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When It's More Than a Tummy Ache

Ulcerative colitis, Crohn's disease and IBS call for treatment

By Alice Rhein

Bruce Zickerman was in his 20s when he first suspected something was wrong with his digestive system. The West Bloomfield resident lost nearly 30 pounds in two weeks, had no appetite, and was extremely tired."I was always running to the bathroom," recalls Zickerman, now 50. Zickerman was diagnosed originally with ulcerative colitis but later found out he actually was suffering from Crohn's disease.

The misdiagnosis is common. Crohn's and colitis are collectively known as inflammatory bowel disease (IBD) and share similar symptoms, which include diarrhea, blood in the stools, weight loss, and lower abdominal pain, according to Mitchell Cappell, M.D., Beaumont Hospital chief of gastroenterology. When patients undergo a colonoscopy, the distinction between the two usually is clarified, he says.

"A patient with ulcerative colitis will have a red, inflamed colon that when severe looks a bit like a pounded raw steak, while someone with Crohn's may have ulcers, scar tissue and more stricture [narrowing of the colon]," says Cappell.

Zickerman found out he was far from alone: According to the Crohn's & Colitis Foundation of America, 1.4 million Americans suffer from IBD, with approximately 30,000 new cases diagnosed each year. Anyone can get IBD, but young adults between 15 and 35 are most susceptible. To make things even more confusing, IBD symptoms often mimic those of the less serious irritable bowel syndrome (IBS), which is estimated to affect 10%-15% of the U.S. population, according to the International Foundation for Functional Gastrointestinal Disorders.

So how do you know if your symptoms are something more than an upset tummy? According to the National Institutes of Health, symptoms of colitis can include abdominal pain, bloody stool, dehydration and diarrhea.

Crohn's disease can bring on similar symptoms that might also include abdominal cramps, fever, fatigue, weight loss, constipation, joint pain, skin rash and swollen gums.

Irritable bowel syndrome symptoms include chronic and frequent diarrhea, often accompanied by constipation, abdominal pain or tenderness following a meal. Intermittent gas, bloating, nausea, vomiting, loss of appetite, emotional distress and depression are possibilities. It is important to seek a physician's advice if these symptoms persist.

Ulcerative colitis and Crohn's disease

The distinction between ulcerative colitis and Crohn's is important because ulcerative colitis can be cured with removal of the colon but Crohn's cannot. While both are believed to be autoimmune disorders, Crohn's can affect any part of the digestive tract. It is a chronic, longterm condition for which there is no cure.

"It can affect the small or large intestine, the mouth, esophagus or stomach," says Ann Silverman, M.D., a gastroenterologist with the Henry Ford Center for Inflammatory Bowel Disease in Novi. "The classic symptoms are abdominal pain, diarrhea and bloody stool, but not everybody follows the textbook."

That's why a careful history, complete blood count, X-rays and an endoscopic test, such as a colonoscopy are so important in making an accurate diagnosis. Children with Crohn's often fail to grow, says Silverman, so a 17-year-old can look like a 12-year-old because of the body's inability to absorb nutrition.

Silverman says the main medications used to treat both Crohn's disease and ulcerative colitis are 5-ASA preparations, corticosteroids, antibiotics and immunosuppressants. Capell says a new class of potentially highly effective medications have been introduced the last few years to treat IBD, especially Crohn's disease.

"These promising therapies are already significantly reducing the need for surgery for Crohn's disease," he says. "In the next five years more options in this ... drug class should become available, and other promising therapies are in the pipeline. With new drugs and treatment, we should see a further decline in the need for surgery."

Capell says that in children, IBD might respond to a restricted diet but generally is not treated this way. Many patients with IBD have lactose deficiency that can lead to worsening diarrhea, Silverman says.

Colon cancer can be a complication of chronic ulcerative colitis or Crohn's colitis (Crohn's disease involving the colon), according to Cappell, so it's important to maintain medical appointments, even if symptoms are under control. As many as 10% to 25% of patients with long-standing ulcerative colitis face the risk of colon cancer. Regular colonoscopies as directed by a gastroenterologist also are crucial.

Irritable bowel syndrome

Even doctors admit IBS can be a confusing condition because there is no standardized test to diagnose the disease. It can affect any age group, although it does affect more women than men.

A diagnosis of IBS is made after ruling out more serious IBD first, according to Silverman. On a colonoscopy, IBS sufferers show a normal digestive tract lining.

New medications are being developed to control the symptoms of diarrhea, bloating and cramping, and patients are encouraged to follow a high-fiber diet.

"There was a study in the American Journal of Gastroenterology showing that a specific population of patients with IBS did get transiently better when they were treated with antibiotics," Silverman says. "I think that this is a multitude of disorders with similar symptoms that get labeled with IBS, and there are probably many different causes."