The Crohn's Disease and Ulcerative Colitis Guidelines That Best Suit Our Situation

Crohn's disease and ulcerative colitis are chronic diseases that require constant management rather than a cure.
It is most important for the patient to understand the disease on his own.
However, symptoms such as abdominal pain, diarrhea, and bloody stool are diverse, and diagnosis and treatment are often complex, so patients and their guardians can easily get lost.
The author, a university hospital specialist and medical doctor, has compiled essential information about Crohn's disease and ulcerative colitis in this book based on his experience treating approximately 2,000 patients.
Not only does it provide an easy-to-understand overview of symptoms, diagnosis, treatment, and complications, it also includes practical, helpful information such as what to eat, which medical institution and doctor to choose, how helpful probiotics and alternative therapies are, what to do if a relapse occurs, what to watch out for during pregnancy and childbirth, how to get support for medical expenses, how to handle income deductions, and how to perform military service.
Crohn's disease and ulcerative colitis: If you understand them correctly, you can live together happily!

Inflammatory bowel disease is broadly divided into Crohn's disease and ulcerative colitis.
The two diseases are similar yet different.
To put it simply, Crohn's disease is a 'chronic inflammatory bowel disease that occurs anywhere in the digestive tract', and ulcerative colitis is a 'chronic inflammatory disease of unknown cause that affects the large intestine'.
Crohn's disease can occur anywhere in the digestive tract from the mouth to the anus.
Unlike ulcerative colitis, the inflammation affects all layers of the intestine, and the lesions are often sparsely distributed rather than continuous. Ulcerative colitis is 'a disease in which inflammation or ulcers occur in the large intestine. The lesions begin in the rectum adjacent to the anus and gradually progress inward, and are characterized by being connected without interruption.' (The author modified the contents of Seoul National University Hospital N Medical Information).
Although Crohn's disease is often said to occur 'anywhere in the digestive tract from the mouth to the anus', it actually mostly affects the ileocecal area, where the large and small intestines connect, and also affects the rest of the small intestine or large intestine.
Simply put, remember that Crohn's disease occurs in the small and large intestines, while ulcerative colitis occurs only in the rectum or large intestine.
These fundamental differences affect many aspects, including symptoms and treatment, which will be explained later.
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The normal frequency of bowel movements varies from person to person, from once every three days to three times a day, so symptoms should be assessed based on your normal bowel movement frequency.
Therefore, if a person who used to have a bowel movement once every two days now has a bowel movement twice a day, this can be considered an increase in the number of bowel movements and diarrhea.
Patients with ulcerative colitis may become accustomed to frequent bowel movements when the condition becomes chronic and may think that they are used to going to the bathroom this frequently. However, since the inflammation is still present, it can be improved with appropriate treatment.
Diarrhea is not only an increase in the number of bowel movements, but also when the stool is loose and has an irregular shape (Bristol Stool Scale 5-7).
In Crohn's disease, diarrhea can occur not only due to intestinal inflammation but also due to bile malabsorption after small bowel surgery.
When the small intestine is shortened due to surgery, food passes through the small intestine more quickly, and bile that is not absorbed in the terminal ileum may flow into the large intestine, irritating the large intestine lining and causing diarrhea.
Additionally, acute enteritis may be accompanied by diarrhea, or occasionally, lactose intolerance may occur and diarrhea may occur after consuming dairy products.
Among the drugs used to treat inflammatory bowel disease, mesalazine in particular occasionally causes diarrhea.
Diarrhea is also a major symptom of irritable bowel syndrome, so differential diagnosis is sometimes problematic.
Diarrhea in patients with inflammatory bowel disease tends to be worse in the early morning and early evening.
Some people skip meals or reduce their food intake during the acute stage because they believe that eating will worsen their diarrhea. However, caution is needed because severe diarrhea can lead to dehydration if sufficient fluids and electrolytes are not replenished.
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The ideal goal of treating inflammatory bowel disease is to induce remission quickly and effectively without side effects, and to maintain remission for as long as possible.
The response time to treatment varies depending on the drug.
