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IBD Overview

Overview

Inflammatory bowel disease is a group of disorders that cause chronic inflammation of the digestive tract. Crohn’s disease and ulcerative colitis are the two most common of these diseases, affecting nearly 2 million Americans.

Crohn's Disease Inflammation

Inflammation from Crohn’s Disease

Crohn’s disease and ulcerative colitis are similar in many ways. They both cause swelling and sores along the tissue that lines the digestive tract and can cause abdominal pain and frequent diarrhea. Crohns disease can develop anywhere in the digestive tract, from the mouth to the rectum, and penetrates into the deep layers of the lining. Ulcerative colitis usually affects only the outermost layer of the tissue lining the colon (the large intestine). [1]

Causes

Scientists estimate that approximately seven people out of 100,000 in the United States develop Crohn’s disease, and 10 to 15 people in 100,000 develop ulcerative colitis. The exact cause of these diseases is remains unknown, but the latest research suggests that a malfunction in the body’s immune system and bacteria in the digestive tract may play a role in the development of IBD. Both Crohn’s disease and ulcerative colitis appear to run in families, and various environmental factors may also increase an individual’s risk for developing Crohn’s disease and ulcerative colitis. [2]

For a more thorough review of the theories surrounding the cause of IBD, please see the Examining the Science section on the Specific Carbohydrate Diet.

Symptoms

Ulcerative colitis patients typically present with rectal bleeding, diarrhea, tenesmus (urgent desire to evacuate the bowels but with passage of little stool), and abdominal pain. Patients with fulminant or toxic colitis usually have more than ten bowel movements daily, continuous bleeding, abdominal distention and tenderness, and radiologic evidence of edema and possibly bowel dilation.

Crohn’s disease patients typically present with diarrhea, abdominal pain, and weight loss. The abdominal pain usually is insidious, is in the right lower quadrant, occurs soon after eating, and may be associated with a tender inflammatory mass. There may be hematochezia, but bleeding is much less common than in ulcerative colitis patients. Fever, weight loss, stomatitis, perianal fistulae or fissures (or both), arthritis, and erythema nodosum are all commonly seen. [3]

Diagnosis

Crohn’s disease and ulcerative colitis are so similar that they often are mistaken for each other. Making an accurate diagnosis is important so that an individual can receive the most effective treatment for his or her disease.

Two newer blood tests are useful in diagnosing inflammatory bowel disease. These tests check for anemia or signs of infection by identifying certain antibodies in the blood, but they are only about 80 percent accurate.

A barium enema is a test that allows the doctor to perform an X-ray examination of the lower portion of the digestive tract. To perform this test, barium, a safe dye, is placed in the colon as an enema. It coats the lining and creates a silhouette of the entire large intestine, which includes the colon, rectum and anus, and a portion of the small intestine on X-ray. For patients in whom Crohn’s disease does not affect higher sections of the digestive tract, a barium enema may be the only test needed for diagnosis.

A flexible sigmoidoscopy provides an internal, real-time view of the lowest two feet of the colon. The doctor inserts a slender, flexible, lighted tube through the rectum and examines the tissue lining this section of the colon, looking for inflammation, ulcers or other problems that signal inflammatory bowel disease. The sigmoidoscopy is very useful for diagnosing disease in the lowest portion of the colon, but it does not allow the doctor to see problems that might exist higher in the colon or in the small intestine.

Barium Enema

Photo of a Barium Enema

A colonoscopy is the most definitive test for diagnosing inflammatory bowel disease. The doctor inserts a thin, flexible, lighted tube that is long enough to view the entire colon, from the anus to the small intestine, with the attached camera. During this procedure, the doctor also can take tissue samples from inside the colon that can be tested in the laboratory for clusters of inflamed cells called granulomas. These clusters are present in Crohn’s disease but not ulcerative colitis, so this is a very useful test for distinguishing the two diseases. [1]

Treatment

There is no medically recognized cure for Inflammatory Bowel Disease. Common traditional options would include medications or surgery.

Medications

There are five primary categories of medications used to treat IBD:

  • Aminosalicylates, or 5-ASA drugs, are anti-inflammatory medicines that can be taken orally or via suppositories to suppress inflammation in the intestine and relieve painful symptoms.
  • Corticosteroids, such as prednisone, are strong, fast-acting anti-inflammatory drugs. However, these drugs are known to trigger extensive and significant side effects, and are not feasible for long-term maintenance.
  • Antibiotics can be used, even though there’s no specific infectious agent associated with IBD, to reduce intestinal bacteria and suppress the intestinal immune system.
  • Immunomodulators weaken the activity of the immune system, which in turn reduces inflammation. These drugs act rather slowly, which is why they are frequently paired with fast-acting corticosteroids.
  • Biologic therapies, a class of medications that target specific proteins and enzymes and suppress immune response. Remicade is a drug in this category.

Surgical Procedures

In more advanced cases of these diseases, surgery may be necessary. Up to 45% of patients with UC will require surgery at some point in their lifetime. This figure is as high as 75% in Crohn’s patients. [4]

In patients with ulcerative colitis, the disease can usually be cured with surgery using one of two primary methods. The first option involves removing the entire colon and rectum (proctocolectomy) and the creation of an opening on the abdomen through which feces is emptied into a pouch (ileostomy). This pouch is attached to the skin with some form of an adhesive.

The other frequently used option is a highly technical surgery in which the surgeon removes the colon, creates an internal ileal pouch from the small intestine, attaches it to the anal sphincter muscle (ileoanal anastomosis), and creates a temporary ileostomy. When the ileoanal anastomosis finally heals, the ileostomy is closed and the patient passes feces through the anus again. However, the number of bowel movements per day generally is in the range of 8-10, and bacterial infection is not uncommon. [5]

Colostomy Pouch

Standard Colostomy Pouch

There are several types of surgical procedures that could be performed for someone suffering from Crohn’s disease. They type of surgery depends on the severity of the illness, the location of the inflammation in the intestines, and whether complications exist. Surgeons may perform a strictureplasty (widening affected portions of the small intestine), a resection (removing portions of the intestines), a colectomy or proctocolectomy (removal of the colon either by itself or along with the rectum), or surgery to address fistulas that may develop.

Alternative or Complementary Options

Alternative and complementary treatment options for IBD might include dietary modification, probiotics, nutrient supplementation, various stress relief techniques, and mind-body therapies, among others. Most alternative therapies are used in conjunction with traditional therapies. Food Rx is focused on providing tools and services to increase patients’ awareness of alternative and complementary therapies.

Selected References