Medically Reviewed On: July 01, 2008

BETTINA GREGORY: Hello. I'm Bettina Gregory. Crohn's Disease and Ulcerative Colitis affect as many as a million Americans. They can cause great discomfort and interfere with everyday life. While these are serious diseases, good therapies are available. Recently, I hosted a panel discussion sponsored by the Crohn's and Colitis Foundation of America. Two experts in gastroenterology helped us understand the possible causes and treatments of these diseases, which together are known as Inflammatory Bowel Disease... or I-B-D.

Dr. Tepper, let's start with you, and let's start at the very beginning. What is IBD?

ROBERT TEPPER, MD: IBD is a general term describing a number of chronic inflammatory conditions of the gastrointestinal tract. That encompasses the mouth, esophagus, stomach, small and large intestines, rectum and anus. The two most common conditions are ulcerative colitis and Crohn's disease. Because they have several similarities, they're grouped under the umbrella term IBD.

BETTINA GREGORY: What are the similarities, Dr. Heller, and the differences between ulcerative colitis and Crohn's disease?

ARTHUR HELLER, MD: Ulcerative colitis is a disease that starts in the rectum, the lowest-most part of the colon, and in a continuous manner can work its way up to a varying degree in the colon. Crohn's disease can affect the gut anywhere from lips to anus, often in a skip pattern, a segmental pattern.

Ulcerative colitis affects inflammation of only the superficial lining cells of the colon, whereas Crohn's disease involves inflammation of the full thickness of the gut.

BETTINA GREGORY: Dr. Tepper, what are the causes of IBD?

ROBERT TEPPER, MD: No one knows the specific cause. Currently, the most attractive theory is that in a genetically predisposed person there is some environmental trigger that causes an abnormal immune response. Of the factors involved, there are certainly genetic factors.

We know this because of patients who have IBD, in 15% of them, they will be able to identify a first-degree relative, a parent, child or sibling, who also has the disease. Secondly, we know that identical twins are more likely to both have the condition than non-identical twins.

We know that there are certain ethnic groups, such as Ashkenazi Jews, who are more likely to have the condition than others. And finally, there's been a recent discovery of a gene called the nod-2 gene, which is twice as likely to occur in Crohn's patients than in patients who do not have the disease.

BETTINA GREGORY: You've been talking about the genetic factors, and you did mention that certain groups, such as the Ashkenazi Jews, are more prone than the general population to have this disease. But can you mention any other populations of who is likely to get it, such as men or women, old or young, things like that?

ROBERT TEPPER, MD: Sure, sure. It can be diagnosed in any age group, but the majority of patients are diagnosed between the ages of 18 and 35. About 10% of patients are below the age of 18. In addition, it can happen in both men and women. There's a slight female predominance of Crohn's disease in women, whereas there's a slight male predominance in ulcerative colitis.

BETTINA GREGORY: And nobody knows why?

ROBERT TEPPER, MD: That's not clear.

BETTINA GREGORY: Oh, okay. Now, Dr. Heller, could you tell us about the symptoms of these diseases?

ROBERT TEPPER, MD: They can vary. Ulcerative colitis typically will have diarrhea, often bloody diarrhea, abdominal cramps and pain. Crohn's disease may or may not have diarrhea. Abdominal pain can be very prominent. Sometimes fever can be associated, because such patients can get abscesses, pus pockets, decreased appetite, painful episodes after eating, and so, often, weight loss will occur because people cut down on how much they're eating, because they put two and two together. You eat, you get pain. You don't eat, you get less pain.

BETTINA GREGORY: Dr. Tepper, what are the treatments for IBD?

ROBERT TEPPER, MD: There are several treatments. They fall into the categories of medical and surgical. The goal of therapy is to control symptoms, to control inflammation, and to help prevent inflammation from returning after the disease is in remission.

In terms of the medical treatments, the first group of drugs is called the aminosalicylates, or 5-ASA agents. These include drugs such as sulfasalazine, mesalamine, balsalazide and olsalazine, and they're good for treating mild to moderate disease. When the disease becomes more severe, often steroids are used, although we try to avoid them if we can because of their toxicity. Steroids can be given intravenously or orally. The traditional oral drug had been prednisone, but more recently a new medication called budesonide was released which had similar efficacy but fewer side effects than prednisone.

In addition, there are medications that are called immunosuppressant drugs. These would include medicines such as 6-mercaptopurine, azathioprine, cyclosporin, methotrexate, and they're reserved for more moderate to severe cases. They can help patients come off of steroids, and they could also help treat more complicated cases of Crohn's disease that include fistulizing disease.

Antibiotics may be used in certain cases of Crohn's disease, particularly when the disease involves the perianal region. And finally, there are the newest drugs, the biologic modulators, such as infliximab, which is an antibody to an inflammatory mediator called tumor necrosis factor. This is a very potent drug which has been very effective in many cases of Crohn's disease, and there's research being done on medicines similar to infliximab which may be helpful in the future.

BETTINA GREGORY: And Dr. Heller, are there surgical options for people with severe IBD?

ARTHUR HELLER, MD: Oh, indeed. And we usually reserve surgery for people who are having severe disease. We learned early on with Crohn's disease that cutting out the diseased area doesn't end the process. It would recur. What we do now is reserve in Crohn's disease surgery for patients who have abscesses, for fistulas that don't respond to medical treatment, and for tight strictures, tight narrowings, that can cause frequent blockages.

For ulcerative colitis, we usually reserve colon removal for those individuals who are having disease that doesn't respond adequately to medical therapy or in the event of toxic mega colon, which is a pretty significant complication.

BETTINA GREGORY: Most people with Crohn's Disease and Ulcerative Colitis can lead normal, useful and productive lives. Effective treatment depends on well-educated patients and knowledgeable caregivers. We're grateful to Dr. Arthur Heller and Dr. Robert Tepper for helping us better understand the possible causes these inflammatory bowel diseases, and treatment options. I'm Bettina Gregory. Thanks for joining us.