Crohn's and Colitis For Dummies

By Tauseef Ali and David T. Rubin

The ultimate reference for those with Crohn's and colitis and their family and friends

Crohn's disease and colitis are frustrating, often debilitating gastrointestinal diseases that can have a severe impact on the overall health of those who suffer from them. According to the latest estimates, more than 600,000 patients in North America have Crohn's disease. Written by a physician specialising in the treatment of IBDs, Crohn's and Colitis For Dummies is a complete plain-English guide to understanding, treating, and living well with these diseases.

• Helps readers actively recognize symptoms of Crohn's and colitis and explains the diagnostic procedures doctors use to identify these diseases
• Outlines how the whole body is affected by Crohn's and colitis, and the potential hazards of letting the disease go untreated
• Offers expert advice and guidance on controlling Crohn's and colitis with diet and outlines the treatment options of medicines and surgery, including the various risks and benefits of each
• Provides practical advice for parents of children with Crohn's and colitis with insights into how children's treatment options can differ from those of adults

• Language: English
• Publisher: Wiley
• Release date: May 22, 2013
• ISBN: 9781118439708

Book preview

Introduction

Millions of people suffer from inflammatory bowel disease (IBD) around the world: more than 1 million in the United States, nearly 200,000 in Canada, and approximately 2 million in Europe. The incidence of this disease is on the rise. Some recent studies suggest that more than 30,000 people are diagnosed with IBD every year in the United States alone. Crohn’s disease and ulcerative colitis, the two major types of IBD, are chronic inflammatory diseases of the intestine. They’re thought to occur because of a malfunctioning of the immune system, genetic defects, or exposure to certain environmental factors — or perhaps a combination of all three. Crohn’s disease and ulcerative colitis mostly affect younger people. There is no miracle drug to cure IBD, but many treatment options can provide relief.

About This Book

In this book, I don’t tell you everything there is to know about Crohn’s disease and ulcerative colitis. Instead, I give you the information you need in order to make the right decisions about your treatment. I’ve also made sure that the information I provide is clear and easy to understand — not a bunch of medical mumbo-jumbo. In this book, you find out what happens in Crohn’s disease and ulcerative colitis — the symptoms they can cause, how they can affect your life at home and at work, what you can do to feel good and function normally, and how you can protect yourself and your family against the long-term unpredictability of the disease. I also offer useful tips, introduce you to the members of your healthcare team, and point you in the direction of other useful resources.

There’s nothing wrong with reading this book from beginning to end, but you don’t have to do that to get the most out of this book. Instead, you can use this book as a reference, drawing on the Table of Contents and Index to locate the information you need.

Conventions Used in This Book

I don’t use many special conventions throughout this book, but I do use a few that you should be aware of:

check.png When I mention a drug, I list the generic name first, followed by the brand name(s) in parentheses.

check.png When I refer to Crohn’s disease, sometimes I just call it Crohn’s. And when I refer to ulcerative colitis, sometimes I just call it colitis. Anytime I refer just to colitis, know that I’m talking about ulcerative colitis. (Other types of colitis exist; see Chapter 2 for more information.)

check.png When I introduce a new term, I use italics and define the term shortly thereafter, often in parentheses.

check.png All web addresses appear in monofont.

Note: When this book was printed, some web addresses may have needed to break across two lines of text. If that happened, rest assured that we haven’t put in any extra characters (such as hyphens) to indicate the break. So, when using one of these web addresses, just type in exactly what you see in this book, pretending as though the line break doesn’t exist.

What You’re Not to Read

You can skip two types of text without missing crucial information:

check.png Sidebars: These shaded gray boxes include information that may interest you but isn’t critical to your understanding of the subject at hand.

check.png Anything marked by the Technical Stuff icon: For more information on the Technical Stuff icon, see "Icons Used in This Book," later in this Introduction.

Foolish Assumptions

Every book is written with a specific audience in mind, and this one is no different. As I wrote this book, I made some basic assumptions about who you are. One or more of the following likely applies to you:

check.png You have Crohn’s or colitis, think that you may have it, or have a friend or family member who has it.

check.png You want information that can help you or a loved one manage Crohn’s or colitis more effectively.

check.png You want information on the latest treatment for Crohn’s or colitis.

check.png You want to work with your doctor to obtain the best possible care — and, yes, you sort of want to impress her with your knowledge.

check.png You want to take charge of your own body.

check.png You like books with black-and-yellow covers.

