- Hey everyone, welcome back to my channel.
I'm Hannah and this week it
is Crohn's and Colitis Awareness Week
and I have ulcerative colitis,
but what the hell is the difference
between Crohn's and colitis?
They are both forms of inflammatory bowel disease,
so obviously there are some similarities,
but there are also some differences.
So what are they?
In the UK, ulcerative colitis affects
about one in every 420 people
and Crohn's Disease affects about one
in every 650 people.
It's highly likely that you know someone
or have met someone, a friend, relative,
colleague, someone you went to school with,
who have some form of IBD.
In the UK, as well as specialist consultants
who will be able to diagnose and treat you,
there are also specialist IBD nurses
who are brilliant.
As someone with IBD, your IBD nurse is usually
your point of contact at the hospital.
There is usually an advice line, a phone number,
or an email where you can directly talk to them.
So if you have any questions
or are experiencing any symptoms
or are in a flare and you need
to talk to someone at the hospital,
they are there and can talk you through things,
get you in for an appointment sooner if necessary,
and just generally help you out.
They are really knowledgeable
and just brilliant at talking to patients
and supporting them through everything.
The charity, Crohn's and Colitis UK,
kindly set me up with IBD nurse Fiona
and she came 'round and we did some filming
all about the differences between Crohn's and colitis.
So I'm joined by Fiona.
- So hi, I'm Fiona and I'm an IBD nurse
from St. George's Hospital in South London.
- Thanks so much for--
- It's my pleasure.
- Coming here and sharing your wisdom and knowledge.
First off, what is Crohn's?
What is colitis?
- So ulcerative colitis is an inflammatory bowel disease
that affects the large bowel, the colon,
from the rectum all the way 'round your large bowel.
Crohn's Disease is an inflammatory bowel disease
that can affect anywhere from the mouth to the anus.
IBD nurses play a pivotal role in the patient's pathway.
I run clinics face to face, telephoning clinics,
and we run an IBD advice line.
So as an IBD nurse, we can help support
and talk you through your diagnosis,
particularly if it's a new diagnosis,
but anywhere throughout your patient journey.
We get more time than the doctors to chat to you in clinic
and also we'll pop up and see you in the ward
if you're unfortunate enough to be an inpatient
just to give you that time and support.
- Yeah, being able to, like, call my IBD nurse
has been just so useful over the years.
- Yeah, definitely. - Just like knowing
that you have that point of contact
in a hospital rather than be,
like, now I have to make an appointment
at my GP and then, like, be referred again.
Like, you know, you already have that direct line.
So we're gonna play a little game (chuckles).
What's the difference between Crohn's and colitis
and we're gonna go through different things
about the disease, the symptoms,
and different treatments that are available.
And I've created (laughs).
- I wanted to make sure. - These paddles.
It's a game show.
So the first section is what actually is the disease?
What is going on?
So it's a chronic, life-long condition.
(bell dings)
Both!
Yay!
I mean, it's not like great news.
- (laughs) Not great news at all.
It's life-long.
There is no cure,
but it doesn't, it,
you know, you should be able to lead
your full potential in life.
- My second point was it occurs in remission and flares.
(bell dings) Yeah.
That basically means that sometimes
you might be having symptoms
and then other times you're not at all.
So next thing is, it's the result of inflammation.
(bell dings)
(chuckles) Both of them. - Yes, yeah.
- So what is inflammation,
but then also there is a slight difference
in how it occurs in both of these.
- Yeah.
So both are autoimmune diseases
that your immune system has just gone a bit wonky.
It's berserk. It doesn't know how to turn itself off
so it's gone into overdrive
and creates inflammation
and the more inflammation that there is,
it's just kind of a vicious circle.
The inflammation that you see in colitis
is usually starts, or always starts,
in the rectum and then it's continuous
as it works up the colon.
So it's in your, I need a sort of picture here I feel.
But it's in your colon
and then works around the U-bend
which is called the Sigmoid.
- Ahh, okay.
So that's why it's called a flexible Sigmoidoscopy.
- Yeah. - Okay.
- So that's sort of looking
at the left hand side of your bowel.
So rectum, around the corner through the Sigmoid,
and then up your descending colon.
So that's what they term if it's just
what you may have heard a term, proctitis.
- Yes.
- So that is disease, ulcerative colitis, in your rectum.
- So I currently have proctitis
because I have my rectum remaining.
- You have the rectum. - Yeah.
