It is possible to have both Crohns Disease & Ulcerative Colitis

I have both Crohns Disease and Ulcerative Colitis. I was not misdiagnosed and it is possible. It is rare but, it is possible! I have had Crohns since I was 9 years old and Colitis since my early twenties. There are more documentation other than what I am presenting below of these diseases in one patient and concurrently however, I could not find more than seven on the www!

Is it possible to have both Crohn’s Disease & Ulcerative Colitis? And concurrently?

Yes, You Can Have Both Crohn’s And Ulcerative Colitis ~ Crohnology.com

Crohn’s disease and ulcerative colitis in the same patient ~ NCBI

Simultaneous ulcerative colitis and Crohn’s disease ~ NCBI

Two for one: coexisting ulcerative colitis and Crohn’s disease ~ NCBI

If you are one of the unlucky ones who also have both, you are not alone! I welcome you to share your experiences and stories here without judgement or negative naysayer comments. (as I have control over the comments to be posted and I will not approve any that fall in those categories.)  Connecting is a key factor to working through illness and this platform is a great place to start!

Light. Love. & Peace.

~Andrea

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CLEVELAND CLINIC

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Link to Publisher's site
Dtsch Arztebl Int. 2009 Feb; 106(8): 123–133.
Published online 2009 Feb 20. doi:  10.3238/arztebl.2009.0123
PMCID: PMC2695363
Review Article

The Diagnosis and Treatment of Crohn’s Disease and Ulcerative Colitis

Daniel C. Baumgart, PD Dr. med.*,1

Abstract

Introduction

Crohn’s disease and ulcerative colitis are chronic inflammatory diseases resulting from an inappropriate immune response, in genetically susceptible individuals, to microbial antigens of commensal microorganisms. This inappropriate response is promoted by certain environmental factors. Both diseases manifest themselves primarily in the gastrointestinal tract yet can, in principle, affect all of the organ systems of the body.

The purpose of this review article is to heighten awareness of these diseases among physicians whose primary clinical activities lie outside gastroenterology.

Methods

This is not a systematic review nor a meta-analysis. It is mainly based on the guidelines of national (DGVS and DACED) and international (AGA, ACG, BSG, CCFA, ECCO) specialist societies and expert groups, as well as on important reviews and a limited number of pivotal randomized, double-blind, controlled, multicenter studies.

Results

More than 300 000 people in Germany suffer from chronic inflammatory bowel diseases. The incidence and prevalence of IBD have risen in the past 10 years, particularly for Crohn’s disease. Every fifth IBD patient is a child or adolescent. A better understanding of key events in the inflammatory cascade, e.g., the activation and polarization of T cells by TNF-alpha, IFN-gamma and IL-12/18 through dendritic cells, has led in recent years to the development of many new immune-modulating and biological treatments. Advanced endoscopic techniques and contrast-enhanced tomographic imaging techniques have expanded diagnostic capabilities.

Conclusion

A cure is still not possible, yet the opportunities for diagnosis and treatment have improved significantly. Early diagnosis is important so that patients can be referred onward for further diagnostic evaluation and appropriate treatment without delay.

Keywords: Crohn’s disease, ulcerative colitis, diagnosis, treatment, chronic disease

Crohn’s disease and ulcerative colitis are the two main forms of chronic inflammatory bowel disease. The clinical features, diagnostic assessment, and treatment of these diseases are the topic of this review article (1, 2). Their complex epidemiology, pathogenesis, and pathophysiology are extensively discussed elsewhere (2, 3).

Very important factors in the epidemiology of these diseases include the following:

  • Ethnic origin
  • The presence of susceptibility regions on at least 12 chromosomes
  • Geographical factors
  • Lifestyle.

These factors can contribute singly or in combination to the occurrence of the disease. In summary, chronic inflammatory bowel diseases result from an inappropriate innate and acquired immune response to commensal microorganisms in genetically susceptible individuals.