How This Book Is Organized

I’ve divided this book into six parts, so you can skip directly to the ones that pique your interest. Here’s a brief overview of each part.

Part I: The Who, What, and Why of Crohn’s and Colitis

Your doctor may have delivered the news that you or a loved one has Crohn’s or colitis. Or maybe he said you might have this disease or probably have this disease. You may be wondering and trying to figure out what it means to you and your loved ones. This part gives you the big picture. Chapter 1 describes how this illness can affect your daily living and how to cope and live with this disease. Chapter 2 gives you the details about Crohn’s and colitis, defining and explaining various signs and symptoms, as well as organ systems involved with the diseases. Chapter 3 takes you on a tour of the wonderful and amazing human digestive system and introduces you to the different parts of your digestive organs. Chapter 4 sheds light on how and why people get Crohn’s or colitis, explaining various factors such as diet, environment, genes, and the immune system and their roles in causing Crohn’s and colitis.

Part II: Getting Medical Help

Developing a long-lasting relationship with your doctor is critical in dealing with Crohn’s or colitis. In Chapter 5, I help you find the right doctor and assemble your healthcare team to manage your Crohn’s and colitis. I also guide you on what questions to ask your doctor and how to manage your health records and keep them straight for your and your doctor’s ease. In Chapter 6, I explain the different tests and investigations that are commonly performed to diagnose Crohn’s and colitis. Chapter 7 covers the different medications used to treat these diseases, how they work, and their common side effects. When medications fail to control the disease, surgery is the next step; Chapter 8 describes various surgeries, when they may be right for you, and potential complications they bring.

Part III: Healing and Dealing with the Disease

In this part, I aim to give you power over your Crohn’s and colitis. Chapter 9 covers nutrition, which plays an important part in your well-being. Although Crohn’s and colitis put you at risk for malnutrition, deficiency of nutrients can also adversely affect your immune system and healing process. I fill you in on the importance of nutrients and provide details about their functions, how to get them, and their importance in the management of Crohn’s and colitis.

Prevention is better than cure, and in Chapter 10 I discuss important preventive steps that are important to keep you healthy as a person with Crohn’s or colitis. I also talk about vaccinations, bone scans, and skin care in this chapter.

Chapter 11 deals with alternative and complementary therapies, including the role of different herbs in treating these diseases. I also tell you about worm therapy, the latest hype in the management of Crohn’s and colitis.

Part IV: Living and Coping with Crohn’s and Colitis

Having Crohn’s or colitis can make you feel isolated, embarrassed, and afraid. It can greatly affect how you interact with your family, your co-workers, your friends, and the world at large. Chapter 12 helps you face the diagnosis and live a happy life, despite your disease. Chapter 13 describes different triggers that you can avoid to prevent flares. Chapter 14 offers tips and techniques for working and traveling with Crohn’s or colitis.

Part V: Considering Special Populations with Crohn’s and Colitis

In Chapter 15, I describe various issues related to kids and teens who’ve been diagnosed with Crohn’s or colitis. I also provide tips for surviving school and college — at least when it comes to these diseases. (I can’t offer any advice on getting a date to the prom or making it to that 8 a.m. class.)

Getting pregnant with Crohn’s and colitis is an important issue, and I devote Chapter 16 to this topic. In this chapter, I also fill you in on which Crohn’s and colitis drugs are safe to take during pregnancy and while breastfeeding.

Part VI: The Part of Tens

Could there be a For Dummies book without a Part of Tens? Not a chance. In this part, I give you some pearls of wisdom — they’re small, but worth a fortune. In Chapter 17, I fill you in on ten myths about Crohn’s and colitis and give you a better and more accurate picture of the facts. In Chapter 18, I tell you about ten great resources for more information about Crohn’s and colitis.

Icons Used in This Book

Icons are a handy For Dummies way to catch your attention as you slide your eyes down the page. They can help you pick out the key ideas and points of information throughout the book. The icons come in several varieties, each with its own special meaning:

remember.eps The Remember icon marks information you’ll want to, well, remember.

technicalstuff.eps When my inner geek comes out, I mark the information with the Technical Stuff icon. Text marked with this icon provides information that’s interesting but not critical to your understanding of the topic at hand.

tip.eps The Tip icon marks time-saving and stress-saving information that you can use to improve your life when you have Crohn’s or colitis.

warning_bomb.eps The Warning icon alerts you to some pitfalls. I save this icon for critical issues, material important enough that could bring harm your way if you don’t heed it.

