Chris Kresser: Actually that’s not true. IBD can be very localized in one particular part of the intestine, and there’s a significant difference between Crohn’s and ulcerative colitis in that regard. Ulcerative colitis, by definition, only exists in the colon. If a patient has ulcerative colitis, their disease activity would be limited to the colon or rectum. They would, by definition, in fact, not have ulcers further up in the digestive tract.
Crohn’s disease, on the other hand, can occur anywhere in the digestive tract from the mouth all the way to the anus. The difference between Crohn’s and ulcerative colitis, above and beyond the difference that I just mentioned, is the levels of tissue that are affected. Ulcerative colitis affects only the superficial layer of the mucosa in the gut, whereas Crohn’s disease can penetrate several different layers of the GI lining. Having said that, it’s much more common for Crohn’s to manifest in the terminal ileum, which is the last part of the small intestine before you reach the colon, or in the colon than it is for it to manifest in the upper parts of the small intestine or the mouth. That’s somewhat rare. So given that HCl works primarily in the stomach, we don’t typically view IBD as a contraindication for HCl.