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Crohn’s and Ulcerative Colitis: Better Diagnostics, Better Treatments

December 05, 2021

Crohn’s disease and ulcerative colitis affect 3 million people in the United States. In Connecticut, there are about 40,000 people who live with one of these two conditions. Dr. Joseph Cappa, a gastroenterologist at Hartford Hospital, said that both Crohn’s and ulcerative colitis are autoimmune conditions that fall under the umbrella of Inflammatory Bowel Disease. Both can be debilitating, and have dramatic negative effects on patients. Symptoms include abdominal pain, weight loss, diarrhea, rectal bleeding and fatigue. With 40,000 patients in the state, that makes the condition fairly common, he added. Cappa said a definitive diagnosis can sometimes be difficult, and there are a gamut of strategies doctors can employ, including:

  • Blood tests to check for anemia or signs of infection from bacteria, toxins or viruses.
  • Stool studies to test for hidden (occult) blood or infectious organisms, such as bacteria, toxins and parasites, in your stool. Stool tests can also be used to determine if an inflammatory or infectious process is occurring as opposed to symptoms of irritable bowel syndrome. The symptoms of IBD and IBS can overlap. It is important to make this distinction before instituting directed therapy.
  • Colonoscopy, which allows your doctor to view your entire colon using a thin, flexible, lighted tube with a camera at the end. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. A biopsy is the way to make the diagnosis of IBD versus other explanations for the symptoms.
  • Upper endoscopy, in which your doctor uses a slender, flexible, lighted tube to examine the esophagus, stomach and first part of the small intestine (duodenum).
  • Capsule endoscopy, in which you swallow a capsule that has a camera in it. The images are transmitted to a recorder you wear on your belt, after which the capsule exits your body painlessly in your stool.
  • MRI and CT Scan can be used to visualize the GI tract as well.
Once the diagnosis is confirmed, Cappa said medication reduces the inflammation in the digestive tract, providing relief. Anti-inflammatories include corticosteroids and aminosalicylates. Immune system modulators, biologics and even newer small molecules can also be prescribed. Sometimes, surgery is necessary as well. Making the appropriate diagnosis to distinguish inflammatory bowel disease from irritable bowel syndrome or an infectious process is important to direct the right treatment. Patient’s lives can be greatly affected by any of the GI disorders, Capp said. “The goal is to have these patients regain their quality of life,” Cappa said. “We have made tremendous strides and gains over the last few years and through active clinical research there are many more to come in the near future.”