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Inflammatory bowel disease (IBD) is a condition that involves chronic inflammation in all or part of the digestive tract. Often painful and debilitating, IBD includes ulcerative colitis and Crohn’s disease, and can lead to life-threatening complications as well as increasing the risk for colon cancer.
IBD is not the same as irritable bowel syndrome (IBS), which does not cause inflammation or damage in the intestines. It is estimated that as many as 1 million Americans suffer from IBD, and most sufferers begin to feel symptoms between the ages of 15 and 30.
Symptoms of IBD
With IBD, the intestines (small, large, and bowels) become inflamed, including redness and swelling. Related symptoms, which can range from mild or severe, include:
- Severe or chronic abdominal pain
- Diarrhea, often bloody
- Sudden weight loss
- Lack of appetite
- Rectal bleeding
- Joint pain
- Skin problems
Symptoms can come on suddenly and flare up at random times, often going away for months or even years at a time. These are known as “relapses” or “flare-ups.” When symptoms are gone (though never permanently, as IBD is chronic), the patient is known as being in remission.
The two most common forms of IBD are ulcerative colitis and Crohn’s disease. The two offer such similar symptoms that doctors have a hard time diagnosing what kind of IBD a patient might have and require testing to rule out other gastrointestinal problems, like celiac disease. The most easily understood difference between the diseases is the parts of the digestive tract that they affect.
Crohn’s disease causes patchy inflammation on all layers of the intestinal wall, whereas ulcerative colitis affects only the top layer of the large intestine. Ulcerative colitis causes swelling and ulcers to form on the surface of the lining, which bleed and produce pus. In severe cases, the ulcers can weaken the intestine and cause a hole, spilling the bacteria-laden contents of the large intestine into the abdominal cavity or the patient’s bloodstream.
Though Crohn's can affect any of the digestive tract, it most commonly affects the end of the small bowel (the ileum) and the beginning of the colon. With Crohn’s disease, the inflammation causes swelling and scar tissue to thicken the intestinal wall. The passageway for food becomes more narrow (known as a stricture) and deep ulceration can cause tunnels (known as fistulas). These fistulas can connect the intestines to organs that they shouldn’t connect to, like the bladder or the skin.
In addition to the damage caused to the digestive tract, IBD can create many other health problems for those afflicted. The loss of blood from the intestines can cause anemia, or below-normal levels of healthy red blood cells. Other problems include arthritis and joint pain, weak bones, eye problems, gallstones, skin issues, kidney stones, and delayed puberty and growth issues in children. Many of these problems are caused by the malabsorption of nutrients, since the digestive tract is not working properly. IBD flareups can also cause inflammation in other parts of the body. Some of these symptoms will improve when the IBD is properly treated.
No one is sure what causes IBD. It is classified as an autoimmune problem, as patients with IBD seem to have an overreacting immune system that attacks normal bacteria in the digestive tract, causing inflammation and digestive tract damage. IBD has been linked to certain genes and often is passed down through families. Though stress and diet can worsen IBD symptoms, they do not cause IBD.
There are a number of ways to diagnose IBD. Blood tests can find signs of inflammation and anemia, while stool tests can test for blood and signs of infection. Doctors may also use a long thin tube with a lighted camera to look into a person’s intestine, either a sigmoidoscopy, which goes as far as the lower part of the large intestine, or a colonoscopy, which goes through the entire large intestine and the last part of the small intestines, and take a biopsy of tissue. A less invasive way to look for intestinal problems is an X-ray after the patient has consumed liquid barium to coat the digestive tract lining. CAT scans and capsule endoscopies also provide insight into any damage that might be occurring to the digestive tract.
Treatment for IBD
Treatment for IBD varies per patient. Some may require medication, which can range from corticosteroids to biologic therapies and antibiotics. For the most part, changes in diet, reducing stress, and getting enough rest are universal ways of treating symptoms. Some patients avoid greasy foods, cream sauces, processed meat products, spicy foods, and high fiber foods.
Other patients with more serious prognoses may require surgery. With ulcerative colitis, 25 to 40 percent of patients will need surgery, which can include complete removal of the large intestine. Patients who undergo this type of surgery will need to have pouches attached either internally or externally, for waste removal. With Crohn’s disease, 65 to 75 percent of patients will need surgery to correct strictures, fistulae, or bleeding in the intestines. A strictureplasty widens the strictures without removing any part of the small intestine, and a bowel resection removes parts of the intestine and the surgeon sews the healthy ends together. Crohn’s patients can also have their large intestine removed, but require an external pouch.
Living with IBD can be stressful and taxing. There are hundreds of support groups for people with Crohn's disease and ulcerative colitis. In these support groups, patients and their loved ones gather to share their stories, seek emotional support, and connect with a community with similar challenges. There are also online communities where patients can chat in a forum and share tips on managing the condition 24/7.