Inflammatory Bowel Disease (IBD) is a chronic disorder in which INFLAMMATION develops alongsegments of the gastrointestinal tract. There are two forms of IBD, Crohn’s disease and ulcerative colitis. Crohn’s disease can affect any portion of the intestinal tract though most commonly involves the lower SMALL INTESTINE and upper COLON. Ulcerative colitis affects the colon including the RECTUM. Doctors and researchers believe IBD is an autoimmune disorder in which the IMMUNE SYSTEM may create antibodies that attack the intestinal mucosa (mucus lining of the intestinal walls). Researchers have detected several GENE mutations that correlate to Crohn’s disease, and both Crohn’s disease and ulcerative colitis have strong familial tendencies. Doctors consider the two conditions collectively because the disease processes, symptoms, and treatments overlap, though each condition has unique clinical features.
Both forms of Inflammatory Bowel Disease (IBD) generate ulcerative sores in the intestinal mucosa that cause irritation and inflammation. The resulting symptoms may include
The inflammation and bleeding typically result in ANEMIA, which is one reason for the fatigue. Other systemic changes related to the autoimmune disease process further contribute to fatigue. Alternating periods of symptoms and REMISSION characterize IBD. When IBD is in remission, gastrointestinal function is normal. When the disease is active, often referred to as an “attack,” the severity of symptoms may range from manageable to debilitating.
The symptoms typical with IBD also are common with many gastrointestinal disorders. Determining the diagnosis requires a careful history of the pattern of symptoms, thorough physical examination, laboratory tests to look for markers of inflammation and autoimmune activity in the blood and in the stool, and imaging procedures to detect ulcerations and changes in the intestinal mucosa.
BARIUM SWALLOW with small bowel followthrough, in which the radiologist takes additional X-rays to follow the flow of barium as it leaves the STOMACH and passes through the small intestine, can visualize the ulcers and strictures (narrowed areas) that characterize Crohn’s disease when it involves the small intestine. Sigmoidoscopy allows visual exploration of the lower colon, the site of ulcerative colitis. Esophagogastroduodenoscopy (EGD) may reveal involvement of the upper gastrointestinal tract in Crohn’s disease.
These procedures help rule out other conditions as much as to confirm IBD. Doctors typically withhold these procedures during active flares of disease, however, to avoid further irritating the intestinal mucosa and because the inflamed mucosa presents an increased risk for inadvertent complications such as bowel perforation.
|CLINICAL FEATURES OF IBD|
|Crohn’s Disease||Ulcerative Colitis|
|“skip” pattern of intestinal involvement||continuous intestinal involvement|
|can affect any part of gastrointestinal tract||affects only the COLON, starts with the RECTUM|
|infiltrates multiple layers of mucosa||involves only the surface layer of mucosa|
Most people achieve relief from Inflammatory Bowel Disease (IBD) symptoms through medications that suppress the immune response or target gastrointestinal function. Treatment protocols draw from various classifications of medications to address acute (active disease) and maintenance (remission) levels of care. Among them are ANTIDIARRHEAL MEDICATIONS, anticholinergic medications, 5-AMINOSALICYLATE (5-ASA) MEDICATIONS, CORTICOSTEROID MEDICATIONS, IMMUNOSUPPRESSIVE MEDICATIONS, ANTIBIOTIC MEDICATIONS, and MONOCLONAL ANTIBODIES (MABS). While antibiotics treat enteric infections and abscesses that develop in the inflamed intestinal mucosa, they also seem to reduce complications and result in overall improvement of symptoms.
All of these medications have significant side effects. Because IBD is dynamic and unpredictable in its cycles of symptoms and remission, finding the most effective therapeutic balance remains a challenge. Medication regimens are highly individualized. As research progresses, new medications and treatment options enter the mix.
Surgery to remove the affected portion of the bowel becomes a treatment option to consider when damage to the intestine becomes extensive or symptoms no longer respond to medical treatments. For ulcerative colitis, surgery typically ends the disease process though the amount and location of bowel removed may have functional consequences, including colectomy (surgery to remove part or all of the colon). For Crohn’s disease, surgery provides long-term relief though the disease may resurface or progress to involve remaining portions of the gastrointestinal tract.
Lifestyle is an important dimension of IBD not so much for its influence on the course of the disease but rather a result of IBD’s influence on lifestyle. IBD is a long-term disorder for which, at present, there is no cure. The unpredictable nature of IBD’s cycles and potential severity of attacks make it difficult for those who have it to stray far from its presence. Treatments attempt to manage symptoms for optimal QUALITY OF LIFE across the spectrum of the disease. During periods of remission most people who have IBD are able to participate fully in the activities they enjoy. During periods of active disease, many people find it difficult to maintain regular activities.
|Common IBD Medications|
- balsalazide (Colazal)
- Canasa suppository
- mesalamine (Asacol, Pentasa)
- olsalazine (Dipentum)
- Rowasa ENEMA
- sulfasalazine (Azulfidine)
oral products coated to dissolve in the SMALL INTESTINE or COLON
- dicyclomine (Bentyl)
|slow intestinal motility to reduce DIARRHEA
- loperamide (Imodium)
- diphenoxylate (Lomotil)
|slow intestinal motility to reduce diarrhea
- metronidazole (Flagyl)
- ciprofloxacin (Cipro)
|treat gastrointestinal INFECTION and abscesses
- budesonide (Encort-EC)
- hydrocortisone (Hydrocort)
- hydrocortisone enema (Cortenema)
available for intravenous, oral, or rectal administration
- azathioprine (Imuran)
- methotrexate (Amethopterin)
- 6-mercaptopurine (Purinethol)
|decrease immune activity|
|MONOCLONAL ANTIBODIES (MABS)
- infliximab (Remicade)
|blocks action of TUMOR NECROSIS FACTOR (TNFS), which reduces INFLAMMATION|
Complications associated with IBD are numerous, arising both from the disease and from its treatments. Autoimmune arthritis, notably ANKYLOSING SPONDYLITIS, often develops. Common with long-standing ulcerative colitis are the EYE infections EPISCLERITIS and UVEITIS, the biliary disorder sclerosing cholangitis, and significantly increased risk for COLORECTAL CANCER. Doctors recommend annual screening colonoscopy for people who have IBD with involvement of the colon or rectum beginning 8 to 10 years after diagnosis or earlier when other risk factors exist. People who have Crohn’s disease are particularly susceptible to kidney stones (NEPHROLITHIASIS) and gallstones (cholelithiasis). Abdominal fistulas (abnormal openings between structures), anal fissures, and RECTAL PROLAPSE are also common complications with Crohn’s disease. During disease flareups, some people who have IBD develop SKIN conditions.
