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|
nflammatory
bowel disease is an umbrella term for a number of long-term conditions that
involve inflammation of the digestive tract, or the gut.
According to the Crohn's and Colitis Foundation, inflammatory
bowel disease (IBD) affects up to 1.6 million Americans.
The majority of these people are diagnosed before age 30.
IBD is often confused with irritable bowel syndrome (IBS) but the two
conditions are different. IBD is a more serious condition, which may lead to a
number of complications including damage to the bowel and malnutrition.
Types of IBD
Ulcerative colitis and Crohn's disease combined affect up to 1.6 million Americans.
The two main types of IBD are ulcerative colitis and Crohn's disease.
Ulcerative colitis
This condition, which may affect up to 907,000
American people, causes inflammation of the large intestine
(colon). There are different classes of ulcerative colitis depending on its
location and severity:
·
Ulcerative
proctitis: Inflammation is confined to the rectum. This tends to be the mildest
form of ulcerative colitis.
·
Universal
colitis or pancolitis: Inflammation affects the entire colon.
·
Proctosigmoiditis:
Inflammation affects the rectum and lower end of the colon.
·
Distal
colitis: Inflammation extends from the rectum and up the left colon.
·
Acute
severe ulcerative colitis: A rare form that affects the entire colon and causes
severe symptoms and pain.
Crohn's disease
Crohn's disease can affect any part of the digestive tract - from mouth to
anus - although the most commonly affected areas are the final section of the
small intestine and the colon.
Crohn's disease may affect up to 780,000 Americans.
The disease can occur at any age, but it is most common in those aged 15 to 35.
While ulcerative colitis and Crohn's disease are the two major forms of
classic IBD, other types include lymphocytic colitis and collagenous colitis.
If doctors are unable to distinguish between the two main types of IBD, the
condition is classed as indeterminate colitis.
Causes
It is not known what causes IBD, but many experts believe several factors
may play a role:
·
Immune
function: IBD may result when an abnormal immune system response to bacteria,
viruses, or food particles, triggers an inflammatory reaction in the gut.
·
Genetics:
Links have been
discovered between IBD and certain gene mutations. Up to 20
percent of those with ulcerative colitis have a close relative
with IBD, but no specific pattern to heredity has been established.
·
Bacteria
or viruses: Research has linked both E.coli and enteroviruses to
Crohn's disease.
·
Environmental:
Factors such as smoking, oral contraceptives, diet, breastfeeding,
vaccinations, antibiotics, and others have been investigated as
potential causes.
Risk factors
A number of risk factors have also been identified in the onset of IBD,
including:
·
Age:
most people are diagnosed before age 30.
·
Ethnicity:
Caucasians and Ashkenazi Jews are at higher risk than others.
·
Genetics:
People with a close relative with IBD are at higher risk.
·
Location:
People living in urban areas and in industrialized countries are more likely to
be diagnosed with IBD.
·
Medications:
Use of certain medications, such as isotretinoin or nonsteroidal
anti-inflammatory medications may increase the risk.
·
Smoking:
Smokers are at higher risk of developing Crohn's disease, although ulcerative
colitis mainly affects nonsmokers.
Symptoms
Symptoms vary according to the location and severity of the disease, as
well as the type of disease. The following symptoms are common to both types of
IBD:
Difficult bowel movements and diarrhea are common symptoms of ulcerative colitis and Crohn's disease.
·
blood
in the stool
·
diarrhea
·
fatigue
·
fever
·
lack
of appetite
·
nausea
·
painful
or difficult bowel movements
·
a
feeling that the bowels are not empty after a bowel movement
·
pus or mucus in the
stool
·
stomach
pain and cramps
·
vomiting
·
night
sweats
·
weight
loss
IBD may also be associated with symptoms that do not appear to be related
to the digestive system, such as:
·
joint
pain
·
canker
sores in the mouth
·
inflammation
of the eyes
·
skin
disorders
·
irregular periods in females
Children with IBD can also experience impaired growth.
Those with IBD can experience periods where symptoms worsen - called
flares or relapses - and periods with little or no symptoms, known as
remission. Flares vary in their number, intensity, and duration.
The goal of treatment is to bring IBD into remission, and keep it there
for as long as possible.