So you've got active disease in your rectum?
- Mm hmm, yeah.
- So that's proctitis.
- I'm like, as if I'm proud of that.
Like, mm hmm, yeah.
I have active disease in my rectum (laughs).
- (laughs) Joy.
- Yeah.
- So if you still had your colon,
passed the rectum is the Sigmoid
so that's proctosigmoiditis if you had disease
in those two areas.
If then it extends up the descending colon,
up the, it's descending because it's coming out.
(laughing)
Up that way.
That's left sided disease.
You might hear that term bandied about in clinics.
Left sided disease or proximal disease
you might also hear it called.
If it keeps extending, the inflammation,
it will cross the transverse colon.
If it gets to that extent
it's termed extensive colitis
or pan-colitis.
- I have pan-colitis.
I recognise that term.
Yeah, that's what it was called for me.
- So you can get inflammation all the way
through your colon and that's extensive colitis.
But that's where it stops with colitis.
With Crohn's you can get inflammation anywhere
from your mouth to your bum,
but it's not continuous in its course.
So you could have proctitis in Crohn's
but then you could have a healthy colon
and just have a patch in your terminal ileum
which is the sort of joint to the small bowel
and then you could have patches throughout your small bowel,
could have a patch in your mouth,
patch in your oesophagus.
- Does it affect the stomach?
- Yeah, it can. - Oh okay.
- Anywhere in your GI tract from your mouth to your bum.
- Ah, yeah.
And then, and like you said, it's not continuous,
so it can be, like, healthy bit
and then. - Yeah.
- Inflamed bit.
Da, da, da, da. - Yeah.
- But in colitis you can't,
even if it is just in the large bowel,
you couldn't have, like, your rectum has some
and then a bit up here has some.
- No, it's always continuous. - Okay.
- And extending.
So it extends from the rectum
and always continuous inflammation.
- It creates ulcers.
(bell dings)
- Yeah, yeah. (laughing)
They do. - Yeah.
So I didn't realise
that this was also relevant to Crohn's
because, obviously, colitis is called ulcerative colitis
so it's in the name.
- So it forms ulcers in your colon
is what ulcerative colitis is doing.
The difference is is that ulcerative colitis
only affects the inner wall in the lining of your colon
whereas Crohn's Disease affects
all the linings of your bowel.
It's called transmural.
If you get colitis that causes ulcers
those ulcers will form in the inner lining of the bowel.
They're horrible.
They can be quite deep ulcers
and they're prone to bleeding
which is why you would get bloody diarrhoea.
In Crohn's it's also ulcer forming,
but it can, if it penetrates the bowel
then it can cause a hole, cause a fistula.
Lots of sort of complications.
You can get abcess formation.
- Inside?
- Inside. - Oh okay.
- There's a small section of people
where actually it's difficult to tell what you've got.
So the way they would do it
is do a colonoscopy and take some biopsies
and under the microscope they can differentiate
between what's Crohn's and what's ulcerative colitis.
- Oh okay.
- Which is then easier to treat your disease.
- And we will get onto treatment in a bit,
but first symptoms.
Symptoms, symptoms, symptoms.
This is the best part.
Diarrhoea.
(bell dings) (laughing)
Yeah. - Yeah.
Not always with Crohn's disease.
- I guess it depends where it is.
Yeah. - Yeah.
But I would say ...
- Colitis.
- Yeah. - 100%.
Blood and mucus in stools.
(bell dings) - Both,
but I would predominantly,
I have I got it the right way 'round?
- Yes.
- Predominantly ulcerative colitis
you'll get bloody stool.
- Increased frequency and urgency
to go to the toilet.
(bell dings)
- So both.
I don't want to get this wrong,
but I think I would probably say slightly more in colitis.
Definitely urgency and frequency in a UC flare
is really, really common.
It is also common in Crohn's
but I would probably put it out there
as a symptom, slightly more in colitis.
- Okay, next symptom.
Vomiting.
(bell dings)
- So predominantly Crohn's.
If you have a flare and you're feeling really crap
you could potentially vomit with--
- Yeah, 'cause that was me. - With Colitis.
- Yeah. - Yeah.
- So if you're really, you know,
acutely unwell this is possible,
but I would say more common to have signs,
to have vomiting in Crohn's Disease,
particularly if you had a blockage in your bowel.
That would almost--
- Oh yeah, yeah, yeah, yeah.
