arnold Bergen from the Mayo Clinic in 1920 studied in depth the role of
Diplostreptococci as the cause of ulcerative colitis. This was due to him finding the bacteria
repeatedly in rectal ulcers of patients with UC. Other infectious agents were implicated as potential
causes of inflammatory bowel disease. These included Chlamydia, Helicobacter hepaticus
(02:50):
or pylori, Poliovirus, Herpes virus and the loss of Helminths. Helminths are parasitic worms like
tapeworms or pinworms. Just after 1930, the surgical treatment for ulcerative colitis was
standardised. These treatments originally being quite experimental. Many treatments from the time
were abandoned like the appendostomy or vagotomy. The vagotomy being the removal of the vagus nerve
and the appendostomy being a hole that goes from the abdomen to the appendix. This allowing for
(03:14):
enemas which is flushing of the intestines or for faecal matter to exit through this way. These
treatments were abandoned for procedures like the ileostomy which is a procedure that brings the
ileum to the surface of the abdomen and creates an opening that allows for faecal matter to pass
through there. Prior to these treatments, medical treatments of ulcerative colitis were more whimsical
and bizarre. This included organotherapy. This was feeding patients raw porcine small bowel segments
(03:38):
or ionisation therapy. This is where the bowel would be irrigated with a solution containing zinc
and an electrical current would be run through the solution. In 1932, Crohn's disease was described by
three doctors by the name of Beryl Crohn, Leon Ginzburg and Gordon D. Oppenheimer. Not the atomic
bombs Oppenheimer, that is J. Robert Oppenheimer. Anyway, back to Crohn's disease. At the time,
it was believed that any disease of the small intestine was caused by tuberculosis,
(04:01):
so intestinal tuberculosis. These three doctors collected the data from 14 patients about their
symptoms which could not be attributed to intestinal tuberculosis or any known intestinal
disease. These doctors named the condition regional ileitis. This name would become Crohn's disease.
Also in the 1930s, ulcerative colitis was considered a psychosomatic illness. This was due
to studies that had no control group with very mixed entry criteria. Psychosomatic meaning the
(04:25):
condition was caused by stress or mental illness. In 1947, Meyer and Gellhorn proposed the idea that
ulcerative colitis was caused by a reduction in the mucus layer above the enterocytes due to an
increase in lysosomal enzymes. Essentially, the protective mucus layer was being eaten by acids
in the intestine. In the 1950s, randomised clinical control trials would begin to take place. In 1955,
(04:45):
a study published in the British Journal of Medicine would describe how patients given
corticosteroids would have improved symptom burden and a decreased mortality in comparison with those
that were not given these. There was also a shift in the concept of treating these conditions when
Nanna Svartz, a Swedish physician, would discover the effects of sulfasalazine in ulcerative colitis.
In an attempt to cure King Gustas, the fifth of his arthritis, Svarts found that those in the
(05:07):
trial that had both arthritis and ulcerative colitis had a decreased symptom burden in their
ulcerative colitis symptoms. The public began to better recognize Crohn's disease as a medical
condition during this time, in part due to President Eisenhower's surgery in 1956, as he did have Crohn's
disease. Many drugs were trialed for ulcerative colitis through the 50s, 60s, and 70s. However,
the first trial testing methotrexate in Crohn's disease wouldn't occur until 1989. What causes
(05:32):
inflammatory bowel disease? We currently do not have a complete understanding of the causes of
inflammatory bowel disease. However, it is known to be caused by the immune system and interactions
with the environment. In inflammatory bowel disease, the immune system inappropriately
attacks the digestive system. The abnormal immune response occurs in those that are susceptible to
IBD through inherited genes, and unknown environmental factors trigger this condition.
What are the genetics and risk factors for inflammatory bowel disease? There is an increased
(05:55):
risk of developing inflammatory bowel disease if you have a first degree relative with these
conditions. Studies have shown that between 5 to 20 percent of people with IBD have first degree
family members that also have the condition. Numerous genes have been implicated in playing
a part in IBD. The first one being found was the NOD2 or CARD15 gene. This gene has been found in
20 percent of people with inflammatory bowel disease and has been associated with development
(06:18):
of Crohn's disease. This gene provides instructions for making an important protein in the immune
system. When mutated, it is linked to Crohn's. There are also environmental factors believed
to contribute to IBD. These include smoking. Those who are active smokers are twice as likely to
develop Crohn's disease than those who are not smokers. Antibiotic use may increase the risk of
inflammatory bowel disease. Non-steroidal anti-inflammatory drugs like aspirin or ibuprofen
(06:40):
may also increase the risk of developing IBD and may also cause flares. Appendicitis.
