Chronic Inflammatory Bowel Diseases

Crohn's disease and ulcerative colitis – what are the differences?

Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD). While ulcerative colitis "only" affects the colon, Crohn's disease can affect the entire digestive tract. In this case, not just the superficial mucous membrane is inflamed (as in ulcerative colitis), but all wall layers of the intestine can be affected.

What symptoms do chronic inflammatory bowel diseases cause?

Typical symptoms of chronic inflammatory bowel diseases are episodic, persistent, sometimes violent watery or bloody-mucous diarrhoea, often accompanied by cramping abdominal pain. Other signs can be weight loss, loss of appetite, but also symptoms that initially seem atypical, such as joint pain, fatigue or inflammatory skin changes or fever.

How are inflammatory bowel diseases diagnosed?

Several examinations are necessary to establish a diagnosis of inflammatory bowel disease. The first step is a physical examination in which the lower abdomen is palpated for painful areas.

Since chronic inflammatory bowel diseases also show various changes in the blood count, a blood test is carried out. For example, an increased CRP value (C-reactive protein) indicates acute inflammatory processes. At the same time, the erythrocyte sedimentation rate (ESR) and the number of white blood cells (leukocytes) are often elevated.

The most important diagnostic method is colonoscopy. A flexible tube with a small camera is inserted into the intestine to view the mucous membrane. The intestinal mucosa shows characteristic tissue changes. The tissue samples (biopsies) taken during the colonoscopy are examined in the laboratory and provide information about the type and severity of the disease.

Since Crohn's disease can affect the entire digestive tract, a gastroscopy is also often performed. During this examination, a thin endoscope is inserted through the mouth to view the stomach and duodenum.

To check whether the bowel wall is thickened, an ultrasound examination (sonography) is usually also carried out.

Pathological changes in parts of the intestine that could not be examined during colonoscopy (especially the small intestine) can be made visible with the help of imaging procedures such as computer tomography (e.g. CT-Sellink) and especially magnetic resonance imaging (e.g. MRI-Sellink) or also capsule endoscopy (PillCam®; a small swallowed capsule that transmits images from the intestine to a data carrier).

How are chronic inflammatory bowel diseases treated?

Conservative treatment

Chronic inflammatory bowel diseases occur in episodes and usually run a chronic course. The aim of treatment is to relieve the symptoms and reduce the number of relapses so that patients are free of symptoms for as long as possible.

Different medications are available for the treatment of inflammatory bowel diseases. These include corticosteroids or cortisone preparations. Since these medicines curb the activity of the immune system, they are mainly used to treat acute attacks. Aminosalicylates (5-ASA preparations) are also used. These medicines have an anti-inflammatory effect and are therefore given for mild to moderate relapses. Immunosuppressants: These suppress the body's excessive immune response and are suitable as a long-term therapy to prevent new flare-ups of inflammation. Typical of these are, for example, TNF-α antibodies: they are very similar to the body's own antibodies and can inhibit the inflammatory processes taking place in the body.

These conventional therapies aim to suppress the excessive inflammation of the intestine. A balance is therefore only established as long as the drug suppression (e.g. by cortisone or other immunosuppressants) is effective. The body is not able to independently balance the degenerative (sclerosing) and inflammatory forces in the intestine. This means that there is no actual healing by the body as it has not "learned" to balance these one-sided forces. In Havelhöhe, we therefore try to mitigate the too-strong (dominant) destruction and sclerosis process in its effect on the intestine and thus on the entire metabolic and digestive system in cases of IBD. The metabolic and digestive process also needs to be strengthened. The inflammatory process that has become independent must be functionally reintegrated into the organ process.

Natural remedies specially developed in anthroposophic medicine (anthroposophics) are used to therapeutically influence such effects of forces. In the case of IBD, therefore, medicines are given that are individually tailored to the disease process. For example, to counteract the dominance of the sclerosis process on the intestine, substances such as quartz (potentised silicea preparations), Formica, Plumbum mellifica, Oxalis, etc. are used. Strengthening of the metabolism can be achieved, for example, with Arsenicum album, Argentum metallicum praep., Cuprum aceticum, Gentiana lutea, etc. The individually adjusted dosage and knowing the current status of the disease are essential. Proven remedies such as frankincense, camomile or arnica in various potencies can also be used as supportive substances during inflammation.

In recent years, knowledge about the microbiota (intestinal flora) and the disruption of the barrier on the intestinal wall has led to new therapeutic approaches using probiotics up to and including "stool transplantation" (faecal microbiome transfer). Immunosuppressive therapies are increasingly being replaced by immunoregulatory approaches.

The administration of potentised Mercurialis compounds (e.g. Mercurius cyanatus or Mercurius vivus nat. etc. in cases of mild inflammation) has been proven to be an essential remedy for IBD. They achieve a balance between the polar forces of sclerosis and inflammation and promote the intestine's ability to encounter food.

Surgical treatment and interdisciplinary cooperation

Cooperation between different specialist departments is of great advantage for the best treatment of inflammatory bowel diseases. At Havelhöhe, for example, there is close cooperation between abdominal surgery with proven expertise in surgical interventions for chronic inflammatory bowel diseases and our gastroenterology department (e.g. operations on stenoses [stricturoplasties], resections of bowel sections up to and including total colon removal with preservation of continence and creation of an ileo-anal J-pouch as well as operations on fistulas). We are also in close contact with the gastroenterology practice of the MVZ Havelhöhe. Special cases are discussed across disciplines in regular conferences. This form of close interdisciplinary cooperation makes it possible to treat even very severe and complex cases of chronic inflammatory bowel disease both according to the most modern standards of conventional medicine and in the spirit of anthroposophic medicine.

Complementary therapy for soul and spirit

In addition to drug therapy, anthroposophic medicine must also include the individual's soul and spirit. Like water and bread for the body, art is the nourishment of the soul. Just as the one-sidedness of polar forces can be balanced on the physical level in the case of illness, art therapy can be used to work with the spiritual forces in order to balance one-sided forces. Therapies used here include music and painting therapy, as well as working with clay (sculpting and modelling). A special artistic movement therapy, eurythmy therapy, is also used.

The spiritual dimension of the human being is met through accompanying talking therapy / psychotherapy. The main focus is on providing support in dealing with the disease and coping with it in everyday life. But the patient's own biographical confrontation with the disease and its meaning can be worked on here too.