Abdominal pain.
(bell dings)
- Definitely both.
- Oh God yeah. - Definitely both.
- Loss of appetite.
(bell dings)
- Definitely both, yeah.
I mean, it's your GI tract, isn't it?
It's function is for you to eat
and get the food and nutrients in
and if your bowel is in flare
and angry and inflamed, you're not gonna want to eat really.
- And also just when you're ill and don't want to,
like, not fun.
Weight loss.
(bell dings) - Both.
For the same reason that you might
just have a decreased appetite.
- And you're just passing stuff out constantly (laughs).
- Yeah, for sure.
Yeah, definitely.
- Tiredness and fatigue.
(bell dings) - Oh huge in both.
- I was talking to some friends recently
and they were discussing, like,
how they used to be, like, in their early 20s
or at uni with, like,
the extreme lack of sleep and everything,
and I was like, I wasn't like that.
I, like, often didn't go out
because I needed sleep
and I've always known that I,
like, needed more sleep than my peers,
but I just thought that was, like, how I was.
- Yeah.
- And then someone on, like, Twitter
was just, like, that might be because of your colitis
even though I was well during that time.
I thought maybe. - Yeah, yeah.
- Feeling generally unwell.
(bell dings) - Yes, both.
- And anaemia.
(bell dings) - Also both.
If you've got active disease
your bowel is unhappy with some bleeding in.
You're more prone to anaemia.
- Yeah, 'cause of the loss of blood?
- Yeah, yeah.
- And then, would that also like contribute
to the tiredness and the fatigue as well?
- Yeah, absolutely. - So kind of all,
like, feeds into each other, I guess.
Okay, so now onto treatments.
- Okay.
- There is a lot of treatments out there.
Steroids.
(bell dings)
- For both. ♪ Ding, ding, ding, ding ♪
- Yes.
- So steroids are,
so the gold standard of treatment
is to have steroid free remission,
but steroids have such a good place in IBD.
- 'Cause they're anti-inflammatories.
- They are, yeah.
So if you have either and you're in flare, in pain,
frequency, diarrhoea, of course the steroids
is like your get out of jail free card,
but two or more courses within a year
we would look to escalate treatment for both.
- Oh really?
Okay.
- Then, you know, they're a fab drug
but they do have horrible side effects used long term.
- Mesalazines.
- Okay, so.
(bell dings) Colitis.
But there will still be some patients
on mesalazines for Crohn's Disease,
but more recently the evidence
is that it's less effective in Crohn's Disease.
- Okay, so what are mesalazines?
- Mesalazines are, so if you have a rash on your skin
you would put some cream on.
This is how I interpret it.
It's a bit like an internal cream
for the lining of your bowel wall.
So really, really kind of relatively
safe medication to take.
Just a yearly blood test to check it's flushing
through your kidneys okay,
but you can take an oral tablet.
You can also take rectal treatments.
I always do that.
- That's the--
- The rectal treatment. - But that's more, it is.
That's what you do. - Yeah, it is.
So you can have a suppository
or you can have a foam enema.
- Oh, so the enemas are mesalazines?
- You can have steroid enemas.
Oh, we didn't mention that.
You can have steroid enemas
or you can have mesalazine enemas.
- Yeah.
- But first, actually, mesalazine enemas
are thought to be more effective
than steroid enemas.
- Oh okay.
- So we always try those first in ulcerative colitis.
- Liquid diet.
(bell dings)
- We've got our first solo.
- Crohn's!
- Liquid diet is used, it's hard.
They use liquid diet a lot in children
because you can be more strict with children
as what they put in their mouths,
but it's an exclusive, call it enteral feeding.
So an exclusive liquid diet.
You're basically giving your bowel a bit of a break
by not having to break down food.
It's already liquid.
You can absorb the nutrients more easily
in a sort of angry bowel.
- Immunosuppressants.
(bell dings) - Both!
♪ Dun, dun, dun, dun ♪
- Yeah, 'cause it's an autoimmune disease.
- Your immune system has gone berserk,
just doesn't know how to turn itself off,
so by suppressing your immune system
it sort of tricks your brain into going,
oh, can chill out. - Yeah.
- Turn myself off and job done.
- Biologics.
(bell dings)
- For both. - Yeah.
- Yeah.
- So what are biologics?
- Biologics are another immuno-modulating drug.
We'll suppress your immune system,
but they work, they're just a bit cleverer
than Azathioprine.
