Inflammatory bowel disease (IBD) is a term used to describe two forms of chronic inflammation of the intestine. These two diseases are known as Ulcerative Colitis and Crohn’s Disease. While these two conditions may have some characteristics in common, there are some differences.With Ulcerative colitis the inflammation affects the mucosa (the inner lining) and the submucosa ( the lining underneath it) and is limited to the large intestine and the rectum. This lining becomes inflamed (swollen and red) and develops open, painful wounds, commonly called ulcers. The affected area is often the most severe in the rectal area, which can result in frequent diarrhea. It is not uncommon to see mucus and blood often appear in the feces (stool / poop) if there is damage to the lining of the intestine.
With Crohn’s disease, the inflammatory process can involve any part of the gastrointestinal tract from the mouth to the anus, however, it most commonly affects the last part of the small intestine (called the terminal ileum) and parts of the large intestine. Another characteristic of Crohn’s disease is that the inflammatory process tends to involve the entire bowel wall, whereas ulcerative colitis affects only the lining of the bowel.
Etiology or Causes of IBD
Although there has been plenty of research the exact cause of IBD is uncertain. However, researchers believe that many factors might be involved, including the environment, diet, and genetics. There is evidence that has shown that in people with IBD, a defect in their genes affects how the immune system works and responds to an offending substance like a virus or bacteria and even some proteins in food. There is also evidence that suggests smoking can increase the likelihood of developing Crohn’s disease.
The most common symptoms of both Ulcerative Colitis and Crohn’s disease are diarrhea and abdominal pain. Diarrhea can range from mild to severe (as many as 20 or more trips to the bathroom a day). If the diarrhea is extreme, it can lead to dehydration, rapid heartbeat, and a drop in blood pressure. And continued loss of small amounts of blood in the stool can lead to anemia.
At times, those with IBD may also be constipated. With Crohn’s disease, this can happen as a result of a partial obstruction (called stricture) in the intestines. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum (known as proctitis).
The loss of fluid and nutrients from diarrhea and chronic inflammation of the bowel can also cause fever, fatigue, weight loss, and malnutrition. Pain is usually from the abdominal cramping, which is caused by irritation of the nerves and muscles that control intestinal contractions.
And IBD can cause other health problems that occur outside the digestive system. Although experts don’t understand why, some people with IBD can show signs of inflammation elsewhere in the body, including the joints, eyes, skin, and liver. Skin tags that look like hemorrhoids or abscesses may also develop around the anus.
Inflammatory bowel disease also might delay puberty or cause growth problems for some kids and teens because it can interfere with them getting nutrients from food.
Diagnosing IBD can be hard because there may be no symptoms and if there are symptoms, they often resemble those of other conditions. Diagnosing IBD starts with a history and physical. Laboratory test to check for anemia and malnutrition are ordered. Your child’s stool will be tested for the presence of blood if blood is not obviously apparent. Upper endoscopy (a tube with a camera to visualize the lining of the esophagus, the stomach and the first part of the small intestine) and colonoscopy (to visualize the lining of the rectal and the large intestine), along with biopsies of the aforementioned areas is common. The endoscopic test allows the doctor to examine for inflammation, bleeding, or ulcers on the wall of the GI tract. Abdominal sonograms and CT scan might be ordered to evaluate for abscesses (infection pockets) and fistulas (unnatural passageways between the intestines and adjacent structures such as the bladder, vagina, and anus).
The main treatment modality for Crohn’s and Ulcerative Colitis is medication. And fortunately, there has been progress seen in treating these diseases. There are two classes of medications being prescribed. First of all, there are anti-inflammatory drugs prescribed to decrease the inflammation. Secondly, doctors are prescribing immunosuppressing drugs to prevent the immune system from attacking the body’s own tissues and causing further inflammation.
Surgery is the second option, if symptoms don’t respond to either of these medicines. However, the surgical procedure for ulcerative colitis is not the same as for Crohn’s disease.
In the case of Crohn’s disease, the doctors will try to avoid surgery, because of the recurring nature of the disease. There are also complications that can occur if surgery is performed such as short bowel syndrome (which can lead to growth failure and a reduction in the intestines ability to absorb nutrients).
In cases of ulcerative colitis, removal of the colon (large intestine) is sometimes performed to completely get rid of the diseased bowel. This may also require the performing of a procedure in which the surgeon forms a pouch from the small intestine to collect stool in the pelvis. This enables the stool to pass through the anus.
Nutritional support is an important aspect in the treatment of IBD. There are 3 goals you would want for your child; 1) Correction of nutritional deficits and replacing the ongoing losses 2) providing sufficient amount of protein and energy for healing, 3) and thirdly, providing an adequate amount of nutrients to support normal growth. A well-balanced, high-protein, high calorie diet is recommended for your child if symptoms do not prohibit taking foods in orally. Also, supplementing your diet with multivitamins, iron and folic acid is very helpful. Sometimes, that nutritional support may include parental nutrition (nutrition given intravenously) and supplementation with special enteral formula (an elemental formula which consists of simple / small proteins).
First of all, IBD is a chronic disease which can consist of long periods of dormancy followed by exacerbation (an acute increase in symptoms). However, overall the prognosis is good. Colorectal cancer is a long-term complication of IBD. Surveillance colonoscopy with multiple biopsies is the gold standard for early detection and should begin approximately 10 years after diagnosis. This should continue every 1-2 years.