Inflammatory Bowel Disease (Crohn’s and Ulcerative Colitis)

Definition

Inflammatory bowel disease (IBD)  is a condition where there is chronic inflammation of parts of the gut. It includes Crohn’s disease and ulcerative colitis. Crohn’s disease can affect any part of the gut and this inflammation can spread deep inside these tissues. Ulcerative colitis causes inflammation primarily of the large intestine and rectum. Inflammatory bowel disease develops over time and is marked by acute attacks throughout life followed by periods of no symptoms (remission).

Symptoms

Despite the differences between Crohn’s disease and ulcerative colitis, the symptoms are largely the same. The symptoms can range from mild to severe. Common symptoms of IBD include :

  • Abdominal cramps and pain
  • Diarrhea
  • Blood and mucus in the stools
  • Fever
  • Reduced appetite
  • Weight loss
  • Malnutrition
  • Fatigue
  • Ulcers which vary in size and depth

Outside of the bowel this disease can also cause arthritis, inflammation of the eyes, liver, kidney among other things. The complication of IBD can be severe and life threatening, in some cases. It can cause severe internal bleeding from the ulcers, constriction of the colon, preventing the smooth passage of stools, perforation or rupture of the bowels. In extreme cases it can lead to toxic megacolon, which is extreme dilation of the colon.

Apart from the physical symptoms, inflammatory bowel disease is a debilitating condition that can adversely affect the quality of life of the sufferer. This may at times lead to being socially recluse and to the development of depression. There is a greater risk of certain types of cancers of the gastrointestinal tract as well.

Causes

The cause of this disease is not known but it appears to be largely an abnormal immune response due to genetic predisposition. The immune activity is directed at the tissue of the bowel wall thereby causing inflammation. It is believed that an abnormality in the gap junction between the bowel wall cells and irregularities with the natural bowel bacteria are some of the reasons why the immune response is disordered apart from a genetic causes.

Some risk factors include :

  • Being middle aged.
  • Ethnicity.
  • Family history.
  • Cigarette smoking.

Stress and a diet rich in fats and refined food can aggravate the symptoms of this disease but are not the cause or trigger of inflammatory bowel disease.

Treatment

Treatment is intended to reduce inflammation in the acute stages and prevent exacerbations in the long term. Anti-inflammatory drugs, such as aminosalicylates, sulfasalazine are used both for reducing inflammation and maintaining a state of remission. Antibiotics may be used to control bacterial populations in the gut although the effectiveness of this approach is questionable in all cases of inflammatory bowel disease.

Corticosteroids may be prescribed for a short period time though it is not recommended for long term use due to side effects. Immunosuppressants such as infliximab may be necessary when the condition is unresponsive to other medication. These drugs suppress the immune system from attacking the bowel wall. It is particularly useful in acute cases and reserved for chronic management. In severe cases, surgical removal of the the colon, particularly in ulcerative colitis, may be considered.

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