The most significant risk factor for IBD is family history, and researchers have identified several genes that correspond to the Crohn’s disease component of IBD. One in four who has IBD has a first-degree relative (parent, sibling, or child) who also has IBD. There are few other indications for why and how IBD develops, though most doctors believe a combination of factors convene to establish the disease process.
Neither the development nor outbreaks of IBD are preventable. Dietary precautions such as eating small meals and avoiding foods that irritate the gastrointestinal system (such as CAFFEINE, ALCOHOL, and highly acidic foods) may help maintain overall gastrointestinal health. High-fiber foods often worsen the symptoms of ulcerative colitis and Crohn’s disease that involves the colon. People who have IBD generally need NUTRITIONAL SUPPLEMENTS, particularly folic acid (folate) and iron, to offset nutritional deficiencies that result from MALABSORPTION. Smoking exacerbates Crohn’s disease. In addition to irritating the gastrointestinal tract, alcohol interacts with many of the medications to treat IBD.
See also ANTIBODY; APPENDICITIS; AUTOIMMUNE DISORDERS; CANCER PREVENTION; CANCER RISK FACTORS; CELIAC DISEASE; COLITIS; DIVERTICULAR DISEASE; ENDOSCOPY; GASTROENTERITIS; GASTROINTESTINAL BLEEDING; ILEUS; IRRITABLE BOWEL SYNDROME (IBS); KAPOSI’S SARCOMA; NUTRITIONAL DEFICIENCY; NUTRITIONAL NEEDS; PERITONITIS.
Resource: Facts On File Encyclopedia Of Health And Medicine
Dyspepsia - the clinical term for indigestion or heartburn. Most people experience dyspepsia as a burning PAIN in the upper abdomen. Some people also experience NAUSEA, VOMITING, and excessive belching. Certain foods or drinks, such as spicy foods or caffeinated beverages, often worsen the discomfort, as do medications such as aspirin and other NONSTEROIDAL
Digestive hormones - chemical messengers that stimulate or inhibit gastrointestinal functions. Organs and structures of the gastrointestinal system synthesize and release digestive hormones in response to chemical and physiologic changes that take place with the ingestion of food and its passage through the gastrointestinal tract.
Colon - the large intestine, which extracts water from and consolidates the waste byproducts of digestion. The colon extends from the ILEUM, the final segment of the SMALL INTESTINE, to the ANUS, the exit from the body for solid digestive waste (feces or stool). The colon goes up the left side of the abdomen (the ascending colon), across the abdomen at the
Zollinger-Ellison syndrome is a rare disorder in which the STOMACH dramatically increases hydrochloric acid production, resulting in rampant PEPTIC ULCER DISEASE. Zollinger-Ellison syndrome develops as a consequence of benign tumors, called gastrinomas, that secrete the digestive HORMONE gastrin. Gastrin signals the stomach to produce acid, which the
Stomach - the pouchlike organ that receives and digests food. The stomach can stretch up to six times its resting size to accommodate influxes of food and drink up to about the combined quantity of a gallon. Three layers of MUSCLE wrap around the deeply pitted gastric mucosa (mucous membrane lining of the stomach). The fibers of each muscle layer run in
Rectum - the segment of the COLON between the sigmoid colon and the ANUS. About six inches long, the rectum retains solid digestive waste until a BOWEL MOVEMENT expels it. The SPINAL CORD regulates the NERVE impulses that initiate the reflexive contractions of the rectum that result in bowel movements. The walls of the rectum are smooth and flexible,
Anus - the opening through which the body passes solid waste (feces), below the final segment of the COLON and the terminus of the gastrointestinal system. The anal sphincter is a ring of MUSCLE that contracts to contain fecal matter and relaxes to expel it. Learning to control the contraction and relaxation of the anal sphincter begins to take place at age
Cecum - the first segment of the COLON (large intestine) into which the ILEUM, the final segment of the SMALL INTESTINE, empties digestive matter. The cecum is a pouchlike structure located in the lower right abdomen that absorbs water from the waste, returning fluid to the body and consolidating the waste for its journey through the end stage of digestion.
Celiac Disease is a condition affecting the SMALL INTESTINE in which consuming foods that contain gluten, a plant protein prominent in wheat, triggers an inflammatory response that prevents the intestinal mucosa (lining) from absorbing NUTRIENTS. Gluten, and more specifically proteins it contains called gliadins, acts as an ANTIGEN to initiate a localized
Cholecystectomy is a surgical OPERATION to remove the GALLBLADDER. Cholecystectomy is the most common treatment in the United States for GALLBLADDER DISEASE including gallstones (cholelithiasis), cholecystitis (INFLAMMATION or INFECTION of the gallbladder), and biliary dyskinesia (diminished ability of the gallbladder to eject BILE). About 500,000 Americans