Differences in Priority of Care in Ulcerative Colitis and Crohn’s Disease

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The distinction between Ulcerative Colitis (UC) and Crohn’s Disease (CD) has been the topic of extensive debate in the medical science community as of late. Both UC and CD are subtypes of a category of chronic diseases called Inflammatory Bowel Disease (IBD) is generally caused by inappropriate autoimmune response to naturally-occurring micro-flora in the intestines and tends to run in families (Annaházi, 2014). Occurence of IBD is most prominent in the western world and its incidence has greatly increased since the beginning of the 20th century (World Health Organization, 2016). Although the two conditions have a very similar profile of outward symptoms, the distinction between the course of UC and CD suggests that the two conditions call for different priorities of care.

Although UC and CD are two clinically distinct conditions, they share several common characteristics. Although onset can take place at any age, both CD and UC most commonly begins during the teen years and young adulthood. The prevalence rate of both; UC and CD, has no statistically significant difference between the male and female populations . The clinical presentation of the two disorders is very similar. The cause of both UC and CD is unknown, but both diseases have a similar set of contributing factors e.g. genetic, autoimmune and environmental (Wijmenga, 2005). Now that the commonalities of the two disorders have been outlined, it is possible to shed light on the characteristics that set them apart.

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Although UC and CD share several clinical and pathological characteristics, the two conditions are distinct from one another in several important ways. The tissue damage associated with UC is limited to the colon (Annaházi, 2014). The tissue damage associated with CD is more widespread and can appear anywhere between the mouth and the anus (Wijmenga, 2005). While in CD there are “patches” of healthy intestinal tissue disbursed in-between patches of inflamed tissue in UC results in widespread inflammation of the colon (Annaházi, 2014). While UC is limited to the deepest layer of the epithelial tissue lining the colon, CD can affect all layers of the intestinal tract (Wijmenga, 2005).

There are several similarities and differences between the priorities of care in CD and UC. Global autoimmune suppression with corticosteroids is a treatment that applies to both UC and CD (Engel & Neureth, 2010). For both CD and UC prevention is key; patients require healthy diet, exercise and minimal stress levels to maximize chances of remission. It is important to educate the patient about diet, exercise and possible psychological interventions. For UC the highest priority of care is to prevent surgical intervention through lifestyle changes first and then with medicine if lifestyle changes are either not made or did not help. UC can be cured by colenectomy, while CD can recur after surgery (Engel & Neureth, 2010). This is why medication is typically continued after surgery in CD patients. In fact, medication is the primary mode of treatment in CD (Engel & Neureth, 2010).

In patients with UC medications are used primarily during flare-ups and efforts are made to avoid corticosteroids by educating the patients about lifestyle changes that are conducive to remission. In CD medications are used continuously as maintenance therapy to prevent flare ups, since once a flare-up of CD begins it can cause such widespread inflammation that the risks of complication from the flare-ups outweigh the risks of prolonged use of corticosteroids (Engel & Neureth, 2010). In general, for both CD and UC the symptoms are remedied as they occur and continuous efforts are made to prevent future flare-ups. The main difference in priority of care in CD patients and UC patients is that CD involves ongoing pharmaceutical treatment, while UC patients are treated on an as-needed basis.

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