Children who undergo an appendectomy are less likely to develop ulcerative colitis later in
life but are more likely to develop Crohn's disease. This is a small risk. If you have
appendicitis, don't let this prevent you from seeking treatment. Diet. Although inflammatory
bowel diseases are not caused by diet, they can be aggravated by certain foods in some people.
(07:00):
Inflammatory bowel diseases are most commonly diagnosed between the ages of 15 and 35. However,
people can be diagnosed younger or older. These conditions affect men and women equally.
So what is inflammatory bowel disease? In the inflammatory bowel disease umbrella,
there is Crohn's disease, ulcerative colitis, and indeterminate colitis. Crohn's disease can occur
throughout the digestive tract, anywhere from mouth to anus. However, it most commonly occurs
(07:21):
in the ileum. This is where the small intestine ends and joins into the large intestine. In
Crohn's disease, the inflammation can extend the entire thickness of the bowel wall. Ulcerative
colitis is limited to the large intestine, also known as the colon. However, it most commonly
begins in the lower part of the colon and the rectum, but it can spread throughout the entirety
of the large intestine. In ulcerative colitis, the inflammation is limited to the innermost
(07:42):
layer of the lining of the colon. Indeterminate colitis is when it is difficult to determine
whether the person has Crohn's disease or ulcerative colitis. In these rare circumstances,
the person gets the diagnosis of indeterminate colitis. So how do we test for inflammatory bowel
disease? Inflammatory bowel diseases cannot be diagnosed through blood tests, but blood tests
will be done to rule out other conditions and to check for various deficiencies. Some blood tests
(08:02):
that might be run are a complete blood count. This will be done to see if you're anaemic,
which is a low red blood cell count. This may indicate internal bleeding. They will also test
for iron levels, folate, vitamin B12 and vitamin D. Low levels of these may indicate that the
intestines are not absorbing nutrients properly. Stool sample testing. Yes, this is looking at the
poo. This is done to see if there is any inflammation in the intestines and to assess
(08:24):
the severity of this. It is also done to assess if there is an infection causing the symptoms and
also to check if there is blood visible in the stool sample. Endoscopy. This is vital in diagnosing
IBD. Endoscopic procedures that may be used are colonoscopy, upper endoscopy, capsule colonoscopy
and sigmoidoscopy. The type of endoscopy will depend on blood and stool tests results as well
as symptoms and physical examination. During an endoscopic procedure, a doctor is likely to take
(08:49):
biopsy samples to assist in diagnosis. We will get right into symptoms and presentation right after
this little break. What symptoms could you expect if you had inflammatory bowel disease? You could
(09:10):
expect diarrhoea, an urgent need to poop or go to the bathroom, abdominal pain, rectal bleeding,
feeling as though you haven't completed pooping after going to the bathroom. You may also have
fever, a loss of appetite, night sweats, fatigue, so extreme tiredness, weight loss and changes in
the menstrual cycle. This may also be an absence in the cycle. What would a doctor expect to see
in inflammatory bowel disease? Blood in the stools, fatigue, chronic diarrhoea, unintended weight loss,
(09:32):
lower abdominal pain, anaemia and blood clots. Anaemia indicates internal bleeding, malnutrition
and malabsorption. This is evident with low levels of various nutrients due to an inability to
adequately absorb nutrients. What are some complications that a doctor should be aware of?
General complications that are found outside of the intestines are mouth sores, eye redness,
swelling and pain, joint swelling and pain, tender bumps and painful ulcerations on the skin,
(09:54):
as well as other sores and rashes that may be present. Osteoporosis, so weakening of the bones,
kidney stones, hepatitis and cirrhosis, primary sclerosing cholangitis. This is a long-term gall
bladder and liver disease. This is characterised by scarring and inflammation of the bile ducts.
