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A4 crohn's d&uc 1ed 07:a4 crohn's d&uc 1ed 07
First Edition 2007
CROHN'S DISEASE &
ULCERATIVE COLITIS
INFLAMMATORY BOWEL DISEASE (IBD)
If you have recently been told you have
What causes ulcerative colitis and
inflamatory bowel disease (IBD) there are
probably many questions running through your
Despite a great deal of research, the precise
mind. We hope this leaflet will help you
causes of ulcerative colitis and Crohn's disease
understand more about your condition, how
are unknown. There is evidence, however, that
you can help yourself, and the treatment you
genetic, environmental, immunological and
may receive.
infectious (bacterial) factors are all involved
to a degree, and it may be their interaction in
What is inflammatory bowel disease
susceptible people that causes IBD to develop.
or "IBD"?
There is no evidence that ulcerative colitis
Inflammatory bowel disease (IBD) is a term used
or Crohn's disease is a contagious disease.
to describe two main diseases, ulcerative colitis
Relatives of people with IBD have a slightly
and Crohn's disease, which cause inflammation
greater risk of developing either disease.
of the bowel. This inflammation is thought to be
Stress and/or diet alone are not thought to cause
due to dysfunction of your immune system, and
IBD, although attention to both these factors is
is not due to an infection.
likely to improve your quality of life with IBD.
Both diseases are more common in the Western
INFLAMMATORY BOWEL DISEASE (IBD)
Ulcerative colitis causes inflammation of only
world, although their incidence is also rising
is a term used to describe two main
the inner lining of the large bowel (colon and
in developing countries
diseases, ulcerative colitis and
rectum). When only the rectum is involved it is
sometimes called ulcerative proctitis or just
Who gets IBD?
proctitis. When the entire colon is involved it is
IBD often develops between the ages of 15
experience swollen joints, inflamed eyes, skin
sometimes called pan-colitis.
and 30 but can start at any age; it is uncommon
rashes or jaundice (yellow discolouration of the
in children. It is slightly more common in women
skin). The symptoms and their severity vary from
Crohn's disease causes inflammation of the full
in Australia than in men. It is estimated that
person to person and may flare up or improve
thickness of the bowel wall and may involve any
about 61,000 Australians have IBD;
over time. Many people will experience periods
part of the digestive tract from the mouth to the
approximately 28,000 have Crohn's disease
of remission when they are completely free of
anus (back passage). Most frequently the ileum,
and 33,000 have ulcerative colitis.
symptoms. With current medical treatment, life
which is the last part of the small bowel, the
expectancy is normal.
large bowel (or colon) or both are involved.
What are the symptoms of IBD?
These patterns of disease location are referred
People with either disease can develop pain in
What tests are used to confirm the
to as ileitis, colitis and ileo-colitis respectively.
the abdomen, diarrhoea (loose and/or frequent
diagnosis of ulcerative colitis or
bowel motions, sometimes with blood and
Sometimes people get confused between
mucous), tiredness and weight loss. Some
The diagnosis of Crohn's disease or ulcerative
inflammatory bowel disease (IBD) and irritable
people may also experience fever, mouth ulcers
colitis is often delayed as the same symptoms
bowel syndrome (IBS). The two conditions are
or nausea and vomiting. People with Crohn's
can occur with other diseases. It is usually
quite different and so are their treatments. The
disease of the anus can experience pain
necessary to exclude other diseases such as
two conditions (IBD & IBS) can, however, occur
(especially while passing a bowel motion)
bowel infections (which may occur from
in the same person. IBS is discussed in other
or an itch around the anus. A few people have
contaminated food or after a prolonged course
literature available from the DHF.
disease affecting other parts of the body and may
of antibiotics) or irritable bowel syndrome.
An information leaflet for patients and interested members of the general public prepared by the Digestive Health Foundation
Tests which help point towards a diagnosis
involved. Occasionally anti-diarrhoeal medicines
of IBD include blood tests which may show
(e.g. loperamide (Imodium) or Lomotil)
anaemia, raised white cell or platelet count and
may be helpful, but these should not be used to
elevation in CRP or ESR, which are markers of
control new onset of diarrhoea, which may
inflammation in the body. Blood tests are also
indicate a flare of disease, without discussion
useful to look for complications of IBD such as
with your doctor.
iron deficiency or other vitamin or mineral
deficiencies. A faecal (bowel motion) specimen
Most people in remission (when the disease has
may need to be examined to exclude infection.
settled down and the bowel movements and
Most people require an examination of part of
other symptoms have returned to normal) are
the bowel, either by direct inspection through a
advised to take a medicine to reduce the chance
flexible tube inserted through the back passage
of a relapse (a return of the symptoms); this is
(colonoscopy or sigmoidoscopy) or mouth
called maintenance therapy. Mesalazine in one of
(gastroscopy), or by x-rays, which may include
its forms (as outlined above) is usually effective
CT or MRI scan and/or barium small bowel
as maintenance treatment. Maintenance
series (where dye is swallowed and x-rays are
treatment has been shown to reduce the number
taken). There is no one test that can reliably
of flares, keeping you well for more of the time.
