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IBD Disguises:Diseases That May Mimic Crohn's Disease and Ulcerative Colitis
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IBD Disguises:Diseases That May Mimic Crohn's Disease and Ulcerative Colitis

by NL, May 26, 2001 12:00AM


Rather than a question, this is some information that may answer several questions here. My disclaimer is that I am not a professional or doctor but mom of a Ulcerative Colitis patient and family member of Colon Cancer surviver.



NL





http://www.ccfa.org/news/previous/news1201b.htm



IBD Disguises:

Diseases That May Mimic Crohn's Disease and Ulcerative Colitis



Ulcerative colitis and Crohn's disease are inflammatory conditions of

the intestinal tract. Each of these inflammatory bowel diseases (IBD) is

characterized by certain symptoms.



On the basis of your medical history and the physical examination, the

physician embarks on a series of investigations (endoscopy with

biopsies, x-ray tests, blood and stool tests) in order to determine the

cause of your illness.



No single symptom or test result "makes" the diagnosis of IBD. For

example, bloody diarrhea occurs not only in IBD, but also in certain

types of infectious colitis.



In fact, ulcerative colitis and Crohn's disease are sufficiently rare

that most patients will turn out to have something other than IBD.



Instead, it is the combination of all the elements of the history,

physical exam and the diagnostic tests that, together, exclude other

conditions and lead to a diagnosis of IBD. For example, when seeing a

patient with bloody diarrhea, the clinician raises the question of

possible IBD, rules out other conditions that may cause bloody diarrhea,

and finally concludes that the patient most likely has IBD.



Even in a person with a well-established diagnosis of Crohn's disease or

ulcerative colitis, any aggravation of symptoms does not necessarily

imply a flare-up of IBD.



An unrelated infection, a medication-related side effect, or an attack

of underlying irritable bowel syndrome (IBS), which can co-exist with

IBD, can all mimic the symptoms of IBD.



Very frequently, the patient "knows" whether the symptoms reflect an IBD

flare or not. Careful evaluation is nevertheless necessary in order to

determine the exact cause of the symptoms and institute the appropriate

treatment.



To complicate matters, infections and medications, such as aspirin and

non-steroidal anti-inflammatory drugs (NSAIDs), can sometimes "trigger"

the onset of IBD, or expose pre-existing but silent IBD. (NSAIDs include

many common over-the-counter pain medications, such as Advil®, Motrin®,

and Alleve®.)



Not surprisingly, the overlap between IBD and other conditions can lead

to an erroneous diagnosis.



Some IBD patients are told that they suffer from other conditions,

delaying the administration of proper treatment. Still other people

receive an incorrect diagnosis of IBD and are subject to wrong and

harmful treatments, such as corticosteroids and immunosuppressants.





Mimics of Ulcerative Colitis



The cardinal symptom of ulcerative colitis is rectal bleeding.



Other symptoms include diarrhea, the passage of mucus, and abdominal

pain.



Patients with disease involving only the rectum often report urgency and

tenesmus, a sensation of incomplete evacuation of stool.



Sicker patients have lack of appetite, nausea, fever and anemia.



In ulcerative colitis, endoscopy reveals widespread inflammation, which

extends from the rectum in a continuous fashion higher up to the sigmoid

colon or left colon, and which sometimes involves the entire colon.

Biopsies (tissue samples) obtained at endoscopy (examination of the

intestine with a lighted tube) are particularly useful, as they

frequently demonstrate specific chronic changes that reflect repeated

bouts of inflammation followed by healing.



In any patient who has a sudden onset of bloody diarrhea, an infectious

cause is most likely and needs to be excluded. In cases of infectious

diarrhea, patients often have had contact with other people who have a

history of diarrheal disease.



The physician orders stool cultures to exclude such organisms as

Salmonella, Shigella, Campylobacter, and Yersinia. The clinician also

tests for Clostridium difficile, an organism that commonly, but not

always, affects people who have received antibiotics.



Enterohemorrhagic Escherichia coli (E. coli O157:H7), a strain of the E.

coli bacterium, can cause diarrhea after a person ingests contaminated

water or food.



This can be complicated by hemolytic uremic syndrome, a condition

characterized by a low platelet count, anemia due to breakdown of red

blood cells, and kidney failure.



In cases of severe colitis, your doctor must be sure to exclude amoeba

(a kind of parasite), because treatment with corticosteroids, which are

standard IBD medications, can lead to dissemination of the infection

with catastrophic consequences.



People whose immune system has been compromised, such as patients who

have received immunosuppressants after organ transplantation or people

suffering from AIDS, are prone to specific opportunistic infections of

the intestine for which appropriate tests and treatments are available.

Individuals engaging in anal intercourse are at risk for gonorrhea,

syphilis, chlamydia and other sexually transmitted infections.



Ulcerative colitis is differentiated from infectious colitis on the

basis of the microbiologic studies and the results of biopsies from the

colon. If these studies are inconclusive, time provides the ultimate

test: infectious colitis resolves, frequently without treatment, whereas

ulcerative colitis declares itself as a chronic, relapsing disease.



Drugs, particularly aspirin and NSAIDs, are other important culprits of

intestinal inflammation. Physicians are increasingly recognizing the

fact that these agents cause inflammation and ulcers, not only in the

stomach and duodenum, but also in the lower small intestine and colon.



Since patients may not volunteer any history of using these drugs, the

clinician must obtain a very detailed medication history of prescription

and over-the-counter preparations. Stopping these drugs leads to

resolution of the symptoms.



Rectal