Inflammatory Bowel Diseases (IBD) is a medical condition that causes chronic or recurring inflammation of the digestive tract. The two most common forms of inflammatory bowel diseases are Crohn’s disease and ulcerative colitis (UC).
In people with IBD, the immune system mistakes food, bacteria, and other materials in the intestine for foreign substances and it attacks the cells of the intestines. In the process, the body sends white blood cells into the lining of the intestines where they produce chronic inflammation. When this happens, the patient experiences the symptoms of IBD.
Inflammatory Bowel Disease should not be confused with Irritable Bowel Syndrome (IBS) that causes intermittent abdominal pain due to muscle contractions of the colon. IBD usually strikes people when they are 15 to 30 years old, though it may occur at any age. IBD occurs more in people of Caucasian and Ashkenazic Jewish origin than other.
The cause of inflammatory bowel disease is unknown but it appears to involves genetic, immunologic, and environmental factors.
Crohn’s disease can involve any location of the digestive tract, but it frequently affects the end of the small bowel and the beginning of the colon. In Crohn's disease, all layers of the intestine may be involved and there can be normal healthy bowel between patches of diseased bowel.
Symptoms include persistent diarrhea (loose, watery, or frequent bowel movements), cramping abdominal pain, fever, and, at times, rectal bleeding. Loss of appetite and weight loss also may occur. However, the disease is not always limited to the gastrointestinal tract; it can also affect the joints, eyes, skin, and liver. Fatigue is another common complaint.
The most common complication of Crohn’s disease is blockage of the intestine due to swelling and scar tissue. Symptoms of blockage include cramping pain, vomiting, and bloating. Another complication is sores or ulcers within the intestinal tract. Sometimes these deep ulcers turn into tracts—called fistulas. In 30% of people with Crohn's disease, these fistulas become infected. Patients may also develop a shortage of proteins, calories, or vitamins. They generally do not develop unless the disease is severe and of long duration. Until recently an increased risk of cancer was thought to exist mainly for ulcerative colitis patients, but it is now known that Crohn’s patients have an increased risk of colon cancer as well.
The five groups of drugs used to treat Crohn’s disease today are aminosalicylates (5-ASA), steroids, immune modifiers (azathioprine, 6-MP, and methotrexate), antibiotics (metronidazole, ampicillin, ciprofloxin, others), and biologic therapy (inflixamab). A majority of patients with Crohn's disease will require surgery at some point during their lives. Surgery may be required when medications can no longer control the symptoms.
Ulcerative colitis affects the colon only. The damage is limited to the top layers of the colon in an even and continuous distribution. The first symptom of ulcerative colitis is a progressive loosening of the stool. The stool is generally bloody and may be associated with cramping abdominal pain and severe urgency to have a bowel movement. The diarrhea may begin slowly or quite suddenly. Loss of appetite and subsequent weight loss are common, as is fatigue. In cases of severe bleeding, anemia may also occur. In addition, there may be skin lesions, joint pain, eye inflammation, and liver disorders. Children with ulcerative colitis may fail to develop or grow properly.
About 1/2 of all patients with ulcerative colitis have mild symptoms. However, others may suffer from severe abdominal cramping, bloody diarrhea, nausea, and fever. The symptoms of ulcerative colitis do tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all.
Complications of ulcerative colitis are less frequent than in Crohn’s disease. Complications can include bleeding from deep ulcerations, rupture of the bowel, or failure of the patient to respond to the usual medical treatments. Another complication is severe abdominal bloating. Patients with ulcerative colitis are at increased risk of colon cancer.
The four major classes of medication used today to treat ulcerative colitis are aminosalicylates (5-ASA), steroids, immune modifiers (azathioprine, 6-MP, and methotrexate), and antibiotics (metronidazole, ampicillin, ciprofloxin, others). Colectormy, removal of the colon, may be considered for some people whose ulcerative colitis does not improve with medication. Once the colon is removed, symptoms of ulcerative colitis do not return.