A/Prof David van der Poorten
Dr Roslyn Vongsuvanh
  Prof Golo Ahlenstiel
Dr Way Siow

Appointments & Enquiries:  (02) 8711 0160

Ulcerative Colitis and Crohn’s disease

ulcerative colitis symptoms

ulcerative colitis

 

Inflammatory bowel disease refers to a two main diseases, Ulcerative colitis and Crohn’s disease that cause inflammation of the bowel.

 

Ulcerative colitis causes inflammation of only the inner lining of the large bowel (colon and rectum). When only the rectum is involved it is sometimes called proctitis. When the entire colon is involved it is sometimes called pan-colitis.

 

Crohn’s disease causes inflammation of the full thickness of the bowel wall and may involve any part of the digestive tract from the mouth to the anus (back passage). Most frequently the ileum, which is the last part of the small bowel, the large bowel (or colon) or both are involved. These patterns of disease location are referred to as ileitis, colitis and ileo-colitis respectively.

 

Despite a lot of research the exact cause of ulcerative colitis and crohn’s disease remain unknown. In both cases damage occurs to the bowel due to inflammation that is driven by a dysfunctional and overactive immune system. Treatments are therefore targeted at reducing inflammation and dampening down the immune system.

 

Specialised Services Provided

    • Accurate diagnosis of Ulcerative Colitis and Crohn’s disease using high definition endoscopy/colonoscopy, blood tests and biopsy
    • Capsule endoscopy to investigate for Small Bowel Crohn’s where appropriate
    • Use of TNF antagonist biological drugs such as Infliximab (Remicade) or Adalimumab (Humira) in patients with severe disease
    • Access to mycophenolate and other specialized therapies where standard medications are ineffective or not tolerated
    • Attention to disease control and patient quality of life as the highest priority

 

Quick Case Studies:

 

Case 1.

A male in his 20's old presented with a 2 month history of sharp lower abdominal pain and a CT scan showing 60cm of thickening in the terminal ileum. Colonoscopy showed scattered deep ulcers throughout the large bowel and intense inflammation, scarring and stricturing of the terminal ielum. Biopsies and results and serology tests confirmed Crohn's disease. I commenced himon a course of prednsisone (corticosteroid), regular mesalazine and the immunomodulator drug azathioprine. Azathioprine metabolism was normal based on the TPMT blood test so he was given 150mg. Within a few weeks his pain had reduced and prednsione was weaned off after 3 months. By the time Colonoscopy was repeated 5 months later there was complete healing of all the ulcers in the large bowel, with ongoing milder inflammation in the terminal ileum (small bowel). One year later, still on the regular azathiprine and mesalazine, he had a flare and azathiorpine was increased to 175mg. Symptoms settled and monitoring blood tests remained stable. One year further on a Colonoscopy showed ongoing active inflammation in the terminal ileum despite himbeing largely asymptomatic. Azathioprine metabolites were checked showing room to increase medication, so he was put onto 200mg. He remains in clinical remission and currently has no symptoms related to his Crohn's disease.

 

NS 1 Case 1 - after treatment

Case 1 - before and after treatment.

 

Case 2.

A female in her 30's presented with a 2 year history of Crohn's disease effecting th rectum and right side of the large bowel. She had ongoing symptoms of diarrhoea with blood and mucous despite having multiple previous therapies with another doctor, including prednisone, mercaptopurine, mesalazine, methotrexate and salazopyrin. Suppositories and enemas had also not worked. She had an associated seronegative arthritis effecting her large joints that was likely to be related to her Crohn's disease. I performed a Colonoscopy which showed active disease in the left colon (see pic 1) and commenced her on Humira (Adalimumab) after obtaining S100 authority from the PBS. Her diarrhoea settled within a month or two of commencing humira and repeat Colonoscopy 12 months later showed complete remission with mucosal healing and no signs of inflammation on biopsy. I treated her with humira for a total of two years and then left her on oral mesalazine alone. 12 months after ceasing the Humira she remains in a complete remission.

 

LB1  LB3

 Case 2: active disease followed by remission.