Episode Details

The following episode is a didactic activity. Our goal is teaching family medicine residents about these diseases and prepare them to treat their patients. We hope those who are suffering from these diseases do not find this activity offensive. May you find an appropriate treatment and get better. Consult your own family medicine doctor to learn more.

Similar but different, sound-alike but opposite, analogous but heterologous. 

Welcome to the Sick Duel, an epic comparison between two merciless opponents.

Our rivals today are: Ulcerative Colitis, “I will show you how to ulcer”; and Crohn’s Disease, “I will drill your guts”.

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the GI tract. Ulcerative colitis and Crohn's disease are the main representatives of these disease. Today we will hear why they don’t get along and hopefully we’ll come to a good end.

Here we have our first guest

Arreaza: Who are you?

UC: Ulcerative Colitis is the name, and inflammation is the game. They say to save the best for last, so I tend to stick to the rectum and distal colon.  I like to come and go (no pun intended), creating episodic, mucinous diarrhea for my victims that is usually bloody.  I can be mild or severe, depending on the extent of mucosal involvement and level of inflammation.  

Arreaza: How do you manifest?

UC: I like to make my victims as uncomfortable as possible, creating urgency, pain, and constipation, while leaving them with a feeling like they aren’t “done” yet (aka tenesmus).  

Arreaza: I thought you said diarrhea, and now you mention constipation?

UC: Yes, I may cause periods of constipation when I am merciful, but diarrhea when I am cruel. Regardless of the thickness of the stools, I give them a mucinous and usually bloody discharge, sometimes leading to anemia. 

I like to attack extra intestinal organs such as the skin (causing pyoderma gangrenosum and erythema nodosum), the eyes (causing uveitis), and the joints (causing arthritis). Yes, my aunt Cronh’s can do some things right!

6. Arreaza: I’ve heard Ms Cronh’s is really mean. Where else do you go?

UC: Occasionally, I’ll make my way to the liver and cause primary sclerosing cholangitis.  My primary goal though is creating crypt abscesses and ulcerations.  If I’m lucky enough, I can progress to a fulminant, toxic level creating systemic symptoms and abdominal distention.  I hope to eventually make my way out of the GI tract through perforation (who doesn’t like a pinata?). 

Arreaza: I can see why your last name, colitis, can be deceiving, you can actually get out of the colon… Who are more likely to be your victims?

UC: I like to run in families. I prefer people who eat lots of fatty foods (Standard American Diet anyone?), high omega-6:omega-3 ratio, with history of previous bouts of gastroenteritis.  HLA autoimmune association, especially HLA-DR2. Even though smoking is a risk in many diseases, in my case, cigarette smoking may protect my victims from my attack, but if they smoked before and quit, I have a better chance to show up.

Arreaza: How do you get caught?

UC:  My victims tend to have chronic diarrhea for at least four weeks.  Because I am an inflammatory villain, many inflammatory tests can be non-specific such as ESR, fecal calprotectin/lactoferrin, etc.  Therefore, if you want me, you’re gonna have to come and get me.  Beware of your hospitalized patients, as a colonoscopy will greatly increase my ability to form a toxic megacolon and perforation!  Flexible sigmoidoscopy is recommended and will show you crypt abscesses, friable mucosa, decreased vascular markings and my continuous pattern of inflammation, yes, continuous, you gotta be consistent, unli