Spectrum of Inflammatory Bowel Disease

The spectrum of inflammatory bowel disease results in major differences with respect to quality of life among patients with ulcerative colitis compared to those with Crohn's disease. In ulcerative colitis, only the colon and rectum is involved, the sphincters are spared and there is no small-bowel involvement. Although many of these patients present with acute fulminating colitis requiring an emergency colecto-my, a high proportion of these patients can today be reassured that the stoma might be temporary and that there is an 80-95% chance of full continence, albeit with some diarrhoea after colorectal excision and pouch construction. There is of course a risk of malignancy and there is the risk that conventional surgery may be associated with complications resulting in a permanent stoma.

At the other end of the spectrum is Crohn's disease, which may affect any part of the gastrointestinal tract. The anal sphincters are commonly affected. There is a high risk of incontinence and repeated operations for recurrence. There is particularly a high risk of unavoidable complications: abscess, obstruction and fistula. Surgical treatment rarely cures Crohn's disease and there is constant worry about relapse requiring medication with potential serious side effects.

Between these two extremes is indeterminate colitis. Most cases of indeterminate colitis present as acute colitis and eventually turn out to behave more like ulcerative colitis than Crohn's disease. However, some cases of indeterminate colitis will, over time, develop the manifestations of Crohn's disease associated with all the co-morbidity of Crohn's disease and its negative impact on the quality of life.

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