Crohn's vs Ulcerative collitis

[matrix123]

Hello everyone. I'm posting this on behalf of my cousin who is 21 years and suffering from what appears to be Crohn's disease.

The quick story is that she was diagnosed about 3 years ago with ulcerative colitis, but saw little improvement. About 4 months ago it got so worse that she had to do surgery to remove most of the colon. During the operation they did a biopsy and it turned out actually it was Crohn's disease (I'm no doctor, but based on her symptoms I was suspecting Crohn's disease all the time). Now she's hoping to do a second operation and reconnect the colon, but the rectum appears very irritated. The doctor prescribed Mesalasine and Asacol, but from what I'm reading they are used to treat Ulcerative Colitis. Also after surgery the doctor told her "don't worry" Crohn and Ulcerative Colitis have the same medication, so it was no big deal that you got Ulcerative Colitis meds.

Now, from what I'm reading although the symptoms are similar, the meds are quite different. Can anyone please shed some light on this, because I suspect the doctors are just telling a lot of bull*** to "protect" themselves and not accept that she got the wrong meds.

Thank you

 

[kiny]

Sorry to hear that, that's ridiculous and also wrong.

In UC, they can readily detect an auto-antigen in 80% of the people. In CD, there is no reproducible auto-antigen.

UC involves the colon, which is very high in gut lumen bacteria. CD tends to involve the small intestine, which means a much lower load in gut lumen bacteria.

People with CD get fistulas because the disease is transmural, UC is topical.

They're vastly different diseases, one example is antibiotics (specifically macrolides and quinolones), used for crohn's disease, completely ineffective for UC.

Another example is intravenous immunoglobulin, used for CD, not used for UC.

 

[matrix123]

Thank you very much kiny for your quick reply. Unfortunately it seems the doctor messed up in this case

 

[kiny]

Yes, confusing the 2 diseases should not happen, it is inexcusable.

It's nice that you look out for her, it's really easy for people to lose hope sometimes, make sure you stick with her through all of it.

 

[Clash]

Although, 5ASA(meslamine, asacol, and others) are approved for UC they are not for CD. Many times they are still px'ed for CD but in studies have proven less efficacious:

Here are a couple of threads that discuss those studies:

http://www.crohnsforum.com/showthread.php?t=36292&highlight=Cochrane+Review

and

http://www.crohnsforum.com/showthread.php?t=50253

The other drugs such as immunosuppressants and biologics I do believe are used in both CD and UC.

You can look through our Treatment forum(<--click here) for more info about treatments.

 

[matrix123]

Thank you very much for the information. It seems I need to get to the bottom of it and discuss all the details with the doctors.

 

[matrix123]

Just came back from a meeting with a Gastro to get a second opinion. Basically he told me the same thing: medication is the same for both, but dosage may vary. It's very confusing and it seems to be 2 alternatives:

1. They are right and medication is the same.
2. Since Crohn is very rare here they have a very basic knowledge and treat people the same way as Ulcerative Colitis.

I even told them that 5ASA aren't approved for Crohn in US and he said like "no no...in Europe it's the same...I don't know about US).

 

[Clash]

Like I said it is common for GIs to px 5ASA's for CD. This is how the treatment pyramid is laid out.

A lot of times steroids are used to get inflammation under control. Steroids like Prednisone shouldn't be used long term and there are alternatives to systemic steroids that have less side effects like entocort. They are used for both CD and UC.

The bottom of the pyramid are 5ASAs(asacol, colozal, pentasa) they are more effective for UC but commonly used in CD.

The next level of meds are immunosupressants- Imuran, 6MP(which are thioprines) and methotrexate. They are commonly used in both CD and UC. You will need regular blood tests with these meds to check levels present and to ensure no problems are arising.

The top level of meds are biologics, these would be like Remicade, Humira and Cimzia. They are taken by infusion(Remicade) or injection(Humira and Cimzia) you will also need regular blood tests with these as well. They are used for both UC and CD

Of course with UC you can have your colon removed and essentially be cured of UC. The same is not true with CD. You may eventually have surgery with CD to remove damaged tissue but this does not do away with CD.

It isn't that you are using a drug that isn't commonly used for CD, 5ASAs are quite common among CD users. For those that have mild CD it can keep things under control. I would just advise to get regular blood work and fecal calprotectin stool tests to make sure that your inflammatory markers aren't rising. If symptoms persist or arise or get worse make sure you let your GI know as you may need to be on stronger meds for your CD.

 

[matrix123]

Thank you Clash for the thorough explanation.

The problem is that my cousin did undergo emergency surgery about 4 months ago to remove most of the colon and only during surgery they did a biopsy which gave Crohn as a result. Before that she only got meds for UC (5ASA and steroids only). My opinion is that had she got proper meds for CD she probably would not have needed surgery. She never gor immunosupressants or biologics...

The problem is that the docs are still saying "it's no problem that she was treated for UC for 3 years, because even if they knew it was Crohn the treatment would be the same". This is very confusing to me and I think it's wrong. If it doesn't matter if you have UC or CD why bother diagnosing one or the other?

 

[Clash]

The main difference(besides differing symptoms and those can be very individual) is with UC when the colon is removed the UC is gone not so with CD.

There are some 5ASA that are designed to release in the colon, others in the TI, and so on which make them more effective for that area of your GI tract.

I'm sorry she was misdiagnosed that must have been hard for her. You will read what her doctors said about the "treatments being the same" here on the forum as well. There are people who are diagnosed with indeterminate IBD(when they are unsure if it is CD or UC) but they still get the same meds.

There are two approaches to CD treatment step up approach and top down approach. The bottom up approach starts with the meds that have the least side effects like 5ASAs. The top down approach(newer and more controversial) is to stop with the most powerful drugs like biologics to try to get the CD under control quicker but with this approach you are also taking the meds with the more serious side effects.

in patients with UC, there is a clear first-line therapy that satisfactorily treats a substantial fraction of patients, both inducing and maintaining remission. In contrast, in Crohn's disease, there is no safe and effective first line for inducing and maintaining remission. Further, it has been documented that over a disease course of 20 years, 80% of patients with Crohn's disease will require at least 1 surgical resection. In the modern era, in comparable patients with UC, rates of surgery are not more than 15–20% and thus the prognosis for avoiding surgical resection is very different.

That is found at this link and has some other great info as well:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096114/