Crohn's disease. Therefore, as long-term steroid
diagnose all cases of IBD, and many people
therapy is not advisable because of the risk of
require several tests.
If your ulcerative colitis is difficult to control,
side-effects, immunomodulators (azathioprine,
with multiple flares or severe disease, medicines
6-mercaptopurine or methotrexate) are used
It is common for it to take 6-18 months from the
that alter the activity of the body's immune system
both more commonly and earlier in Crohn's
first onset of symptoms until a positive diagnosis
may sometimes be used to settle ongoing
disease compared to ulcerative colitis. These
of IBD is made. In most cases this delay does not
inflammation and as maintenance treatment.
drugs are used both to help control the
lead to any additional problems.
These medicines are referred to as
inflammation and as maintenance therapy.
immunomodulator or immunosuppressant
These immunomodulators generally take some
How is IBD Treated?
drugs. Commonly used immunomodulators in
weeks to exert their full effect however, and
The type of treatment you will be offered depends
ulcerative colitis include azathioprine (Imuran
because of this, active Crohn's disease is
on whether you have ulcerative colitis or Crohn's
or Thioprine) or 6-mercaptopurine (6-MP or
generally initially treated with steroids
disease, which part of your gut is affected and
Puri-Nethol) and methotrexate. For the most
(prednisolone) either as tablets (if you are well
how severe your disease is. There are also some
severe attacks, treatment in hospital with steroids
enough to be at home) or intravenously through
opportunities for you and your doctor to choose
given directly into a vein may be required.
a drip (if you are too sick to be at home and
between treatments that are similarly effective, but
Sometimes with a severe attack, when
msut stay in hospital). Sometimes, antibiotics are
may have different actions and side effect profiles.
intravenous steroids are not helpful, stronger
also used, especially if you have complications of
immunosuppressant drugs are used
your disease. Where standard drug treatment is
Ulcerative colitis (UC)
intravenously to prevent the need for surgery
ineffective, other, new generation therapies may
The treatment of ulcerative colitis depends on
to remove the bowel. This is rarely required.
be used. These generally target the inflammation
the amount of the large bowel affected and the
of IBD more powerfully. These newer drugs are
severity of the inflammation. If the disease is
If drug treatment is not effective, surgery to
licensed for use in Australia but are expensive,
confined to the lower part of the bowel, a mild
remove the large bowel (rectum and colon) may
and government subsidy is not available for all
attack may be treated with drugs (such as,
be recommended. If this is done the disease is
patients. Your doctor can discuss this with you
mesalazine or steroids) given directly into the
cured and cannot return. Your doctor will fully
in more detail if it is thought to be required.
rectum through the back passage (eg. by an
discuss the surgical options available to you and
enema or suppositories). When more of the
there will be time to talk with a specialist nurse
In contrast to ulcerative colitis, it is not possible
bowel is affected, your doctor may suggest you
or another person who has already undergone
to remove the entire bowel that may be affected
take medicine by mouth. Medicines used to treat
an operation for ulcerative colitis.
by Crohn's disease, so the disease cannot be
IBD include sulphasalazine (Salazopyrin),
cured by surgery. However, some people do
coated mesalazine (Mesasal, Salofalk Granules
require surgery if drug treatment is ineffective,
and Tablets, Pentasa Tablets and Granules),
The medicines used to treat Crohn's disease are
or if Crohn's disease causes a blockage or leak in
balsalazide (Colazide) or olsalazine (Dipentum).
mostly the same as those used for ulcerative
the bowel. Surgery may also be necessary
Steroid tablets (usually prednisolone) may be
colitis, however there are some differences.
for people with Crohn's disease of the anus
required if the inflammation is more severe
Medicines like mesalazine are of less benefit in
that is not responding to tablets.
or if more extensive amounts of the bowel are
In Crohn's disease, when surgery is performed,
loss can lead to anaemia (a low blood count),
This information booklet has been designed by the
a conservative approach is generally adopted,
which may require iron tablets. However, there is
Digestive Health Foundation as an aid to people who
have Ulcerative Colitis or Crohn's Disease or for those
to keep as much of the gut intact as possible.
little evidence to suggest that extra vitamins
who wish to know more about it. This is not meant to
After an operation, your doctor may recommend
or special food supplements are necessary or
replace personal advice from your medical
that you take maintenance therapy as this is
helpful for most people with Crohn's disease
practitioner.
shown to reduce the chance of the disease
or ulcerative colitis.
returning in the future. You should discuss
The Digestive Health Foundation (DHF) is an
this with your gastroenterologist.
