What is IBD?
The term inflammatory bowel disease (IBD) is commonly used to
refer to Crohn’s disease and ulcerative colitis. There are also some cases
where the colon is inflamed but the diagnosis may be unclear—these cases may be
called indeterminate colitis. These chronic diseases cause inflammation and
ulceration in the inner lining of the gastrointestinal (GI) tract. It is
estimated that more than 1.5 million Americans suffer from IBD. IBD afflicts
people of all ages, but up to 25 percent of cases are diagnosed before the age
of 20 years. IBD is actually one of the most significant chronic diseases
affecting children and adolescents.
Crohn’s
Disease
Crohn’s disease can cause inflammation any part of the GI tract
from the mouth to the anus. However, the lower part of the small intestine
(ileum) and the large intestine (colon) are most often involved. The lining of
the intestines becomes raw and ulcerated with inflammation that can extend
through the entire thickness of the intestinal wall.
Ulcerative
Colitis
Ulcerative colitis is a disease of the colon. Intestinal
inflammation is similar to Crohn’s in that the inside lining of the colon is
diseased, but the bowel injury occurs n the inner lining of the colon and does
not extend deeper into the intestinal wall.
Causes
The actual cause of IBD is unknown but the current scientific
evidence suggests that it is the result of a complex interaction of factors
involving a person’s genes, their immune system and the environment. The immune
system of an individual with IBD can become stimulated by something in the
environment—or by the microorganisms within the gastrointestinal tract. Once
this immune system is stimulated or “turned on” it often does not know how to
turn itself off. The resulting inflammation leads to damage in the
gastrointestinal tract that then leads to symptoms.
Symptoms
IBD symptoms (which are similar for both Crohn’s disease and
ulcerative colitis) can develop gradually or suddenly.
The symptoms of Crohn’s disease vary depending on the severity and
location of the inflammation, and include:
- Abdominal pain
- Lack
of appetite
- Diarrhea
- Weight
loss
- Rectal
bleeding
- Anal
sores/skin tags or perianal abscesses
Ulcerative colitis symptoms often include:
Some children with Crohn’s disease and ulcerative colitis may also
experience rashes, mouth sores, joint pain and growth failure.
Diagnosis
In addition to a thorough medical history and physical
examination, three tests are used to identify IBD:
- Blood
tests
- Radiographic
studies
- Endoscopies
Treatment
Often, the same drugs are used to treat Crohn’s disease and
ulcerative colitis. The main focus of therapy is to help the person’s immune
system control itself and stop the inflammation that is causing damage to the
intestines.
These medications include:
- Drugs
containing mesalamine or 5-aminosalicylic acid (5-ASA) (e.g. Azulfidine®, Pentasa®, Asacol®, Colazal®, Dipentum®, Lialda®, Apriso®)
- Corticosteroids
(e.g. prednisone, budesonide)
- Immunosuppressive
agents (e.g. 6-Mercaptopurine®, Imuran® (azathioprine), methotrexate,
Remicade® (infliximab), Humira® (adalimumab),
Cimzia® (certolizumab)
- Antibiotics
(e.g. metronidazole, ciprofloxacin, rifaxamin)
Dietary therapy at times can have the similar effects as drug
therapy. IBD dietary therapy may include consumption of predigested formula by
mouth or feeding tube. It may also involve not eating altogether, but receiving
nutrition through an intravenous line (total parenteral nutrition/TPN). Dietary
therapies are often used to complement some of the medication therapies.
Surgery may be necessary in Crohn’s disease when medications no
longer control symptoms or when an intestinal obstruction or other complication
arises. In most cases, surgery involves removing the irreversibly diseased
segment of the bowel and then rejoining the two ends of the healthy bowel
together. For ulcerative colitis, surgically removing the entire colon and
rectum is considered a permanent cure. A small opening called an ileostomy is
created in the front of the abdomen, where the remaining small intestine is
attached, to drain liquid waste into a small bag attached to the skin. Later,
the lowest part of the small intestine may be reattached to the anal opening.
Once healed, the ileostomy is closed and feces will move normally through the
anus.