Crohn’s disease is a transmural inflammatory disease of the mucosa with episodic progression. It can affect every part of the gastrointestinal (GI) tract from the mouth to the anus. Typical manifestations include discontinuous involvement of different segments of the GI tract (L1–L4) and the development of complications such as strictures, abscesses, and fistulae (B1–B3p) (46). The Montreal classification also takes the age at initial diagnosis into account (A1–A3) (box).

Box

Montreal classification of Crohn’s disease and ulcerative colitis (5)

Crohn’s disease
A1 < 16 years old at diagnosis
A2 17 to 40 years old at diagnosis
A3 > 40 years old at diagnosis
L1 terminal ileum
L2 colon
L3 ileocolon
L4 upper GI tract
L4+ lower GI tract and distal disease
B1 without stricture formation, nonpenetrating
B2 with stricture formation
B3 internally penetrating
B3p perianally penetrating
Ulcerative colitis
E1 proctitis
E2 left colitis
E3 pancolitis

Ulcerative colitis is a nontransmural inflammatory disease with episodic progression that is restricted to the colon. Depending on the part of the colon that is involved, it can be designated according to the Montreal classification as proctitis (E1), left colitis (sigmoid and descending colon) (E2), or extensive colitis (pancolitis) (E3). In a few patients, inflammation of the terminal ileum (“backwash ileitis”) can also develop, making it difficult to distinguish this form of ulcerative colitis from Crohn’s ileocolitis (5, 7, 8) (box).

Methods

This article is neither a systematic review nor a meta-analysis. Excellent meta-analyses are already available, e.g., in the library of the Cochrane Collaboration (www.cochrane.org/reviews/eu/topics/73.html). Rather, it is intended as a general, practice-oriented overview of the diagnosis and treatment of Crohn’s disease and ulcerative colitis. The guidelines of national (DGVS, DACED) and international (AGA, ACG, BSG, CCFA, ECCO) specialist societies and expert groups are emphasized, and important review articles are cited, along with only a few pivotal randomized, double-blind, multicenter studies. Recent international guidelines are given priority over national consensus statements in order to give the reader the most up-to-date information possible.

Therapeutic recommendations are based mainly on the ECCO Consensus (ECCO = European Crohn’s and Colitis Association) and the guidelines of the German Society for Digestive and Metabolic Diseases (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, DGVS), which are discussed in the context of the author’s own clinical experience and practice. The evidence levels (EL) and recommendation grades (RG) given here are based on the categories of the Oxford Centers for Evidence-Based Medicine (www.cebm.net/levels_of_evidence.asp#refs); thus, 1 is the highest level of evidence and A is the strongest recommendation grade. In the DGVS guidelines, the recommendation grade is given as A, B, C, or D.

Clinical features

The clinical features of the disease depend on its localization (box) and often include diarrhea, abdominal pain, fever, clinical signs of subileus or ileus, and/or the passage of blood and mucus per rectum. Patients with Crohn’s disease often do not have bloody diarrhea, but rather abdominal pain or nonspecific abdominal symptoms. Patients with left colitis or ulcerative proctitis generally have a milder disease course (box, table 1).

Table 1

Differential diagnosis of ulcerative colitis and Crohn’s disease (1)

Extra-intestinal manifestations

Patients with Crohn’s disease and ulcerative colitis can develop extra-intestinal manifestations (table 2). The most common types affect the musculoskeletal system (figure 1), the skin (figure 2), the eyes, and the hepatobiliary system (9, 10). These extra-intestinal manifestations are to be distinguished from the so-called associated autoimmune diseases (table 2).

Table 2

Common extra-intestinal manifestations and associated autoimmune diseases (9, 10)

Figure 1


Articles from Deutsches Ärzteblatt International are provided here courtesy of Deutscher Arzte-Verlag GmbH
*Note: Although this article continues I do not agree with their way of treatments so, I have chosen not to include it here. Link is above for further reading if you so choose.
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