Inflammatory bowel disease (patient information)

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 * Assistant Editor-in-Chief: Meagan E. Doherty

Overview
Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine.

The main forms of IBD are Crohn's disease and ulcerative colitis (UC).

Accounting for far fewer cases are other forms of IBD:
 * Collagenous colitis
 * Lymphocytic colitis
 * Ischaemic colitis
 * Diversion colitis
 * Behçet's syndrome
 * Infective colitis
 * Indeterminate colitis

The main difference between Crohn's disease and UC is the location and nature of the inflammatory changes. Crohn's can affect any part of the gastrointestinal tract, from mouth to anus (skip lesions), although a majority of the cases start in the terminal ileum. Ulcerative colitis, in contrast, is restricted to the colon and the anus.

Microscopically, ulcerative colitis is restricted to the mucosa (epithelial lining of the gut), while Crohn's disease affects the whole bowel wall.

Finally, Crohn's disease and ulcerative colitis present with extra-intestinal manifestations (such as liver problems, arthritis, skin manifestations and eye problems) in different proportions.

In rare cases, patients have been diagnosed with both Crohn's disease and ulcerative colitis, which is really called Crohn's colitis.

What are the symptoms of Inflammatory bowel disease?
Symptoms of ulcerative colitis include:
 * Abdominal pain and cramping that usually disappears after a bowel movement
 * Abdominal sounds (a gurgling or splashing sound heard over the intestine)
 * Diarrhea, from only a few episodes to very often throughout the day (blood and mucus may be present)
 * Fever
 * Tenesmus
 * Weight loss

Other symptoms that may occur with ulcerative colitis include the following:
 * Gastrointestinal bleeding
 * Joint pain
 * Nausea and vomiting

The main symptoms of Crohn's disease are:
 * Crampy abdominal (belly area) pain
 * Fever
 * Fatigue
 * Persistent, watery diarrhea

Other symptoms may include:
 * Abdominal fullness and gas
 * Clotting problems (deep vein thrombosis)
 * Constipation
 * Eye inflammation
 * Fistulas (usually around the rectal area, may cause draining of pus, mucus, or stools)
 * Gastrointestinal bleeding
 * Joint pain
 * Kidney stones
 * Liver inflammation
 * Loss of appetite
 * Pain with passing stool (tenesmus)
 * Rectal bleeding and bloody stools
 * Skin rash
 * Swollen gums
 * Unintentional weight loss

What are the causes of Inflammatory bowel disease?
Causes of ulcerative colitis:

The cause of ulcerative colitis is unknown. It may affect any age group, although there are peaks at ages 15 - 30 and then again at ages 50 - 70.

The disease usually begins in the rectal area and may eventually extend through the entire large intestine. Repeated swelling (inflammation) leads to thickening of the wall of the intestine and rectum with scar tissue. Death of colon tissue or sepsis may occur with severe disease.

The symptoms vary in severity and may start slowly or suddenly. Many factors can lead to attacks, including respiratory infections or physical stress.

Causes of Crohn's disease: While the exact cause of Crohn's disease is unknown, the condition is linked to a problem with the body's immune system response.

Normally, the immune system helps protect the body, but with Crohn's disease the immune system can't tell the difference between good substances and foreign invaders. The result is an overactive immune response that leads to chronic inflammation. This is called an autoimmune disorder.

There are five different types of Crohn's disease:
 * Ileocolitis is the most common form. It affects the lowest part of the small intestine (ileum) and the large intestine (colon).
 * Ileitis affects the ileum.
 * Gastroduodenal Crohn's disease causes inflammation in the stomach and first part of the small intestine, called the duodenum.
 * Jejunoileitis causes spotty patches of inflammation in the top half of the small intestine (jejunum).
 * Crohn's (granulomatous) colitis only affects the large intestine.

A person's genes and environmental factors seem to play a role in the development of Crohn's disease. The body may be overreacting to normal bacteria in the intestines.

The inflammation related to Crohn's disease frequently occurs at the end of the small intestine that joins the large intestine, but it may occur in any area of the digestive tract. There can be healthy patches of tissue between diseased areas. The ongoing inflammation causes the intestinal wall to become thick.

Who is at risk for Inflammatory bowel disease?
Risk factors include:
 * Family history of Crohn's disease
 * Family history of ulcerative colitis
 * Jewish ancestry
 * Smoking
 * Age: it usually occurs in people 15-30 and then again at ages 50-70

How to know you have Inflammatory bowel disease?
Although very different diseases, both may present with any of the following symptoms: abdominal pain, vomiting, diarrhea, hematochezia, weight loss, weight gain and various associated complaints or diseases (arthritis, pyoderma gangrenosum, primary sclerosing cholangitis). Diagnosis is generally by colonoscopy with biopsy of pathological lesions.

When to seek urgent medical care
Speak with your doctor and set up an immediate consultation if you experience any of the symptoms associated with Inflammatory bowel disease.

Treatment options
Depending on the level of severity, IBD may require immunosuppression to control the symptoms. such as azathioprine, methotrexate, or 6-mercaptopurine. More commonly, treatment of IBD requires a form of mesalamine. Often, steroids are used to control disease flares and were once acceptable as a maintenance drug. In use for several years in Crohns disease patients and recently in patients with Ulcerative Colitis, biologicals has been used such as the intravenously administered Remicade. Severe cases may require surgery, such as bowel resection, strictureplasty or a temporary or permanent colostomy or ileostomy. Alternative medicine treatments for bowel disease exist in various forms, however such methods concentrate on controlling underlying pathology in order to avoid prolonged steroidal exposure or surgical excisement.

Usually the treatment is started by administering drugs with high anti-inflammatory affects, such as Prednisone. Once the inflammation is successfully controlled, the patient is usually switched to a lighter drug to keep the disease in remission, such as Asacol, a mesalamine. If unsuccessful, a combination of the aforementioned immunosurpression drugs with a mesalamine (which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.

Diseases with similar symptoms

 * Diverticulitis
 * Colorectal cancer
 * Irritable bowel syndrome
 * Lactose intolerance
 * Intestinal abscess
 * Bacterial infection

Where to find medical care for Inflammatory bowel disease
Directions to Hospitals Treating Inflammatory bowel disease

Prevention of Inflammatory bowel disease
Because the cause is unknown, prevention is also unknown.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may make symptoms worse.

Due to the risk of colon cancer associated with ulcerative colitis, screening with colonoscopy is recommended.

The American Cancer Society recommends having your first screening:


 * 8 years after you are diagnosed with severe disease, or when most of, or the entire, large intestine is involved
 * 12 - 15 years after diagnosis when only the left side of the large intestine is involved

Have follow-up examinations every 1 - 2 years.

What to expect (Outlook/Prognosis)
While IBD can limit quality of life due to pain, vomiting, diarrhea, and other socially unacceptable symptoms, it is rarely fatal on its own. Fatalities due to complications such as toxic megacolon, bowel perforation and surgical complications are also rare.

While patients of IBD do have an increased risk of colorectal cancer this is usually caught much earlier than the general population in routine surveillance of the colon by colonoscopy, and therefore patients are much more likely to survive.

After treatment, the patient is usually switched to a lighter drug with fewer side effects. Every so often an acute resurgence of the original symptoms may appear: this is known as a "flare-up". Depending on the circumstances, it may go away on its own or require medication. The time between flare-ups may be anywhere from weeks to years, and varies wildly between patients - a few have never experienced a flare-up.