Crohn’s disease and ulcerative colitis: what are these serious intestinal diseases?

Chronic inflammatory bowel diseases (CIBD) encompass various complex disorders of the digestive system. Among these are Crohn’s disease and ulcerative colitis, which are the most recognized. Both Crohn’s disease and ulcerative colitis are autoimmune conditions affecting the gastrointestinal tract.

Although they share some similarities, these diseases possess unique characteristics that affect their diagnosis, treatment, and the patients’ lives. Marked by episodes of inflammation and periods of remission, they require meticulous medical supervision and lifestyle adjustments.

Despite significant therapeutic advancements, CIBD are not curable at this time.

Understanding CIBD

Chronic inflammatory bowel diseases are defined by persistent inflammation in a portion of the digestive tract. This inflammation can affect different areas depending on the specific condition, leading to a variety of sometimes debilitating symptoms.

Crohn’s Disease: A Silently Debilitating Illness

Crohn’s disease can impact any part of the digestive tract from mouth to anus, but it mainly affects the terminal ileum and colon. The inflammation in Crohn’s disease is often patchy, alternating between healthy and inflamed sections throughout the intestinal wall.

Symptoms include:

• Chronic abdominal pain,
• Frequent diarrhea, sometimes with blood,
• Weight loss, intense fatigue,
• Fistulas and intestinal abscesses, serious complications that may require surgical intervention.

Ulcerative Colitis: Specific Distinct Features

In contrast to Crohn’s disease, ulcerative colitis is limited to the large intestine (colon) and rectum. The inflammation in ulcerative colitis is continuous, usually starting at the rectum and potentially spreading upward through the colon. This particular localization results in specific symptoms, manifesting as:

• Bloody stools and mucoid diarrhea.
• Abdominal cramps and urgent urges to defecate.
• Anemia due to recurring bleeding.
• An increased risk of colorectal cancer after several years of disease progression.

From Diagnosis to Follow-Up: Every Step Is Important!

How Is It Diagnosed?

Diagnosing chronic inflammatory bowel diseases requires a combination of clinical evaluations, laboratory tests, endoscopy, and imaging studies.

• Imaging studies: X-rays, ultrasounds, CT scans, and MRIs may be used to assess the extent of the disease.
• Blood tests: these can indicate inflammation, nutritional deficiencies, and the presence of specific markers.
• Stool analysis: checking for calprotectin helps evaluate intestinal inflammation.
• Colonoscopy: this is the gold standard, allowing direct visualization of the intestinal lining and the possibility of taking biopsies.

What Treatments Are Available?

Treatment for CIBD aims to control inflammation, alleviate symptoms, and avert complications. Consequently, it involves various classes of medications. The therapeutic strategy is customized based on the disease’s severity, location, and patient characteristics.

• Anti-inflammatories: 5-aminosalicylic acids and corticosteroids to manage flare-ups.
• Immunosuppressants: used for long-term treatment (cyclosporine, azathioprine, methotrexate).
• Biologic therapies: monoclonal antibodies like infliximab or adalimumab, effective for severe forms.
• Symptomatic treatments: antidiarrheals and nutritional supplements.
• Surgery: as a last resort, to address complications or against treatment resistance.

Are Complications Possible?

CIBD can lead to a variety of complications, including:

• Digestive complications: strictures, fistulas, abscesses, intestinal perforations.
• Extra-digestive complications: arthritis, skin lesions, eye inflammations.
• Increased colorectal cancer risk: necessitating regular monitoring.
• Treatment-related complications: side effects from medications, infection risks linked to immunosuppressants.

Inflammatory Bowel Diseases: A Daily Struggle

Sadness, Isolation, The Psychological Impact

CIBD profoundly affects the quality of life of patients, extending beyond physical symptoms. Chronic fatigue, recurrent abdominal pain, and the fear of intestinal crises or emergencies often lead to significant anxiety, diminished self-esteem, and social isolation.

Going out, traveling, or even engaging in work activities can become stress-inducing, particularly due to the urgent need for restroom access. This constant worry may lead to restrictions on social interactions and even depression.

Psychological support is crucial in managing patients with CIBD. Cognitive-behavioral therapy (CBT) can assist in addressing the stress and anxiety associated with the disease. Additionally, support from family and friends is vital: open dialogue with loved ones often enhances the experience of living with the condition and reduces stigma.

Diet Can Provide Relief

Nutrition plays a significant role in managing CIBD, although it is not a direct cause of these diseases. Adapting one’s diet can help limit inflammation, prevent nutritional deficiencies, and improve the patients’ quality of life.

During acute inflammatory phases, the goal is to minimize digestive irritation and provide easily digestible foods:

• During a flare-up:
  • Opt for a low-residue diet (white rice, lean meats, applesauce),
  • Avoid irritating foods, such as insoluble fibers (raw vegetables, whole grains), dairy if intolerant, spices, coffee, and alcohol.
  • Increase protein intake: During active phases of the disease, protein needs rise to promote healing of the intestinal lining. The recommendations are 1.2 to 1.5 g/kg/day for adults.
  • Ensure proper hydration: consume enough water to compensate for losses due to diarrhea.

Once the flare-up is managed, it’s crucial to diversify the diet to meet all nutritional needs:

• During remission:
  • Begin reintroducing cooked and seedless vegetables like zucchini. Gradually expand to raw vegetables such as carrots, peeled and seeded ripe tomatoes, and lettuce hearts. If tolerated, progressively reintroduce all vegetables.
  • Start by testing well-ripened, peeled, and seeded raw fruits (excluding figs, strawberries, and other berries, kiwi), adjusting based on your tolerance.
  • Gradually incorporate legumes (red lentils, pureed split peas) and foods containing whole grains.
  • Depending on lactose tolerance, start with plain yogurt or hard cheese (Comté, Emmental) before reintroducing other dairy products.

Initially avoid foods high in irritating fibers (cabbage, bell peppers, raw vegetables, whole legumes, dried fruits), strong spices, overly fatty or fried dishes. The key is to progress at your own pace!

Who Can Help?

Patient associations, such as the François Aupetit Association (AFA), play a vital role in support by providing discussion groups, practical advice, and psychological assistance. Indeed, these organizations allow individuals to connect with others facing similar challenges and share enriching experiences.

Moreover, access to therapeutic innovations, clinical trials, and new approaches to nutrition and the microbiome are critical in enhancing the management of patients and their quality of life.

In conclusion, CIBD are still not well-known to the general public, despite affecting an increasing number of individuals. Raising awareness about these diseases, improving early diagnosis, and promoting therapeutic education are key challenges ahead.

Living with CIBD involves much more than mere medical management: it represents a genuine adaptation journey. From dietary adjustments to psychological support, each patient must discover the strategies that allow for better disease management.

IMPORTANT TO KNOW

The law of February 11, 2005, broadened the definition of disability, enabling the recognition of debilitating health issues like chronic inflammatory bowel diseases (CIBD) as a form of disability. Access to rights such as the Recognition of Quality of Disabled Workers (RQTH) is now possible, even if the disability is not visible.