Inflammatory bowel disease (IBD) refers to a group of gastrointestinal system disorders that causes inflammation in the gastrointestinal system. The gastrointestinal system consists of your mouth, esophagus, stomach, small intestine, and large intestine. Their role is to break down food, getting nutrients from the foods and remove unusable waste products.
What are the types of inflammatory bowel disease?
The two most common types of inflammatory bowel disease are ulcerative colitis and Crohn’s disease.
Ulcerative colitis is classified according to the location of inflammation and severity of symptoms:
- Ulcerative proctitis.This is the mildest form of ulcerative colitis. Inflammation is often in the area close to the anus.
- Proctosigmoiditis.Inflammation occurs in the rectum and sigmoid colon (the lower end of the colon).
- Left-sided colitis.Inflammation extends from the rectum up through the sigmoid and descending colon.
- Pancolitis often affects the entire colon.
- Acute severe ulcerative colitis.Previously called fulminant colitis, this rare form of colitis affects the entire colon.
Crohn’s disease can affect people differently, but it commonly affects the ileum (the last part of the small intestine) and the colon.
You should not be confused with inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). IBS is characterized by abnormal contraction of the intestine wall, while IBD refers to conditions that cause inflammation.
What are the signs and symptoms of inflammatory bowel diseases?
Despite being very different condition, both ulcerative colitis and Crohn’s disease have some shared symptoms:
- Abdominal pain and cramping;
- Nausea and vomiting;
- Rectal bleeding;
- Severe internal cramps/muscle spasms;
- Unintended weight loss;
- Fever and fatigue;
- Reduced appetite.
Over time, the inflammation of the lining of the intestine leads to ulceration. The intestine wall then loses the ability to process food, waste and absorb water, resulting in diarrhea. Small sores develop in the intestine can cause abdominal pain and blood in your stool.
It may affect other parts of the body, such as the eyes, skin, and joints. People with IBD can develop eye inflammation, skin disorders, and arthritis.
There might be times when the symptoms are active and times when there are no symptoms. In Crohn’s disease, 35% of people in remission will have 1 or 2 relapses over the next 5 years. The remission is higher for people with ulcerative colitis, where 30% of people in remission will experience active disease in the next year.
What are the causes and risks of inflammatory bowel diseases?
There is no exact cause of inflammatory bowel diseases. Some factors can trigger or make the symptoms worse. The two most possible causes are an immune system malfunction and heredity.
- Abnormality in the immune system: The immune system attacks the intestine lining instead of the bacteria and virus.
- Heredity: People with a family member with this condition often has inflammatory bowel diseases.
- Diet: A high-protein diet of meat and fish might cause cell poisoning and ulceration.
- Age: IBD is often diagnosed in people younger than 35, but it can happen to anyone.
- Gender: IBD can affect both sexes. But there are more cases of ulcerative colitis among men, while Crohn’s disease is more common among women.
- Smoking: Smoking can increase the risk of Crohn’s disease as well make the symptoms worse. However, smokers are less likely to get ulcerative colitis than nonsmokers and ex-smokers.
- Isotretinoin (Amnesteem®, Claravis®, Sotret®; formerly Accutane®): There isn’t a clear connection between IDB and isotretinoin yet, but some studies suggest it to be a risk factor. This medication is used to treat cyst or acne.
- NSAIDS. Nonsteroidal anti-inflammatory medications such as ibuprofen (Advil®, Motrin IB®, others), naproxen sodium (Aleve®, Anaprox®), diclofenac sodium (Voltaren®, Solaraze®) and others: These medications may increase the risk of developing IBD or worsen disease in people who have IBD.
How can inflammatory bowel disease diagnose?
You doctor will perform a physical exam and ask about family history for diagnosis. They might request some tests to confirm the diagnosis, including the following:
- Complete blood count.
- Nutritional evaluation: Vitamin B12 evaluation, iron studies, red blood cell folate, nutritional markers.
- Erythrocyte sedimentation rate and C-reactive protein levels.
- Fecal calprotectin level.
- Serologic studies: Perinuclear antineutrophil cytoplasmic antibodies, anti-Saccharomyces cerevisiae
- Stool studies: Stool culture, ova and parasite studies, bacterial pathogens culture, and evaluation forClostridium difficult infection.
- Upright chest and abdominal radiography.
- Barium double-contrast enema radiographic studies.
- Abdominal ultrasonography.
- Abdominal/pelvic computed tomography scanning/magnetic resonance imaging.
- Computed tomography enterography.
- Colonoscopy, with biopsies of tissue/lesions.
- Flexible sigmoidoscopy.
- Upper gastrointestinal endoscopy.
- Capsule enteroscopy/double balloon enteroscopy.
What are the treatments and management of inflammatory bowel disease?
There are several treatments for inflammatory bowel disease. Treatment often starts with medication and then change to surgery.
Your doctor might suggest medicines to treat the inflammation and prevent symptoms:
Aminosalicylates to treat flare and prevent remission. These medicines are more effective in ulcerative colitis than Crohn’s disease. Aminosalicylates are available as oral, enema, suppository formulations. Some common drugs are 5-Aminosalicylic acid derivatives (e.g., sulfasalazine, mesalamine, balsalazide, olsalazine).
Antibiotics are used sparingly in ulcerative colitis. However, it can lead to several side effects. Antibiotics (e.g., metronidazole, ciprofloxacin, rifampin) and monoclonal antibodies (e.g., natalizumab) are often used.
Corticosteroids are used for acute disease flares. It can be taken through intravenous, oral, topical, and rectal. Corticosteroid agents include hydrocortisone, prednisone, methylprednisolone, prednisolone, budesonide, and dexamethasone.
Immunomodulators are effective for steroid-sparing action in refractory disease; primary treatment for fistulas and maintenance of remission in patients intolerant of or not responsive to aminosalicylates.
Immunosuppressant agents (e.g., azathioprine, 6-mercaptopurine, methotrexate, cyclosporine).
Clinical trial agents can be used for each specific disease (i.e., an agent works for Crohn’s disease but not for ulcerative colitis, or vice versa). You might get other medication to treat symptoms such as diarrhea or stomach cramps:
- H2-receptor antagonists (eg, cimetidine, ranitidine, famotidine, nizatidine).
- Proton pump inhibitors (eg, omeprazole, lansoprazole, esomeprazole magnesium, rabeprazole sodium, pantoprazole).
- Antidiarrheal agents (eg, diphenoxylate and atropine, loperamide, cholestyramine).
- Anticholinergic antispasmodic agents (eg, dicyclomine, hyoscyamine).
Surgery can be used to cure ulcerative colitis. However, Crohn’s disease might still have remission even with surgery.
Surgery for ulcerative colitis will remove the entire colon and rectum. The surgeon will attach a pouch connecting from the end of your intestine to your anus, allowing you to expel waste normally. This procedure is called ileoanal anastomosis. If a pouch is not possible, the surgeon will create a permanent opening in the abdomen and attach a bag to collect stool.
Surgery for Crohn’s disease doesn’t eliminate the condition from recurring. Most people with Crohn’s disease will need at least one surgery in their treatment. Surgery involves removing the damaged portion of the intestine and connect the healthy tissue.
Inflammatory bowel disease can affect anyone. Unfortunately, there is no cure yet for these conditions. The best way to treat inflammatory bowel disease is to prevent flare-ups and control symptoms. You can ask your doctor for prevention methods and any change in diet that you need to follow.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: January 4, 2017 | Last Modified: January 4, 2017
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Inflammatory bowel disease (IBD). http://emedicine.medscape.com/article/179037-overview. Accessed September 10, 2016.