This narrows the bile ducts and makes it harder for bile to flow through them. For those with
Crohn's disease, doctors should be aware of fistulas. This is an ulcer on the external wall
(10:18):
of the intestine creating a tunnel to another organ, skin or even another part of the intestines.
Strictures, this is a narrowing of a section of the intestine caused by scarring. This can lead
to an intestinal blockage. Abscesses, this is a collection of pus which can develop in the abdomen,
pelvis or even the anal area. Perforated bowels, this is chronic inflammation of the intestine
causing weakening of the wall of the bowel leading to a hole developing. Malabsorption
(10:40):
and malnutrition, including deficiencies in vitamins and minerals. People with Crohn's
disease also have a slightly higher overall mortality than the general population. This
is due to an increased risk of cancers, especially lung cancer, chronic obstructive pulmonary disease,
gastrointestinal diseases and diseases of the genital and urinary tracts. For those with
ulcerative colitis, doctors should be aware of heavy and persistent diarrhoea, rectal bleeding
(11:01):
and pain. Perforated bowels, this is where the bowel ends up with a hole in it due to chronic
inflammation weakening the bowel. Toxic megacolon, this is where severe inflammation causes the
enlargement of the colon. There is also an increased risk of dying from all diseases in
ulcerative colitis when compared to the general population. Those with extensive bowel inflammation
have an increased risk of dying from gastrointestinal cancers and lung diseases but not lung cancer.
(11:22):
However, death due to ulcerative colitis and the complications associated with it are rare.
How do we treat inflammatory bowel disease? Inflammatory bowel disease is not curable,
however it is manageable with medications. Some of these medications used to treat
inflammatory bowel disease are anti-inflammatory treatments. These are the first line treatment,
especially in ulcerative colitis. Examples of these anti-inflammatories that may be used are
aminosalicylates such as mesalamine and olsalazine. They may also use limited
(11:47):
causes of corticosteroids to attempt to induce remission. Immune system suppressors may also be
used. These drugs work to suppress the immune response and decrease the release of chemicals
that cause inflammation. Some examples of these are azathioprine and methotrexate.
There are also small molecule drugs that have the same purpose. These include ozanamide and
tofacitinib. Biologics are a newer treatment that is used to neutralise some of the proteins causing
(12:10):
inflammation. This includes infliximab. In cases where there is a risk of infection such as perianal
Crohn's, antibiotics may be used such as ciprofloxacin and metronidazole. There may also
be surgery used to help treat the condition. For ulcerative colitis the entire colon and rectum may
be removed. If possible, an internal pouch is made and attached to the anus. If this is not possible,
a permanent opening in the wall of the abdomen is made. This is normally an ileal stoma. This is
(12:34):
used to connect it to an external bag so excrement can pass this way. In Crohn's disease, up to two
thirds of people will require surgery. However, it is not curative. During this type of surgery,
the surgeon will remove the damaged part of the digestive tract and reconnect the healthy ends.
However, if Crohn's does reoccur, it is likely to be where the two ends were joined.
Cases in the media. Who are some famous people who have inflammatory bowel disease? There is
(12:55):
Shinzo Abe, the Japanese Prime Minister. He has ulcerative colitis and at one point he had to
resign from the role due to the severity of his disease. However, after new medication he was able
to become the Prime Minister again. And also Dan Reynolds, the singer of the band Imagine Dragons,
also has ulcerative colitis. Mike McCready, the singer of Pearl Jam, has Crohn's disease. Originally
struggling to deal with the condition along with his career due to the lifestyle changes and the
(13:18):
support of his band, he is now managing much better. What is the TV show that features inflammatory
bowel disease? There is Boiling Point. This TV show is a drama about a London restaurant. In
one of the episodes it features one of the characters having a Crohn's flare and depicts
the issues surrounding the condition. If you would like to check out a foundation, for those in the
US, there is Crohn's and Colitis Foundation. This foundation is dedicated to finding cures
for Crohn's disease and ulcerative colitis and improving the quality of life of those affected
(13:41):
by these conditions. If you would like to check them out, they will be the first link in the
episode description. For those in the UK, there is Crohn's and Colitis UK. They drive research into
these conditions and aim to improve the lives of those with Crohn's and colitis. To check them out,
they will be the second link in the episode description. For those in Australia, there is
Crohn's and Colitis Australia. They aim to empower those in Australia living with these conditions by
providing support services, advice and fundraising towards treatment. To check them out, they will be
(14:05):
the third link in the description. If you want to check out the sources, social media links or any
other links, you can head to anatomyvillains.com. If you enjoyed this episode and would like to hear
more, subscribe to be notified about our latest episodes. If you have any questions, comments or
even any ideas for upcoming episodes, you can contact us on Discord or Instagram. The links
to those will be on the website. Otherwise, stick around for the next episode.