Where to Go from Here

You can dive in anywhere that interests you and get valuable information. Use the Table of Contents and Index to find the information you need. If you aren’t sure where to start, you can’t go wrong with Part I.

No matter where you choose to begin, begin now! In your hands, you hold the information you need to live well with Crohn’s and colitis.

Part I

The Who, What, and Why of Crohn’s and Colitis

9781118439593 pp0101

In this part . . .

When you’re new to Crohn’s and colitis — either your own diagnosis or the diagnosis of a loved one — you may be overwhelmed. Your head is spinning with questions. And this part is for you. Here you find out what Crohn’s and colitis are, how your digestive system works, and who gets these diseases and why.

Chapter 1

Crohn’s and Colitis One Step at a Time

In This Chapter

arrow Finding out about Crohn’s disease and ulcerative colitis

arrow Reviewing the treatment options

arrow Taking control of your quality of life

arrow Living a full life with Crohn’s and colitis

arrow Looking at issues specific to pregnancy and kids

Knowing your disease is key to your quality of life. Knowledge is power! While I was writing this book, I thought about the questions I hear most often from my patients and their family members. I answered those questions just as I do for my patients. This chapter is an overview of the book as a whole — it gives you a taste of what I elaborate on in the chapters that follow.

Knowing Crohn’s and Colitis

Crohn’s and colitis are chronic inflammatory diseases of the intestines. Together, these illnesses are also known as inflammatory bowel disease. So, what exactly are Crohn’s and colitis?

When you get a cut to your skin, it hurts, bleeds, swells, and eventually forms a scar. Similarly, Crohn’s and colitis cause cuts inside your intestinal wall; these cuts are called ulcers. Pain, bleeding, and swelling occur with ulcers, too — they just happen inside your intestinal wall where you can’t see them. Eventually, scars form (just as you might have a scar from a bad cut on your skin), leading to the formation of strictures (abnormal narrowing) and causing obstruction. This happens more frequently in Crohn’s disease and rarely in ulcerative colitis. In Chapter 2, I offer even more information on what Crohn’s and colitis are.

The signs and symptoms of Crohn’s and colitis (also covered in Chapter 2) depend on the part of the intestines involved:

check.png Crohn’s disease: Crohn’s disease most commonly involves the last part of the small intestine and the beginning of the large intestine. The common symptoms of Crohn’s disease are abdominal pain, especially on the right lower side of the abdomen, diarrhea, and weight loss.

check.png Colitis: Colitis can involve the whole large intestine or a part of it. The process of inflammation usually starts in the rectum and moves upward to involve other parts of the colon. Bloody diarrhea is a common symptom of colitis. Urgency (the sudden feeling of needing to have a bowel movement) and tenesmus (the feeling of incomplete relief after the bowel movement) are also common symptoms and are caused by the inflammation of the rectum, also known as proctitis.

In both diseases, the process of inflammation can also cause fever, loss of appetite, weight loss, night sweats, and fatigue. Your nutritional status is usually compromised and if you don’t pay attention to your diet and calorie intake, you can easily become malnourished.

If it’s been a while since you took a biology class and you need a refresher course on the digestive system, check out Chapter 3.

Who gets Crohn’s and colitis? We still don’t have the exact answer to this question. Scientists believe that different factors may play a role in causing these illnesses — including malfunctioning of the immune system, genetic defects, or exposure to certain environmental factors. For more information on who gets Crohn’s and colitis, turn to Chapter 4.

Getting the Treatment You Need

The first part of getting treated for Crohn’s disease is assembling your healthcare team. Crohn’s and colitis are lifelong diseases, so you want to choose a doctor you can trust and with whom you can develop a long-term relationship. You also need to be familiar with other key players of your healthcare team, such as nurses, nutritionists, psychiatrists, and surgeons. For more information on assembling your team, turn to Chapter 5.

When it comes to getting diagnosed with Crohn’s or colitis, most of the time it’s symptoms of diarrhea, abdominal pain, and blood in stools that prompts people to go to the doctor’s office. Your doctor will run a battery of tests to rule out (or rule in) the diagnosis of Crohn’s or colitis. These tests may include blood tests, stool tests, endoscopic exams, and radiology tests. The different tests used to confirm the diagnosis of Crohn’s or colitis are covered in Chapter 6.