For example, oral steroids commonly used for acute exacerbations usually show a response within about two weeks of starting treatment, and remission should be induced within four weeks.
For expensive drugs such as biological agents and small molecule agents, the induction period is specified in terms of domestic insurance standards.
After the induction period is over, the effectiveness of the drug is evaluated, and only if it is effective, will insurance apply for maintenance treatment.
In the evaluation of Crohn's disease, the CDAI score, which is a combination of self-questionnaires and blood test results, can be used to diagnose Crohn's disease, but endoscopic evaluation is essential for ulcerative colitis.
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Patients and their caregivers are often discouraged when they hear that inflammatory bowel disease is a chronic condition with no known underlying cause, requiring lifelong medication.
It's mind-boggling to think that I'll be dependent on medication for the rest of my life (though this very thought is an overly pessimistic view of the situation).
Therefore, many people ask whether it is okay to stop taking medication if symptoms have been well controlled for a long time.
The risk of relapse when a drug is discontinued varies depending on whether it plays a primary or secondary role in the current treatment.
Additionally, patients who maintain long-term, deep remission have a lower risk of relapse when discontinuing medication than patients who occasionally experience disease activity.
Simply put, the more suffering a patient has had, the greater the risk of relapse if they stop taking the medication.
Therefore, discontinuation of medication should be decided carefully after consulting with the attending physician.
If you quit, you need to be fully prepared on how to monitor for early detection of relapse and how to respond in case of relapse.
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Inflammatory bowel disease increases the risk of colon and small bowel cancer because chronic, repetitive inflammatory responses induce mutations in intestinal mucosal cells.
Therefore, it is also called colitis-associated cancer.
Because gastrointestinal cancers that arise from inflammatory bowel disease are more difficult to diagnose early than common small intestine and colon cancers, the best approach is to control inflammation well.
Although recent advances in treatment have reduced the risk compared to the past, people with inflammatory bowel disease still have about twice the risk of developing colon cancer compared to the general population.
The cumulative risk of developing colorectal cancer in patients with ulcerative colitis is approximately 1% 10 years after diagnosis, 3% 20 years, and 7% 30 years after diagnosis.16 The mortality rate from colorectal cancer is also 1.2 to 2 times higher.17 The risk of developing colorectal cancer is higher in patients diagnosed at a young age, with a wide range of involvement, with severe or poorly controlled inflammation, and with a long history of inflammatory bowel disease.
Since bloody stool is a well-known symptom of colon cancer, patients with ulcerative colitis may worry that they may have colon cancer whenever they see bloody stool. However, patients with ulcerative proctitis, where inflammation is limited to the rectum, do not have a different risk of colon cancer than those in the general population, so there is no need to worry too much.
However, for left-sided colitis or extensive colitis, it is recommended to undergo periodic colonoscopy for colon cancer surveillance after approximately 8 years from the onset of symptoms.
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If diagnosed with inflammatory bowel disease, you are usually assessed as Grade 5 according to the Military Manpower Administration's physical grade assessment criteria and are exempt from military service.
However, those who are assessed as having a physical grade of 5 must go to the Central Military Service Physical Examination Center of the Military Manpower Administration in Daegu Metropolitan City to receive a second assessment.
For this, a medical certificate for military service issued within the past 3 months is required, and to obtain a medical certificate for military service, a treatment history of at least 6 months is required.
You must bring your medical records (medication records for at least the past 6 months), color photos or CDs of endoscopy and interpretation sheets, stained pathological tissue slides and results sheets, and blood test results sheets.
The medical certificate for military service will be written by your attending physician, and the remaining required documents can be requested through an outpatient nurse or staff member.
For more information, please refer to the Military Service Determination Audit on the Military Manpower Administration website or contact the Military Manpower Administration.

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