(14:30):
Did you know the digestive system has its own nervous system? This is called the enteric nervous
system. It is part of the autonomic nervous system.
Recently, you've been feeling really tired and have lost weight without even trying.
(00:03):
Additionally, you've been suffering from abdominal pain and now get urgent sensations to go to the
bathroom without much warning. After visiting the restroom, you notice there is blood on the toilet
paper. Concerned about your health, you decide to see a doctor.
(00:29):
Hello and welcome to Anatomy of Illness. Today's episode is about Crohn's disease and ulcerative
colitis. Before we get into the condition, we are going to start with the history.
So why do we know Crohn's disease and ulcerative colitis exists?
To make things easier, I may refer to this as inflammatory bowel disease or IBD.
We begin around 460-370 BCE with Hippocrates. He had discussed many potential causes for chronic
(00:50):
diarrhoea during his time. The earliest potential complete description of Crohn's disease is likely
from 1769 by Giovanni Battista Mogagni. There was a case report in his treatise,
‘The Seats and Causes of Diseases’. In this he describes a 20-year-old male who had a
long-standing illness causing fever, abdominal pain and bloody diarrhoea. On autopsy, there were
perforations and transmural inflammation with ulcerations stretching from the terminal ileum
(01:13):
to the start of the colon. In 1793, with Matthew Bailey, he described a deadly bowel disease.
The symptoms and observations of this correspond to the current day description of ulcerative
colitis. In 1859, the term ulcerative colitis was coined by Samuel Wilkes, describing a patient with
bowel disease. However, based on the symptom description, this was more likely to be a
presentation of Crohn's disease. In 1907, John Percy Lockhart-Mummery used the first ever
(01:37):
electronically illuminated endoscope. This endoscope was designed to reach the sigmoid colon.
He reported malignancy in 7 out of the 36 ulcerative colitis patients examined.
The sigmoid colon is the part above the rectum. This is the terminal part of the colon before
reaching the rectum. Malignancy means an abnormal cell growth, normally cancer. After this, there
was an increase in studies to determine the transmissible agents causing the condition,
(02:01):
as they were trying to explain a breakout of inflammatory bowel disease. This included a case
series that reported inter-spouse Crohn's disease transmission. The primary bacteria being researched
at the time was Mycobacterium tuberculosis. Yes, that is right, tuberculosis is not just for the
lungs. This was due to the granulomatous lesions and surprising response to anti-tuberculosis
therapies, justifying the research. In 1913, Thomas Kennedy Dalziel describes 9 cases of
(02:26):
potential Crohn's disease. He described the bowel as having the "consistence and smoothness of an
eel in rigour mortis." Jacob Arnold Bergen from the Mayo Clinic in 1920 studied in depth the role of
Diplostreptococci as the cause of ulcerative colitis. This was due to him finding the bacteria
repeatedly in rectal ulcers of patients with UC. Other infectious agents were implicated as potential
causes of inflammatory bowel disease. These included Chlamydia, Helicobacter hepaticus
(02:50):
or pylori, Poliovirus, Herpes virus and the loss of Helminths. Helminths are parasitic worms like
tapeworms or pinworms. Just after 1930, the surgical treatment for ulcerative colitis was
standardised. These treatments originally being quite experimental. Many treatments from the time
were abandoned like the appendostomy or vagotomy. The vagotomy being the removal of the vagus nerve
and the appendostomy being a hole that goes from the abdomen to the appendix. This allowing for
(03:14):
enemas which is flushing of the intestines or for faecal matter to exit through this way. These
treatments were abandoned for procedures like the ileostomy which is a procedure that brings the
ileum to the surface of the abdomen and creates an opening that allows for faecal matter to pass
through there. Prior to these treatments, medical treatments of ulcerative colitis were more whimsical
and bizarre. This included organotherapy. This was feeding patients raw porcine small bowel segments
(03:38):
or ionisation therapy. This is where the bowel would be irrigated with a solution containing zinc
and an electrical current would be run through the solution. In 1932, Crohn's disease was described by
three doctors by the name of Beryl Crohn, Leon Ginzburg and Gordon D. Oppenheimer. Not the atomic
bombs Oppenheimer, that is J. Robert Oppenheimer. Anyway, back to Crohn's disease. At the time,
it was believed that any disease of the small intestine was caused by tuberculosis,
(04:01):
so intestinal tuberculosis. These three doctors collected the data from 14 patients about their
symptoms which could not be attributed to intestinal tuberculosis or any known intestinal
disease. These doctors named the condition regional ileitis. This name would become Crohn's disease.