For more information on nutrition and diet in
educational body committed to promoting better
health for all Australians by promoting education
IBD, see the GESA leaflet entitled: Dietary Advice
and community health programs related to the
You can obtain more detailed information about
for Chronic Gastrointestinal Disease.
digestive system.
the medicines used in the treatment of ulcerative
colitis and Crohn's disease from the ACCA/DHF
Inflammatory bowel disease in children
The DHF is the educational arm of the
publication "Drugs and Inflammatory Bowel
IBD is uncommon in children but does occur.
Gastroenterological Society of Australia, the
Disease", and more information on surgery
professional body representing the Specialty of
Children with IBD develop the same symptoms
gastrointestinal and liver disease in Australia.
from the ACCA/DHF publication "Surgery and
as adults. However, untreated IBD can lead to
Members of the Society are drawn from physicians,
Inflammatory Bowel Disease". You can also get
delayed or impaired growth and it is important
surgeons, scientists and other medical specialties
more information about the medicines used on
to keep inflammation under control to prevent
with an interest in GI disorders.
the GESA website, www.gesa.org.au
this. The treatment of children with ulcerative
colitis or Crohn's disease is very similar to that of
Since its establishment in 1990 the DHF has been
How important is diet?
involved in the development of programs to improve
adults with IBD.
community awareness and the understanding of
Most people with IBD do not need a special
diet and can eat a healthy balanced diet. It is
Can people with IBD lead a normal life?
particularly important to eat enough to prevent
The vast majority of people with IBD lead useful
Research and education into gastrointestinal disease
weight loss. Some people are advised to take
and productive lives, even though they need to
are essential to contain the effects of these disorders
nutritional supplements to maintain their weight.
take medications. When their disease is in
on all Australians.
If you find that you can eat a normal mixed
remission, they feel well and are usually free
Further information on a wide variety
balanced diet without any ill effects, then
of symptoms. People with IBD marry, engage
of gastrointestinal conditions is available
continue to do so.
in sexual activity and have children. They hold
on our website.
down jobs, care for families and enjoy sport
There is no evidence that ulcerative colitis or
and recreational activities.
Crohn's disease are due to food allergies. You
may find that some foods seem to make your
Even though there is no cure for IBD, current
diarrhoea worse, particularly foods with a high
medical therapy has improved the health and
fibre content (eg. fruits, vegetables, nuts and
quality of life of most people with ulcerative
wholemeal grains), spicy foods or fatty foods.
colitis and Crohn's disease. There is good reason
If so, it is sensible to reduce the amount of
to believe that research underway today will
these foods in your diet.
lead to further improvements in medical
and surgical treatment of inflammatory
A few people with Crohn's disease are unable to
bowel disease.
absorb particular nutrients. These individuals
may need to take vitamin or mineral tablets.
Some require an injection of vitamin B12 every
3 months. Nutritional deficiency is uncommon in
people with ulcerative colitis, although blood
Phone (02) 9256 5454
This brochure is promoted as
If you have further questions
a public service by the Digestive
you should raise them with your
Fax (02) 9241 4586
Health Foundation. This leaflet
own doctor.
cannot be completely comprehensive
145 Macquarie Street
and is intended as a guide only. The information given here is
Copyright.
SYDNEY NSW 2000
current at the time of printing,
Digestive Health Foundation,
but may change in the future.
updated August 2007.
Source: http://www.materhillgastro.com.au/docs/infosheets/info05.pdf
Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults : Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache S. Holland, S.D. Silberstein, F. Freitag, et al. April 24, 2012 This information is current as of
Reducing bacterial resistance with IMPACT – Interhospital Multi-disciplinary Programme on Antimicrobial This guideline is available for download at: HKU Centre of Infection http://www.hku.hk/hkucoi/impact.pdf DH Centre for Health Protection IMPACT Third Edition (Version 3.0) Editors: PL Ho and SSY Wong Third Edition 2005