What is Inflammatory Bowel Disease?
Inflammatory bowel disease (IBD) is a general term for chronic inflammation of the gastrointestinal tract, which may be limited to the intestines or involve other areas as well. It comprises two major conditions—ulcerative colitis and Crohn’s disease. When inflammation persists over time, it can cause significant damage, which is why diagnosis and proper treatment and management of these diseases are so important.
Gastrointestinal Specialists of Georgia specializes in identifying and treating these conditions and in colon cancer screening for individuals at high risk.
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In people with IBD (about 1.3% of the U.S. population, or 3 million adults1), there is a defect in the immune system. The immune response to environmental triggers, rather than to foreign pathogens, involves an attack on the gastrointestinal tract. In addition to environmental factors, there is a genetic, or inherited, component to IBD, as those with a family history of the disease are more at risk of developing it over their lifetime.
Ulcerative Colitis vs. Crohn’s Disease
Both diseases fall under the same umbrella as inflammatory bowel disease but behave differently. Ulcerative colitis (UC) affects only the large intestine, while Crohn’s can affect any part of the gastrointestinal tract. However, it most often affects the ileum or lower part of the small intestine.
In either condition, the intestinal immune system malfunctions. White blood cells then accumulate in the mucosa or inner lining of the intestines. These release chemicals that trigger inflammation, which, over time, causes injury to the tissues affected. With UC, this inflammation is confined to the inner lining of the intestine. Crohn’s disease, on the other hand, involves the entire thickness of the bowel and intestinal wall. Both can lead to complications, such as colon cancer and other problems that will be discussed later.
Limited to the large intestine and rectum, UC causes inflammation usually in the sigmoid colon, but it can affect the entire colon as well. It is most often diagnosed in individuals younger than 30 but can begin at any age. The immune system reactions, which may be to normal bacteria or other bacteria and viruses in the body, cause ulcers, or severe sores, in the large intestine’s innermost lining.
The symptoms of UC include:
- Frequent diarrhea or a constant urge to use the bathroom
- Rectal pain, bloody diarrhea, and mucus
- Constipation, depending on the area of colon affected
- Abdominal pain and cramps
- Fever, in severe cases, when the entire body is affected
- Weight loss due to prolonged diarrhea and other symptoms
- Anemia, or lack of red blood cells/iron due to blood loss
Any part of the gastrointestinal tract can be affected by Crohn's Disease, from the mouth to the anus. The small intestine is most often affected first before the condition spreads to the large intestine. While signs of UC tend to be continuous, areas affected by Crohn’s are patchy. Diseased tissue can be located next to healthy areas, but the inflammation and damage can extend into multiple tissue layers.
Also known as granulomatous enteritis, regional enteritis, colitis, or ileitis, Crohn’s disease typically begins in people from 15 to 35 years old. Statistically, there’s also a peak in newly diagnosed cases in people over 50. Someone who has a relative affected by the disease is 10 times more likely to develop it, and 30 times more likely if their sibling has it.
Crohn’s disease is characterized by:
- Abdominal pain
- Diarrhea, which may be bloody
- Weight loss
- Loss of appetite
- Night sweats
Complications of IBD
Both diseases can lead to complications, such as:
- Colon cancer: The risk of developing cancer is higher in people with IBD. Although general guidelines call for a colonoscopy at age 50, and every 10 years thereafter, having IBD can require being tested sooner and more often.
- Blood clots: Anyone with inflammatory bowel disease has an increased risk of developing clots in their arteries and veins.
- Skin, joint, and eye inflammation: Flare-ups of IBD may be associated with conditions such as arthritis, inflammation of the eyes, and lesions on the skin. Extra-intestinal complications may also include bone loss and liver and kidney diseases.
- Side effects of medications: The side effects vary, depending on the medicine, condition, and individual’s reaction. Osteoporosis, a thinning and weakening of bones, is associated with corticosteroids; high blood pressure may be triggered by these as well. Some IBD medications are even associated with an increased risk of cancer.
Ulcerative colitis is associated with complications such as toxic megacolon, a rapid swelling, and widening of the colon. This can be life-threatening and require surgery. In severe cases, the colon can become perforated or develop a hole. Perforated colon can also occur without signs of toxic megacolon. Severe dehydration is another complication, which can be brought on by diarrhea.
Crohn’s disease can lead to a wide range of complications, including:
- Bowel obstruction: The intestinal wall can thicken so much it obstructs the normal flow of digestive materials, sometimes requiring diseased portions of the intestine to be surgically removed.
- Ulcers: Open sores in the digestive tract can occur in the intestines, the mouth, the anus, and near the genitals. Ulcers are more commonly associated with chronic inflammation.