There is no cure for Crohn’s or colitis, but medications work in the majority of patients. Many drugs are available for the treatment of these diseases. The drugs help to control symptoms and bring the disease under control. You’ll have to take these medications long term (until your doctor changes your prescription or you require surgery). For more information on the various medications used to treat Crohn’s and colitis, turn to Chapter 7.

In some patients, medications may stop working or patients may be unable to tolerate the medications because of side effects. In these cases, your doctor will talk to you about surgery. Colitis is cured after surgery, but Crohn’s disease comes back even after surgery and may require further medications or surgeries. For more on the surgical options for treating Crohn’s and colitis, check out Chapter 8.

Recognizing That You’re Not Powerless

Some people with chronic conditions like Crohn’s or colitis get discouraged — you don’t want to have to cope with a disease that has the potential to disrupt your life and cause pain. But the good news is, you can take all kinds of steps to improve your quality of life when you have Crohn’s or colitis.

A key part of your health as a person who has Crohn’s or colitis is your diet. Eating a well-balanced diet and avoiding trigger foods are very important steps when it comes to managing these illnesses. Good nutrition is important for your immune system and your body’s ability to heal from the inflammation. Nutrition is also important for kids and pregnant women suffering from Crohn’s and colitis because they have increasingly higher demands for calories and because malnutrition can really affect growth and worsen the process of inflammation. On the other hand, your body may not be able to handle sugar, high-fiber foods, and fatty foods, especially during periods of active disease, and you may want to avoid them. For more information on the role diet has in Crohn’s and colitis, check out Chapter 9.

Crohn’s and colitis can affect your whole body, not just your digestive system. For example, you may be more prone to a variety of skin conditions, including skin cancer. In addition, Crohn’s and colitis can impact the balance of calcium and vitamin D in your body, which can lead to osteoporosis or osteopenia (a precursor to osteoporosis). For more information on whole-body health for people with Crohn’s and colitis, turn to Chapter 10.

When you have Crohn’s or colitis, you don’t have to rely solely on conventional medicine. You can try a variety of alternative and complementary therapies, from exercise and physical therapy to herbal therapy and homeopathy to traditional Chinese medicine and more. Chapter 11 has the lowdown on a variety of options that may improve your quality of life.

Living a Full Life with the Disease

When you first get diagnosed with Crohn’s or colitis, handling the diagnosis is a challenge. Then you have to figure out a way to talk about it to your family and friends — because they’ll be affected by your diagnosis, too (after all, you’re a big part of their lives). In Chapter 12, I offer advice on these subjects and more, including planning for the holidays. Chapter 12 is also for you if you’re not the one with Crohn’s or colitis, but your family member or friend has the disease.

Part of living and coping with Crohn’s and colitis is figuring out how to avoid triggers that cause flares. Common triggers include different drugs or foods, smoking, stress, and lack of sleep. Chapter 13 is all about how to reduce triggers in your life so you can focus on what you’d rather be doing — living!

Work and travel are two big parts of life for many people, and when you have Crohn’s or colitis, you need to know how to manage your disease while you do one or both. You may need to talk about your diagnosis with your employer — something that can cause stress in and of itself, depending on your relationship with your boss and how secure you feel in your job. And anxiety can increase if you’re on the road and find yourself needing a bathroom fast. Chapter 14 covers work and travel, offering useful tips for doing both when you have Crohn’s or colitis.

Special Advice for Pregnant Women and Kids

Twenty-five percent of Crohn’s and colitis patients are under the age of 20, and the number of kids suffering from these diseases is increasing. The goal for treating kids is all about controlling symptoms while causing minimal disruption to their lives, from school to sports to hanging out with friends. In Chapter 15, I offer advice to parents of kids with Crohn’s and colitis.

Finally, if you have Crohn’s or colitis and you want to get pregnant (or don’t want to get pregnant), Chapter 16 is for you. There, I discuss everything from libido and sex to fertility. I also fill you in on the impact of your disease on the life of your baby.

Chapter 2

Defining Crohn’s and Colitis

In This Chapter

arrow Getting clear on Crohn’s and colitis

arrow Identifying the symptoms of Crohn’s and colitis

arrow Exploring the other organs involved in Crohn’s and colitis

arrow Taking a peek at the complications

You’ve heard of Crohn’s and colitis — maybe you’ve even been diagnosed with one of these diseases — but you may not know exactly what they are. If so, you’ve come to the right place. In this chapter, I explain what Crohn’s and colitis are and introduce you to inflammatory bowel disease (IBD) in general. I fill you in on the symptoms of Crohn’s and colitis and tell you which organs in the body can be affected by these diseases. Finally, I explain the complications that can occur because of Crohn’s and colitis — from intestinal complications to nutritional complications to cancer.