Also in the 1930s, ulcerative colitis was considered a psychosomatic illness. This was due
to studies that had no control group with very mixed entry criteria. Psychosomatic meaning the
(04:25):
condition was caused by stress or mental illness. In 1947, Meyer and Gellhorn proposed the idea that
ulcerative colitis was caused by a reduction in the mucus layer above the enterocytes due to an
increase in lysosomal enzymes. Essentially, the protective mucus layer was being eaten by acids
in the intestine. In the 1950s, randomised clinical control trials would begin to take place. In 1955,
(04:45):
a study published in the British Journal of Medicine would describe how patients given
corticosteroids would have improved symptom burden and a decreased mortality in comparison with those
that were not given these. There was also a shift in the concept of treating these conditions when
Nanna Svartz, a Swedish physician, would discover the effects of sulfasalazine in ulcerative colitis.
In an attempt to cure King Gustas, the fifth of his arthritis, Svarts found that those in the
(05:07):
trial that had both arthritis and ulcerative colitis had a decreased symptom burden in their
ulcerative colitis symptoms. The public began to better recognize Crohn's disease as a medical
condition during this time, in part due to President Eisenhower's surgery in 1956, as he did have Crohn's
disease. Many drugs were trialed for ulcerative colitis through the 50s, 60s, and 70s. However,
the first trial testing methotrexate in Crohn's disease wouldn't occur until 1989. What causes
(05:32):
inflammatory bowel disease? We currently do not have a complete understanding of the causes of
inflammatory bowel disease. However, it is known to be caused by the immune system and interactions
with the environment. In inflammatory bowel disease, the immune system inappropriately
attacks the digestive system. The abnormal immune response occurs in those that are susceptible to
IBD through inherited genes, and unknown environmental factors trigger this condition.
What are the genetics and risk factors for inflammatory bowel disease? There is an increased
(05:55):
risk of developing inflammatory bowel disease if you have a first degree relative with these
conditions. Studies have shown that between 5 to 20 percent of people with IBD have first degree
family members that also have the condition. Numerous genes have been implicated in playing
a part in IBD. The first one being found was the NOD2 or CARD15 gene. This gene has been found in
20 percent of people with inflammatory bowel disease and has been associated with development
(06:18):
of Crohn's disease. This gene provides instructions for making an important protein in the immune
system. When mutated, it is linked to Crohn's. There are also environmental factors believed
to contribute to IBD. These include smoking. Those who are active smokers are twice as likely to
develop Crohn's disease than those who are not smokers. Antibiotic use may increase the risk of
inflammatory bowel disease. Non-steroidal anti-inflammatory drugs like aspirin or ibuprofen
(06:40):
may also increase the risk of developing IBD and may also cause flares. Appendicitis.
Children who undergo an appendectomy are less likely to develop ulcerative colitis later in
life but are more likely to develop Crohn's disease. This is a small risk. If you have
appendicitis, don't let this prevent you from seeking treatment. Diet. Although inflammatory
bowel diseases are not caused by diet, they can be aggravated by certain foods in some people.
(07:00):
Inflammatory bowel diseases are most commonly diagnosed between the ages of 15 and 35. However,
people can be diagnosed younger or older. These conditions affect men and women equally.