- Anal fissure: Infections near the anus can lead to tissue tears, affecting the skin and/or underlying tissues.
- Fistulas: Occurring near the anus or anywhere in the intestine, a fistula is an ulcer that affects every layer of the intestinal wall, creating a connection between different parts of the intestine that shouldn’t be there. An infected fistula can form a dangerous abscess. Fistulas between the intestine and bladder, and the intestine and skin, can develop as well.
- Malnutrition: Pain and diarrhea associated with Crohn’s disease can make it difficult to eat. The disease also affects the absorption of nutrients by the intestine. This can lead to various types of malnutrition, while anemia (from low iron and vitamin B12 levels) is also common.
Colon cancer is a risk in both types of IBD. For people with ulcerative colitis, this risk increases 8 to 10 years after diagnosis, while Crohn’s disease involving the entire colon is associated with a risk equal to that of people with UC. Crohn’s is associated with an increased risk of malignancies in the small intestine, a reason testing is important if you have IBD (available from Gastrointestinal Specialists of Georgia).
In both diseases, the severity and intensity vary from person to person, and each can wax and wane over time. The disease triggers the most severe inflammation in its active stage, or a flare-up, but can be much diminished or completely absent during remission.
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Learn More About Inflammatory Bowel Disease
Possibilities include immune system malfunction, causing abnormal immune responses to pathogens such as viruses and bacteria. Diet and stress aren’t believed to cause it but can aggravate the condition. Inflammatory bowel disease can occur in any race, although people of Ashkenazi Jewish ancestry are at a higher risk.
In addition, nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen sodium can increase one’s risk or worsen IBD. A diet high in fat or refined foods increases risk, as does living in an industrialized country. Cigarette smoking is also a risk factor for developing Crohn’s disease, as it is for colon cancer.
Like UC, the exact cause of Crohn’s disease is unknown, although some scientists believe certain strains of bacteria may be in play. With IBD, the immune system is activated despite there not being a known invader, such as bacteria, viruses, or fungi. The case for genetic inheritance is strong. A gene (NOD2) has been linked with Crohn’s disease, especially in people with a mutation of this gene, while issues with regulating E. coli levels in the digestive tract have also been found. If you have symptoms and a family history of IBD, it is important to discuss the risk factors with your doctor.
Testing and Diagnosis
The symptoms are important in diagnosing IBD, but a physical exam alone isn’t enough to confirm the presence of disease. Doctors, therefore, perform various tests to verify a person has UC or Crohn’s disease, such as:
- Stool tests: Able to eliminate bacterial, viral, and parasitic factors, a stool test can find evidence of IBD; a fecal occult blood test can find traces of blood one won’t necessarily see visually.
- Complete blood count: Elevated white blood cell count levels can mean there’s an infection, while decreased red blood cell and hemoglobin levels may result from severe bleeding.
To find more conclusive evidence of a gastrointestinal disease, these following tests may be performed:
- Barium x-ray: The patient swallows a chalky white substance that makes the inside of the gastrointestinal tract visible. An x-ray can then find abnormalities in the esophagus, stomach, duodenum, or small intestine. A test of the lower GI tract, or barium enema, allows doctors to examine the colon and rectum.
- Colonoscopy: As with a colon cancer screening, an endoscopic instrument is inserted into the colon to provide a visual look inside. Physicians can do a complete colonoscopy or a sigmoidoscopy, which examines the lower third of the large intestine, checking for inflammation, bleeding, and ulcers, or signs of other abnormalities. Biopsies can be taken to further evaluate tissues and aid in diagnoses.
- Upper endoscopy: The upper GI tract can be visualized in a similar way by inserting a narrow, flexible tube into the esophagus. An endoscopy can detect signs of ulceration due to Crohn’s disease in the stomach and duodenum.
Capsule endoscopy, computerized tomography, and magnetic resonance imaging may also be performed to look for signs of disease.
Treatment and Prevention
Treatment varies, depending on the disease and a person’s response to therapy. Medications are used to suppress the inflammatory response so tissues can heal, and to reduce the frequency of flare-ups. Over the course of treatment, the least harmful drugs are used, including amino-salicylates for the intestinal lining in people with Crohn’s disease. Corticosteroids may be used next, while immune modifying agents may be used if these fail or a longer-term treatment is required. In some cases, biologic agents such as anti-TNF and non-anti-TNF agents may be used, but experimental agents can be recommended if all other medicinal options fail.
Surgery, although less common than it was before advancements in medications, may involve removing damaged parts of the intestine and/or GI tract. The surgical procedure varies greatly, depending on the sections of the GI tract affected and the complications of IBD one experiences.