Information is power, and the information you find in this chapter will empower you to talk with your doctor about your condition and get the best possible treatment so you can live a long, happy, and healthy life.

What Crohn’s and Colitis Are

Crohn’s disease and ulcerative colitis are closely related to each other — I usually call them cousins because they have a lot in common. But recognizing these diseases as two separate entities is important, because their symptoms and treatments could be different.

Looking at the big picture: Inflammatory bowel disease

Inflammatory bowel disease is a chronic inflammation of the gastrointestinal tract, usually involving the small and large intestines (see Figure 2-1). Doctors still aren’t sure what causes IBD, but various factors — from defects in the immune system to genetic abnormalities to environmental factors — are thought to play a role.

9781118439593-fg0201.eps

Illustration by Kathryn Born

Figure 2-1: The small intestine and large intestine.

technicalstuff.eps IBD is actually a group of conditions. The two main types of IBD are Crohn’s disease and ulcerative colitis, but other conditions also fall under the IBD umbrella, including microscopic colitis (which includes collagenous colitis and lymphocytic colitis) and indeterminate colitis.

remember.eps Throughout this book, when I refer to colitis, I’m talking about ulcerative colitis. If I’m referring to another type of colitis, I use the more specific term.

Zeroing in on Crohn’s and colitis

Crohn’s and colitis are the two main types of IBD. In this section, I define these two conditions and explain how they differ from each other. First, though, you need just a little info on the intestinal tract.

The intestinal tract is made up of several layers, one on top of the other, kind of like an onion (see Figure 2-2). The innermost layer of the intestinal tract, called the mucosa, helps in the absorption of food and secretes digestive enzymes. This layer is wrapped in another layer, called the submucosa, followed by a layer of muscle, called muscularis. The outermost layer is called the serosa.

9781118439593-fg0202.eps

Illustration by Kathryn Born

Figure 2-2: The layers of the intestinal tract.

Defining Crohn’s disease

In Crohn’s disease, the inflammation begins in the mucosa but can eventually involve all the layers of the intestine (refer to Figure 2-2). In medical terminology, this inflammation is called transmural inflammation. Crohn’s disease can involve any part of the gastrointestinal tract, from the mouth to the anus. However, the most common site of inflammation is the last part of the small intestine (the terminal ileum) along with the large intestine.

technicalstuff.eps You may hear your doctor call Crohn’s disease by other names, including the following:

check.png Crohn’s colitis

check.png Crohn’s disease of the colon

check.png Granulomatous enteritis

check.png Ileitis

check.png Ileocolitis

check.png Regional enteritis

check.png Regional ileitis

check.png Terminal ileitis

Defining colitis

In ulcerative colitis, the inflammation is mostly confined to the mucosa (refer to Figure 2-2). In severe cases of colitis, the inflammation can sometimes trickle down to other layers. The inflammation usually starts in the rectum (the last part of the intestines) and may spread throughout the colon.

technicalstuff.eps You may hear your doctor call ulcerative colitis by a number of other names:

check.png Colitis ulcerosa

check.png Idiopathic proctocolitis

check.png Idiopathic ulcerative colitis

check.png Nonspecific ulcerative colitis

technicalstuff.eps There are other forms of colitis, but the one I talk about in this book is ulcerative colitis. Here’s a brief rundown of the other types of colitis:

check.png Infectious colitis: Inflammation of the colon due to an infection, such as virus or bacteria

check.png Ischemic colitis: Inflammation of the colon that occurs when the intestines don’t get enough blood, such as with extremely low blood pressure and shock

check.png Neutropenic colitis: Inflammation of the colon that happens in cancer patients undergoing chemotherapy

check.png Radiation colitis: Inflammation of the colon caused by radiation therapy in cancer patients

technicalstuff.eps When patients are first diagnosed with ulcerative colitis, approximately 45 percent of them have a form of the disease limited to the rectum and sigmoid (the last part of the colon), 35 percent have the disease extending beyond the sigmoid but not involving the entire colon, and 20 percent have involvement of the entire colon.

In some patients, the inner lining of the last few inches of the ileum becomes mildly inflamed. This is called backwash ileitis. Doctors don’t know the exact cause of this phenomenon yet.