So what is inflammatory bowel disease? In the inflammatory bowel disease umbrella,
there is Crohn's disease, ulcerative colitis, and indeterminate colitis. Crohn's disease can occur
throughout the digestive tract, anywhere from mouth to anus. However, it most commonly occurs
(07:21):
in the ileum. This is where the small intestine ends and joins into the large intestine. In
Crohn's disease, the inflammation can extend the entire thickness of the bowel wall. Ulcerative
colitis is limited to the large intestine, also known as the colon. However, it most commonly
begins in the lower part of the colon and the rectum, but it can spread throughout the entirety
of the large intestine. In ulcerative colitis, the inflammation is limited to the innermost
(07:42):
layer of the lining of the colon. Indeterminate colitis is when it is difficult to determine
whether the person has Crohn's disease or ulcerative colitis. In these rare circumstances,
the person gets the diagnosis of indeterminate colitis. So how do we test for inflammatory bowel
disease? Inflammatory bowel diseases cannot be diagnosed through blood tests, but blood tests
will be done to rule out other conditions and to check for various deficiencies. Some blood tests
(08:02):
that might be run are a complete blood count. This will be done to see if you're anaemic,
which is a low red blood cell count. This may indicate internal bleeding. They will also test
for iron levels, folate, vitamin B12 and vitamin D. Low levels of these may indicate that the
intestines are not absorbing nutrients properly. Stool sample testing. Yes, this is looking at the
poo. This is done to see if there is any inflammation in the intestines and to assess
(08:24):
the severity of this. It is also done to assess if there is an infection causing the symptoms and
also to check if there is blood visible in the stool sample. Endoscopy. This is vital in diagnosing
IBD. Endoscopic procedures that may be used are colonoscopy, upper endoscopy, capsule colonoscopy
and sigmoidoscopy. The type of endoscopy will depend on blood and stool tests results as well
as symptoms and physical examination. During an endoscopic procedure, a doctor is likely to take
(08:49):
biopsy samples to assist in diagnosis. We will get right into symptoms and presentation right after
this little break. What symptoms could you expect if you had inflammatory bowel disease? You could
(09:10):
expect diarrhoea, an urgent need to poop or go to the bathroom, abdominal pain, rectal bleeding,
feeling as though you haven't completed pooping after going to the bathroom. You may also have
fever, a loss of appetite, night sweats, fatigue, so extreme tiredness, weight loss and changes in
the menstrual cycle. This may also be an absence in the cycle. What would a doctor expect to see
in inflammatory bowel disease? Blood in the stools, fatigue, chronic diarrhoea, unintended weight loss,
(09:32):
lower abdominal pain, anaemia and blood clots. Anaemia indicates internal bleeding, malnutrition
and malabsorption. This is evident with low levels of various nutrients due to an inability to
adequately absorb nutrients. What are some complications that a doctor should be aware of?
General complications that are found outside of the intestines are mouth sores, eye redness,
swelling and pain, joint swelling and pain, tender bumps and painful ulcerations on the skin,
(09:54):
as well as other sores and rashes that may be present. Osteoporosis, so weakening of the bones,
kidney stones, hepatitis and cirrhosis, primary sclerosing cholangitis. This is a long-term gall
bladder and liver disease. This is characterised by scarring and inflammation of the bile ducts.
This narrows the bile ducts and makes it harder for bile to flow through them. For those with
Crohn's disease, doctors should be aware of fistulas. This is an ulcer on the external wall
(10:18):
of the intestine creating a tunnel to another organ, skin or even another part of the intestines.
Strictures, this is a narrowing of a section of the intestine caused by scarring. This can lead
to an intestinal blockage. Abscesses, this is a collection of pus which can develop in the abdomen,
pelvis or even the anal area. Perforated bowels, this is chronic inflammation of the intestine
causing weakening of the wall of the bowel leading to a hole developing. Malabsorption
(10:40):
and malnutrition, including deficiencies in vitamins and minerals. People with Crohn's
disease also have a slightly higher overall mortality than the general population. This
is due to an increased risk of cancers, especially lung cancer, chronic obstructive pulmonary disease,
gastrointestinal diseases and diseases of the genital and urinary tracts. For those with
ulcerative colitis, doctors should be aware of heavy and persistent diarrhoea, rectal bleeding
(11:01):
and pain. Perforated bowels, this is where the bowel ends up with a hole in it due to chronic
inflammation weakening the bowel. Toxic megacolon, this is where severe inflammation causes the
enlargement of the colon. There is also an increased risk of dying from all diseases in
ulcerative colitis when compared to the general population. Those with extensive bowel inflammation
have an increased risk of dying from gastrointestinal cancers and lung diseases but not lung cancer.