Complications
A number of complications are associated with IBD - some of which can be
life-threatening. Possible complications of Crohn's disease include:
·
bowel
obstruction
·
fistulas,
abnormal tunnels in the gut
·
malnutrition
Possible complications of ulcerative colitis include:
·
colon
cancer
·
fulminant
colitis, where normal contractions of the intestinal wall stop temporarily
·
a
hole or tear in the colon
·
strictures
or narrowing of the colon
·
toxic
megacolon, where swelling and trapped gas can lead to colon rupture,
septicemia, and shock
Diagnosis
In order to diagnose IBD, a doctor will take a full medical history before
ordering one or more diagnostic tests. Types of tests used include:
·
stool
sample
·
blood
tests to test for anemia or infection
·
X-rays,
if a serious complication is suspected
·
CT scan
·
MRI scans,
to detect fistulas in the small intestine or anal area
Endoscopic procedures may also be used. A flexible probe with a camera
attached is inserted through the anus. These procedures help uncover intestinal
damage and allow the doctor to take a small sample of tissue to examine. Types
of endoscopic procedures typically used include:
·
colonoscopy
- to examine the entire colon
·
flexible
sigmoidoscopy - to examine the last section of the colon
·
upper endoscopy -
to examine the food pipe, stomach, and first part of small intestine
A capsule endoscopy is another option. This procedure requires a person to
swallow a capsule that has a camera inside, which allows a doctor to examine
the small intestine.
Treatment
There is no cure for IBD. The goal of treatment is to reduce symptoms,
achieve and maintain remission, and avoid associated complications. The most
common available treatments are medications and surgery.
Medication
Doctors may prescribe drugs, beginning with the milder ones first and
working up to more aggressive treatments.
·
Anti-inflammatory
drugs: 5-ASA medications are typically the first line of defense against IBD
symptoms. They reduce inflammation in the gut, and may help achieve and
maintain remission.
·
Corticosteroids:
Fast-acting anti-inflammatory steroids that may be prescribed if the milder
class of anti-inflammatories aren't effective. They are only used to treat
flares and should not be used long-term.
·
Immune
suppressors: These work by preventing the immune system from attacking the
bowel cells, leading to a reduction in inflammation. They can take up to 3
months to take effect, and cause a number of side effects such as increased
susceptibility to infection.
·
Biologic
therapies: Antibodies that target certain substances responsible for
inflammation in the body.
In addition, other medications recommended for those with IBD can include:
·
antibiotics
·
antidiarrheal
drugs
·
laxatives
·
vitamin and mineral supplements, for cases of nutritional
deficiency associated with IBD
Surgery
In some cases, surgery may be necessary to treat IBD symptoms and
complications. Surgery may be recommended to widen a narrow bowel or remove
fistulas.
People who have ulcerative colitis, may undergo surgery to remove the
colon and rectum. Those with Crohn's disease may have surgery to remove certain
portions of the intestines.
Management
Certain dietary and lifestyle factors are thought to make IBD symptoms
worse. Making positive changes in these areas can help manage symptoms, reduce
flares, and even maintain remission.
Diet
Keeping a daily food log can help identify which foods cause IBD symptoms.
Dietary measures that may be beneficial for those with IBD include:
·
keeping
a food diary to track if certain symptoms are associated with certain foods
·
limiting
the intake of dairy products
·
limiting
the intake of high-fat foods
·
limiting
or avoiding spicy foods, caffeine, and alcohol
·
limiting
high-fiber foods, particularly if narrowing of the bowel is an issue
·
eating
frequent small meals rather than several large ones
·
drinking
plenty of water
·
taking
vitamin and mineral supplements to prevent deficiencies
Stress
Many people with IBD say they experience more severe symptoms during
stressful periods. Learning to manage stress may help reduce the number and
severity of these types of flare-ups.
Stress management techniques include exercise, meditation, breathing
exercises, progressive muscle relaxation, and engaging in hobbies and other
enjoyable activities.
Smoking
Smoking has been shown to
negatively affect those with Crohn's disease. Not only is smoking a risk factor
for developing the disease, but it also makes symptoms worse.
Some research has suggested that smoking may actually benefit those with
ulcerative colitis but the health risks associated with smoking far outweigh
any benefits.
Emotional support
IBD can have an emotional effect on those with the condition, especially
in severe cases. Therefore, it is important to have a good network of supports
among family and friends.
People with IBD might consider joining an IBD support group or attending
counseling sessions, which they may find beneficial.
Prevention
Because the exact cause of IBD is not yet known, it is difficult to know
how best to prevent it.
The genetic factors associated with IBD are beyond a person's control but
it is possible to reduce the risk by eating a healthful diet, quitting smoking, and exercising regularly.
Outlook
Although there is no cure for IBD, it can be managed with medical
interventions and lifestyle changes.
With effective treatment, approximately 50
percent of those with Crohn's disease will be in remission or
only have mild symptoms in the next 5 years. Around 45 percent of people in
remission won't experience a relapse in the next year.
In any given year, 48 percent of those with ulcerative colitis are in
remission, and 30 percent have mild symptoms. The longer someone remains in
remission, the less likely they are to experience a flare in the following
year.
Death due to IBD or its complications is uncommon. People with Crohn's
disease have only a slightly higher overall mortality rate than the general
population. Those with mild-to-moderate ulcerative colitis do not have a higher
risk.
If people experience any persistent changes in bowel habits or any other
symptoms of IBD, they should consult their doctor.
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