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Bowel Diseases

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is a group of chronic disorders that affect about a million people in the United States. Characterized by swollen and damaged tissues in the lining of the intestinal tract, these conditions vary in severity from patient to patient and change over time. Periods of active disease may alternate with periods of remission. During a flare-up, a patient may experience frequent bouts of watery and/or bloody diarrhea, abdominal pain, weight loss, and fever. Between these flare-ups, symptoms frequently diminish. Many patients may go through extended periods of remission before another flare-up occurs.

The cause of IBD is not known, but these diseases are thought to be due to an autoimmune process that has been triggered by a genetic predisposition, a viral illness, and/or an environmental factor. IBD affects both sexes equally and is seen most frequently in Caucasians who live in industrialized countries. The most common inflammatory bowel diseases are Crohn's disease (CD) and ulcerative colitis (UC). Both may affect anyone at any age, but the majority of cases are first diagnosed in patients 15 to 35 years of age, and a smaller number of cases diagnosed between the ages of 50 and 70. In addition to gastrointestinal symptoms, children affected by CD or UC may experience delayed development and growth retardation. Patients who are diagnosed with one of these conditions at a young age are also at an increased risk of developing colon cancer later in life.

Crohn's disease can affect any part of the gastrointestinal tract from the mouth to the anus but is primarily found in the last part of the small intestine (the ileum) and/or in the colon (large intestine or bowel). With CD, affected bowel tissue may be in patches with normal tissue in between. Inflammation may penetrate deep into the tissues of the intestines/colon and form ulcers or fistulas - tunnels through the intestines that allow waste material to move into other areas. Other complications of CD may include bowel obstructions, anaemia from bleeding tissues, and infections. According to the Crohn’s & Colitis Foundation of America, about two-thirds to three-quarters of patients with Crohn's disease will eventually require surgery, either to remove damaged sections of the intestines/colon or to treat an obstruction or fistula.

Ulcerative colitis (UC) primarily affects the surface lining of the colon. Although the symptoms may be similar to those seen with CD, the tissue inflammation caused by UC is continuous, not patchy, and usually starts from the anus and moves up the colon. UC tends to present more frequently with bloody diarrhea. The most serious complication of UC is toxic megacolon, a relatively rare acute condition in which a section of the colon becomes essentially paralyzed. Waste does not move through the section; it accumulates and dilates the colon. This can cause abdominal pain, fever, and weakness and can become life-threatening if left untreated.

Tests

The diagnosis of an IBD is primarily made with non-laboratory tests, but laboratory testing is an important tool for ruling out other causes of diarrhea, abdominal pain, and colitis. These causes can include viral or bacterial infections, parasites, medications, abdominal or pelvic radiation, colon cancer, and a variety of other chronic conditions, such as celiac disease and cystic fibrosis.

Treatment

Treatment of inflammatory bowel diseases is targeted at reducing inflammation, relieving symptoms such as pain and diarrhea, controlling and healing damage where possible, identifying and addressing complications, and supplementing any nutritional shortages. Since the course of an IBD is usually one of flare-up followed by remission, the needs of someone with an IBD will vary from person to person and frequently change over time.

Patients with UC or CD will need to be regularly monitored and should work with their doctors to become educated about their condition. While lifestyle changes, such as diet modification, rest, and stress reduction may help improve a patient’s quality of life and extend a remission, they cannot prevent an IBD flare-up. Acute symptoms are treated with a variety of medications. These drugs are effective but many can only be given for short periods of time because of their side effects. Current therapies include the use of corticosteroids, anti-inflammatories, immune suppressive drugs, and antibiotics. Biologic therapies, drugs derived from living organisms and their products (such as proteins), may be used in the treatment of IBD. An example of these is a group of drugs (called anti-TNF) aimed at blocking and inactivating tumor necrosis factor (TNF). One or more surgeries may eventually be necessary to remove damaged tissue, to treat fistulas, and to relieve obstructions.

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