Are my symptoms suggestive of colitis or Crohn's disease?

Question

Hi doctor,

I have been experiencing bloody diarrhea for the past ten weeks, going to the bathroom 16 to 20 times a day. This has completely disrupted my life, making it difficult to work or even leave home.

I suffer from severe cramping and left-sided abdominal pain, along with tenesmus (the sensation of incomplete evacuation). I often have urgent bathroom needs with very little warning, which sometimes leads to accidents. As a result, I have lost 23 pounds because eating significantly worsens my symptoms.

I feel exhausted all the time, occasionally running a low-grade fever, and I have developed painful joint aches in my knees, ankles, and wrists. Additionally, I have painful red eyes (episcleritis) and red, painful bumps on my shins (erythema nodosum).

A recent colonoscopy revealed continuous inflammation and ulceration, with a loss of the normal vascular pattern starting from the rectum and extending to the hepatic flexure. Biopsies confirmed chronic active colitis, showing crypt distortion and abscesses without granulomas. I would like to know if this is definitely ulcerative colitis or if it could be Crohn's disease.

What are the differences between the two, and how can they be distinguished?
What causes ulcerative colitis (UC), and what factors are involved?
How extensive is my disease?
Would it be classified as proctitis, left-sided or distal colitis, or extensive or pancolitis?
What medications are available to treat?
Will I need to take steroids long-term, or are they only for flare-ups?
What happens if medications do not work (treatment failure)?
Is it possible that I will eventually need surgery?
What is my colon cancer risk, and when will surveillance colonoscopies start?
Can a specific carbohydrate diet or other dietary modifications help?
What is the difference between a flare and remission?
What triggers flares?
Is ulcerative colitis curable, or is it a lifelong condition?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

Based on your symptoms (bloody diarrhea, urgency, and weight loss) and the findings from your colonoscopy, it appears that you are dealing with ulcerative colitis (UC).

This condition primarily affects the colon, starting at the rectum and spreading continuously without the skip lesions characteristic of Crohn's disease.

In contrast to Crohn's, which can affect any part of the gastrointestinal tract and involves the entire thickness of the bowel wall, UC only impacts the innermost lining of the colon. Notably, your biopsy results, which did not show granulomas, further support the diagnosis of UC.

Your inflammation has reached the hepatic flexure, indicating you have extensive colitis, specifically pancolitis. The severity of your condition is concerning, as you are experiencing more than six bloody stools a day, along with weight loss, fever, and systemic symptoms like joint, eye, or skin issues. This falls under the category of severe UC, which can significantly impact your daily life.

Treatment typically involves the use of steroids during flare-ups, followed by maintenance medications such as biologics or immunomodulators. If these options prove ineffective, surgery, specifically a colectomy, may be necessary.

It is important to keep in mind that the risk of colon cancer increases with UC, so regular screening via colonoscopy should begin eight to 10 years after your diagnosis. While diet changes may help alleviate some symptoms, they are not a cure.

UC is a lifelong condition characterized by periods of flare-ups and remission, but with proper treatment, many people can achieve a good quality of life.

I hope this clarifies your doubts. Please take a moment to rate and provide your valuable feedback.

Thank you.