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The history of Crohn’s disease

Medical historians suggest that Crohn’s disease was first described as early as the 9th century a.d. Alfred the Great (849–899 a.d.) suffered from a painful illness for much of his life. Records described his illness as abdominal pain, discomfort, diarrhea, and rectal problems beginning at the age of 20. Now we know that this was probably Crohn’s disease. In 1913, Sir Kennedy Dalziel published an article in the British Medical Journal describing patients having transmural inflammation of the small and large intestines, a characteristic finding of Crohn’s disease.

In 1932, Dr. Burrill Bernard Crohn and his two colleagues, Dr. Leon Ginzburg and Dr. Gordon Oppenheimer, published an important paper describing similar conditions in 14 patients; they called it terminal ileitis. This paper was presented to a large medical audience in New York and, as a result, was given a large amount of recognition and publicity. Because Crohn was the first author on the paper, the disease was subsequently called Crohn’s disease.

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Seeing how Crohn’s and colitis are different

Crohn’s disease and ulcerative colitis, the two major types of IBD, can be treated very differently. However, the two diseases also share many common symptoms, and sometimes it’s hard to distinguish the two types, especially in the early years. It’s estimated that approximately 9 percent of patients initially diagnosed with one of these diseases has a change in diagnosis within two years.

Sometimes even experienced physicians have difficulty differentiating these two types of IBD. The term indeterminate colitis has been coined to describe such cases.

Location of the disease

Crohn’s disease can affect any part of the digestive tract, from the mouth to the anus; most commonly, it occurs in the last section of the small intestine and the beginning of the colon. Colitis affects only the colon. See Figure 2-3 for an illustration of where these two diseases occur.

technicalstuff.eps The terminal ileum is the last part of the small intestine. This part may show some mild inflammation in ulcerative colitis. This condition is referred to as backwash ileitis.

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The history of colitis

Ulcerative colitis is even older than Crohn’s disease. The first description of ulcerative colitis dates back to ancient Greece. Many physicians from this period, including Hippocrates (ca. 460–377 b.c.), described a condition of chronic diarrhea associated with blood and ulceration of the large intestines. In the late 1600s, Thomas Sydenham (1624–1689) coined the term bloody flux to describe this type of diarrheal disease. Historians have speculated that Bonnie Prince Charles, The Young Pretender (1720–1788), suffered from ulcerative colitis and cured himself by adopting a milk-free diet in 1745. Sir Samuel Wilks (1824–1911) described ulcerative colitis as a specific disease for the first time in 1859 and recognized it as distinct from the then more common infectious diarrhea. In 1909, around 300 cases of ulcerative colitis were collected from various London hospitals and presented at a symposium of the Royal Society of Medicine.

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9781118439593-fg0203.eps

Illustration by Kathryn Born

Figure 2-3: The location of Crohn’s disease and ulcerative colitis in the gut.

Pattern of inflammation

Crohn’s disease is a patchy one; it can involve different segments of the intestines at the same time, and the segment of the intestine between the two diseased areas may appear normal. Colitis, on the other hand, tends to be continuous; it begins in the rectum and spreads up through the colon.

In Crohn’s disease, the entire wall of the intestine can get inflamed. The term transmural inflammation often is used to describe the type of inflammation in Crohn’s disease. Because of this involvement of multiple layers of the intestinal wall, patients are more prone to deep ulceration, perforation, and stricture and fistula formation. On the other hand, only the innermost lining of the intestinal wall is involved in the majority of colitis patients; this type of inflammation is called mucosal inflammation.

Appearance of the intestine

During a colonoscopy, the physician can view the mucosa of the colon and the terminal ileum. In Crohn’s disease, the mucosa shows deep ulcers and may show areas that appear normal.

In colitis, the mucosa shows continuous inflammation, characterized by redness and superficial ulcers in the mucosa. There are no patches of healthy tissue in the diseased section.

The effect of smoking

In Crohn’s disease, smoking makes the disease worse and increases the risk of flares and surgery. Studies also have shown that the outcomes of surgery are poorer in smokers and that Crohn’s disease recurs early in patients who smoke.

For some unclear (and surprising) reasons, smoking has a protective effect in colitis. Therefore, colitis is sometimes called a disease of nonsmokers.

warning_bomb.eps Even though smoking has a protective effect in colitis, smoking is not recommended because of its other significant