(11:22):
However, death due to ulcerative colitis and the complications associated with it are rare.
How do we treat inflammatory bowel disease? Inflammatory bowel disease is not curable,
however it is manageable with medications. Some of these medications used to treat
inflammatory bowel disease are anti-inflammatory treatments. These are the first line treatment,
especially in ulcerative colitis. Examples of these anti-inflammatories that may be used are
aminosalicylates such as mesalamine and olsalazine. They may also use limited
(11:47):
causes of corticosteroids to attempt to induce remission. Immune system suppressors may also be
used. These drugs work to suppress the immune response and decrease the release of chemicals
that cause inflammation. Some examples of these are azathioprine and methotrexate.
There are also small molecule drugs that have the same purpose. These include ozanamide and
tofacitinib. Biologics are a newer treatment that is used to neutralise some of the proteins causing
(12:10):
inflammation. This includes infliximab. In cases where there is a risk of infection such as perianal
Crohn's, antibiotics may be used such as ciprofloxacin and metronidazole. There may also
be surgery used to help treat the condition. For ulcerative colitis the entire colon and rectum may
be removed. If possible, an internal pouch is made and attached to the anus. If this is not possible,
a permanent opening in the wall of the abdomen is made. This is normally an ileal stoma. This is
(12:34):
used to connect it to an external bag so excrement can pass this way. In Crohn's disease, up to two
thirds of people will require surgery. However, it is not curative. During this type of surgery,
the surgeon will remove the damaged part of the digestive tract and reconnect the healthy ends.
However, if Crohn's does reoccur, it is likely to be where the two ends were joined.
Cases in the media. Who are some famous people who have inflammatory bowel disease? There is
(12:55):
Shinzo Abe, the Japanese Prime Minister. He has ulcerative colitis and at one point he had to
resign from the role due to the severity of his disease. However, after new medication he was able
to become the Prime Minister again. And also Dan Reynolds, the singer of the band Imagine Dragons,
also has ulcerative colitis. Mike McCready, the singer of Pearl Jam, has Crohn's disease. Originally
struggling to deal with the condition along with his career due to the lifestyle changes and the
(13:18):
support of his band, he is now managing much better. What is the TV show that features inflammatory
bowel disease? There is Boiling Point. This TV show is a drama about a London restaurant. In
one of the episodes it features one of the characters having a Crohn's flare and depicts
the issues surrounding the condition. If you would like to check out a foundation, for those in the
US, there is Crohn's and Colitis Foundation. This foundation is dedicated to finding cures
for Crohn's disease and ulcerative colitis and improving the quality of life of those affected
(13:41):
by these conditions. If you would like to check them out, they will be the first link in the
episode description. For those in the UK, there is Crohn's and Colitis UK. They drive research into
these conditions and aim to improve the lives of those with Crohn's and colitis. To check them out,
they will be the second link in the episode description. For those in Australia, there is
Crohn's and Colitis Australia. They aim to empower those in Australia living with these conditions by
providing support services, advice and fundraising towards treatment. To check them out, they will be
(14:05):
the third link in the description. If you want to check out the sources, social media links or any
other links, you can head to anatomyvillains.com. If you enjoyed this episode and would like to hear
more, subscribe to be notified about our latest episodes. If you have any questions, comments or
even any ideas for upcoming episodes, you can contact us on Discord or Instagram. The links
to those will be on the website. Otherwise, stick around for the next episode.
(14:30):
Did you know the digestive system has its own nervous system? This is called the enteric nervous
system. It is part of the autonomic nervous system.
Popular Podcasts
Bookmarked by Reese's Book Club
Welcome to Bookmarked by Reese’s Book Club — the podcast where great stories, bold women, and irresistible conversations collide! Hosted by award-winning journalist Danielle Robay, each week new episodes balance thoughtful literary insight with the fervor of buzzy book trends, pop culture and more. Bookmarked brings together celebrities, tastemakers, influencers and authors from Reese's Book Club and beyond to share stories that transcend the page. Pull up a chair. You’re not just listening — you’re part of the conversation.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com