Central  South  Dakota Medical News
The Clinical View
by P.E. Hoffsten, M.D.
5 APRIL 2001

Inflammatory Bowel Disease - Colitis

       Problems with a person's bowel habit are one of the most common complaints that patients have. With age, there is a tendency for constipation and over-the-counter laxatives are one of the major medical expenditures in our society. As noisome as constipation can be, it is unusual that constipation is disabling or requires hospitalization.

    Not so for problems with diarrhea. Anyone who has visited a foreign country and developed a case of so-called "Montezuma's revenge" will remember how unpleasant a case of infectious diarrhea can be. Rarely consumption of uncooked hamburger contaminated with
certain bacteria can cause a fatal infectious colitis here in the United States. The topic for this column is two relatively unusual diseases called Crohn's disease and ulcerative colitis. Medical research continues to pursue the causes of these two conditions and effective treatments but to this time the problem has not been worked out. We do have medications that will help with these two diseases as will be discussed below.

    To project an idea of what inflammatory bowel disease represents imagine a time when you got poison ivy or an irritated rash secondary to a solvent or toxic exposure. Alternatively, one might remember a time when they had a burn with raw skin that results from that. On the outside of the body, a burn or a rash can be covered and kept clean allowing the area to heal and resolve the problem. Imagine what your rash would be like if instead, the area was constantly exposed to gastric digestive juices, bile and stool fecal material. Imagine the grotesque idea of having fecal material constantly rubbing over a raw spot on your skin. Patient’s with Crohn’s disease or ulcerative colitis functionally have a raw spot on the inside of the colon and that raw spot is constantly bathed in fecal material and all of its associated bacterial contamination. As you might imagine, these people get really sick. They develop diarrhea and frequently have bleeding that can be life threatening and infections that can leak into the blood stream. Before antibiotics and modern medicine, this was very frequently a fatal condition.

    The cause of these two diseases appears to be different although the effect on the body is often very much the same. Ulcerative colitis appears to have hereditary factors but the episodes of sickness and recurrent diarrhea that come with this disease are not predictable and do not seem to have a detectable relationship to the person's activities. With Crohn's disease, the problem appears to be an allergy to foods which causes an irritation in the bowel very much like poison ivy does on the skin. We discovered this by observations in patients who would have part of their bowel bypassed so that no food went through that part. The inflammatory Crohn's disease in that part of the bowel would simply stop and go away. When that part of the bowel was reconnected, the Crohn's disease would often recur. It is thus obvious that at least part of the problem in Crohn's disease is an allergy to some component of food. Try as we will, medical science has never determined which component or which type of food causes the problem to get worse.

    Fortunately, there are treatments available for both Crohn's disease and ulcerative colitis. Both conditions are often treated with large doses of cortisone that suppress the allergic type reactions that cause the ulcers in the colon. Frequently, a product called sulfasalazine is effective in decreasing the irritation in the colon. Several more expensive derivatives of this product are available but the basic product sulfasalazine itself seems to work remarkably well. Unfortunately, surgery is frequently required to deal with colitis problems and many patients with ulcerative colitis eventually have a total removal of their colon because the condition cannot be controlled. After 10 to 15 years of active colitis, the incidence of cancer of the colon increases substantially and patients are usually advised to have a colectomy done at that time to avoid the risk of cancer of the colon. For reasons completely unknown, Crohn's disease does not carry this risk, although surgery is frequently required to deal with obstructions and bleeding that occurs.

    A third type of colitis problem that is very common in our hospitals today is called Clostridium difficile colitis. In this condition, the normal bacterial population of the colon is killed off by antibiotics the person receives to treat colds or pneumonia or kidney infections.
When the normal bacterial population is killed off, another resistant organism called Clostridium difficile increases its growth rate and takes over the population of the colon. This particular bacterium is highly corrosive for the colon and causes ulcerations that also can be life threatening. Fortunately, there is a specific antibiotic that will kill the Clostridium bacteria and allow the person to get well but the illness can be very severe. Unfortunately, the colitis that results from an antibiotic is often much more severe than the infection that the antibiotic was originally given for. This is the reason that healthcare professionals choose antibiotics very carefully and only when clearly indicated. Even then, this infectious form of colitis does occur. Colitis problems almost always present as diarrhea being the basic complaint.

The healthcare professionals at your local clinic can help sort out the cause for a person's diarrhea problem whether it is a sudden onset of acute infection or a chronic problem such as Crohn's disease or ulcerative colitis.