As stated in our previous classes, we know that the 2 common forms of Inflammatory Bowel Syndrome are Ulcerative Colitis and Crohn's Disease. But while these two are the most commonly diagnosed amongst IBD patients, they have many differences. Two differences will be discussed in this topic: the location of inflammation and how inflammation works.
For people diagnosed with Crohn's Disease, they are typically seen to have general inflammation. This means that the inflammation can basically occur anywhere along the digestive tract/GI. Ulcerative Colitis based patients, however, are only seen to have inflammation along the large intestine (colon). Another major difference is that with Crohn's Disease, inflammation can occur randomly and in patches while UC causes an inflammation that is continuous along affected areas.
Knowing these differences between Crohns' Disease and Ulcerative Colitis is important for surgical purposes since this determines whether or not surgery can be used as a cure or a method to calm down the disease.
Since UC is more localized, surgery can be used to remove the affected areas. One method used is to remove the entire colon/rectum and attach the lowest part of the small intestine to a hole made in the internal abdominal wall. This will act as a substitute for the rectum in that it will allow waste products to leave the body and empty into an external bag. The most common procedure, however, is the Ileal Pouch Anal Anastomosis (IPAA). The colon and rectum are still removed with this method but a new rectum called the J-Pouch is surgically created out of the Small Intestine. This procedure will allow patients to have regular bowel movements without the usage of an external bag. And while this may be undesirable, many people still choose this route when the UC begins to affect their daily life and work.
Crohn's Disease, however, cannot be cured with surgery; only treated. This is due to the wide range of places in the digestive tract that can be affected and inflamed. So even if surgery is used to remove the inflamed area, the only thing that surgery will do is cause CD to go into remission. It can last for weeks, months, or years but there is no way to completely rid a patient of CD through surgery.
To be clear, picture this. A patient with CD on the colon undergoes surgery to remove said colon but four months later, the same patient comes back to the hospital in regards to CD inflammation showing up on the small intestine and/or esophagus this time. This is why surgery cannot cure Crohn's Disease.
But while surgery can only push CD into remission, it may be necessary and required for a patient due to certain complications like toxic megacolon (the stretching of the colon which allows toxins to spread through the blood) and the formation of a fistula (connections between two body parts that are not supposed to connect). So when it comes to surgery for UC and CD, it's not a one-fits-all kind of treatment but more for a case-by-case study.
"Differences between Crohn's Disease and Ulcerative Disease." Columbia St. Mary's. N.p., n.d. Web. 24 Oct. 2014.
"Slideshow: Ulcerative Colitis Surgery – What to Expect." WebMD. WebMD, n.d. Web. 24 Oct. 2014.
"Surgery for Crohn's Disease: Types of Surgery, Complications, Recovery, and More." WebMD. WebMD, n.d. Web. 24 Oct. 2014.
Your examples describing the treatment of CD really helped make clear just how tricky the disease is to manage. Treating it in one area might be effective for certain time span, but because it is so widespread, the outcomes are uncertain at best. Your statement concerning surgery and CD really hit home. In unfortunate circumstances, surgery really is not only required, but also necessary. What's really sad to me is the fact that even after an individual undergoes multiple surgeries, there is still no promise of a cure.
ReplyDeleteI was really interested in the complications you brought up in your post, particularly toxic megacolon. This appears to be a complication that results from the inflammation spreading to deep layers of the colon, which interrupts bowel motility and allows for the build up of wastes and gases in the intestinal lumen. There are two major concerns with toxic megacolon: the development of sepsis (a life threatening full body infection) or perforation (a tear in the intestinal wall which would allow wastes to enter the abdominal cavity). It wasn't immediately clear to me if sepsis occurs because of increased permeability of capillaries allowing for bacterial movement into the bloodstream. For anyone else who is interested, I have provided two links below.
ReplyDeletehttp://emedicine.medscape.com/article/181054-overview#a0101
http://www.hopkinsmedicine.org/healthlibrary/conditions/digestive_disorders/toxic_megacolon_134,180/
Thanks for sharing this Syndey! I found it very insightful into the mechanism of how surgical intervention could come into place with someone with IBD. It was interesting to me that in diseases that are so commonly grouped together as just IBD could have such different effects on he GI tract, and how different the surgical intervention was. I found the surgical intervention of the removal of the colon and for insertion of IPAA to be particularly interesting, but in the case of toxic megacolon as mentioned in the comment above, it seems that in many cases, there is no other option that surgical intervention as unfortunate as it sounds to have your stool emptied into a bag attached to you, this uncomfortable inconvenience would be worth avoiding the risk of sepsis or perforation.
ReplyDeleteThanks for posting this, talking about the differences between Ulcerative Colitis and Crohn's Disease helps us to understand what they are and why they are treated differently. I found the treatments most interesting especially the formation of the IPAA. I did some more research on it and after the surgery the patients will have trouble absorbing a lot of water back but after time the body adapts and returns to a nearly normal routine.
ReplyDeleteThis is great! it was really nice to see that there is alternative to a colostomy bag. I can't imagine how hard it is for people to completely wrap their heads around this concept. However, it does seem like there are significant drawbacks to this alternative procedure. Do you know how many people are affected by these side effects? And also how many people after getting this alternative procedure eventually switch to a colostomy bag? Thanks for this!
ReplyDeleteDuring discussion and after reading all the papers regarding IBD, I thought I understood the general differences between CD and UC patients in respect to location and whatnot but this post really helped me understand the differences between the two on a personal level and how they would affect patients lives differently. My dad had colon cancer and he had a colostomy bag and it was terrible, just from person experience I believe that the colostomy bag has vast psychological effects on a patient as well as the obvious physical drawbacks. Some side effects I found on IPAA were relatively mild such a diarrhea but it seams as though patients can return to a "normal" life as long as they follow diet restrictions. Because metabolism is altered they have to drink more fluids, eat smaller meals, take B12 and iron supplements, and eat foods loaded with carbs in order to thicken stool.
ReplyDeleteBonnie, I found a Penn State handbook online stating that only 5% of people need to switch to a colostomy bag which is a really good rate! Let me know if you find any other sources that have similar rates. The link is below:
http://emedicine.medscape.com/article/1892231-overview
http://www.pennstatehershey.org/c/document_library/get_file?uuid=2f337825-f2b2-482b-9849-5fcd0445330f&groupId=78386