As the name “chronic inflammatory bowel diseases” implies, both ulcerative colitis and Crohn’s disease are chronic disorders. This means that the patient will continue to have them for the rest of his or her life. The progression of the disease, however, can differ significantly from patient to patient. While some individuals experience very mild disease with infrequent flare-ups, others will suffer from much more severe disease with frequent hospitalizations. It is, unfortunately, impossible to predict at the outset the comparative severity of an individual patient’s future clinical course. Large studies, however, have shown that more than half of all patients with ulcerative colitis or Crohn’s disease tend to exhibit a mild clinical course and do not require even one course of treatment with cortisone preparations. Treatment problems such as osteopporosis, ileostomy, psychic stress, risk of cancer and others are described in the Special problems of IBD section.
What treatment methods are available?
Treatment options fall into four main groups and include drugs, surgery, diet (Dietary Guidelines for Crohns and colitis) and supportive measures. One very important supportive measure is for the patient affected with Crohn’s disease to quit smoking. Compared to smokers, patients who quit smoking have a 60% lower chance of experience disease recurrence within a two-year period.
Different researchers have expressed different opinions on the need for and expected success of psychotherapeutic treatment. On the one hand, it is certain that inflammatory bowel diseases cannot be cured by psychotherapy. Whether such therapy can help prevent a flare-up in patients with psychic stress is not known. It is probable, however, that a behavioral therapy that helps patients better cope with the problems of their disease and of daily life could be useful. In any case, such a treatment should only be conducted in cooperation with your physician.
Course of the disease
Probably the most important question you will wish to discuss with your physician deals with the future course of your disease: how will it progress and what problems will confront you in the future? When discussing your prognosis (that is, the probable future course of your disease), your physician will explain that, in individual cases of inflammatory bowel disease, reliable predictions are often possible only after fairly extensive periods of observation. We know today that patients’ life expectancies are not reduced in either ulcerative colitis or Crohn’s disease, provided they are correctly diagnosed and appropriately treated. Ulcerative colitis and Crohn’s disease are chronic diseases that will affect your life for years to come. Both diseases tend toward an episodic pattern of activity, alternating between symptom-free and active disease states. Early diagnosis and appropriate treatment can usually suppress the inflammatory activity and lead to re-establishment of an inactive disease phase. Complications are more likely in patients in whom the inflammation has become chronic and has led to progressing changes in the bowel. The most effective way of reducing the risk of complications is regular follow-up by your physician who can recognize inflammatory flare-ups early and institute appropriate treatment. Flare-ups and associated complications can severely reduce your quality of life and overall happiness. Thus, minor side effects of special drug therapy can be tolerated with this larger goal in mind.