So there are several.
So drugs that you might have heard of,
like Infliximab, Adalimumab, Vedolizumab.
- All the mabs.
- All of the mabs.
And it's administered IV as well.
It's like--
- There's a difference.
So the first line biologic
that you would have for either
of these would be Infliximab or Adalimumab.
Infliximab is a drip
so you would come in for an infusion.
I said infusion once
and a patient was like, "What, like tea?"
(laughing)
- I've always called them infusions, though.
- Yeah.
But Humira or Adalimumab, Humira's a brand name,
Adalimumab is a sub cut injection
into the fat of your thigh or your belly,
a bit like an EpiPen.
- Okay.
This one I'm not aware of.
- Ah, okay.
It's quite popular because you're in the driving seat.
You have the drug at home.
- Ah yeah, yeah, yeah. - It's really quick.
Just pinch up a bit of skin,
jab it in, and you do that every other week.
- So the way the biologics work,
'cause it's like, it's kinda like in the name.
It's an immunosuppressant but it's,
like, putting antibodies in your, like.
- Yeah, so.
- When I first had it,
and it was like all new,
I was 15 and a friend of mine,
she, like, wanted to become a doctor.
She now is a doctor,
but she was like nerding out about the whole thing
and she was like,
"They're putting mouse genes in your body, Hannah."
- Okay, so Infliximab is mouse derived.
- Yeah (laughs).
- But Humira or Adalimumab,
Humira, human, is the human form.
- Ah!
- But they're both really similar in their makeup of drugs.
We need your friend here with her nerdiness (laughs).
But generally, put simply for me,
when you have inflammation,
your body produces a protein called TNF
and Infliximab, Adalimumab are anti-TNFs.
You flood your body with anti-TNFs
and it blocks the TNF
so thereby reducing inflammation.
- Antibiotics.
(bell dings)
- Crohn's. ♪ Crohn's ♪
- Why?
Because Crohn's can, if Crohn's breaks through your bowel
you can get abscess formation
and it can cause fistulas
which can cause infection.
So the antibiotics, of course, to reduce
or to clear up infection.
- Surgery.
(bell dings)
(vocalising)
- For both.
- Yes.
- So there's, for colitis you are a shining example of.
- You can have your colon removed.
- (chuckles) Yeah.
So that's your main surgery for colitis,
having your colon removed.
In essence, if you got rid of your colon
then, are you cured?
- Yeah, some people do say that it is a cure for colitis.
Obviously I'm not cured yet
because I still have my rectum but,
like, I could potentially have that removed
in the future.
- So you could have what they call a total colectomy
where they take out the whole colon including the rectum,
or a subtotal colectomy which is what you've had
where they leave your rectum in.
Crohn's, there's sort of multiple surgeries
that you can have.
Because it's not continuous in its inflammation,
if you've got small areas of inflammation
throughout your bowel,
if one area becomes so narrowed
and stenosed and causes a blockage,
that would need to be removed.
- Oh okay.
And then the final thing in terms
of the difference between the two is diet.
So which one is diet more, like, connected to?
- So everyone's individual
and I would say diet plays a bigger part
with Crohn's Disease, (bell dings)
although it does play a part in colitis as well,
particularly if you're in flare.
The only time a healthcare professional
will tell you to eat more processed food,
white rice, white bread, peppy processed food.
- Love it.
- So yeah, go wild.
Crohn's Disease, everyone will find their triggers, though.
Some people, no matter what the evidence says,
that diet really doesn't make
much difference to trigger a flare,
there will be people that say, actually,
I have found that this does trigger a flare.
- Yeah.
- But Crohn's Disease, if you have active Crohn's Disease
diet can really help improve your symptoms.
And it may be that you're referred
to a dietician to support you through things
like using a low FODMAP diet.
But in general we'd say a low residue diet
if you have active disease for either.
- Fantastic.
So thank you so much for watching this video.
I hope that you have learned something.
I have certainly learned a few new things about IBD.
Please give this video a thumbs up (chuckles)
if you enjoyed it and you liked my arts and crafts.
This is just a pencil stuck to the back of these.
I'm gonna leave some links in the description
to where you can find out more info
about Crohn's and colitis as it is awareness week.
Thanks again for watching and don't forget to subscribe
and hit that notification bell
'cause I make new videos every week.
Now I'm just going to fan myself.
(hums)
Thanks for watching.
Bye!
(sighs)