Inflammatory Bowel Disease
What is inflammatory bowel disease?
Inflammatory bowel disease (IBD) occurs when inflammation in the small intestine and colon produces redness, bleeding and pus, which, in turn, cause such symptoms as diarrhea. Inflammation impairs the colon’s ability to hold its contents, resulting in frequent elimination. IBD includes two distinct conditions, ulcerative colitis and Crohn’s disease. Although both conditions involve inflammation and produce somewhat similar symptoms, in Crohn’s disease, the inflammation can extend to other organs in the digestive tract, including the stomach and esophagus, while ulcerative colitis specifically affects the colon (large intestine).
IBD can affect one side of your colon or your entire colon. Left-side colon involvement is called limited, or distal, colitis. Ulcerative proctitis describes inflammation occurring in the lower part of the colon and rectum. Ulcerative colitis is confined to the superficial mucosal layer that lines the large intestine. Crohn’s disease affects the full thickness of intestine, resulting in significant scarring and fistula formation.
Both forms of IBD affect young adults, with disease onset usually occurring between ages 15 and 30 years, and less commonly between 50 and 70 years of age for ulcerative colitis. Crohn’s disease is diagnosed most commonly in people from most commonly 20 to 30 years of age. IBD can run in families, with at least 20% of people affected having a family member with the condition. The prevalence of ulcerative colitis is higher in Caucasians and people with Ashkenazi (Eastern European) Jewish ancestry (Source: NDDIC).
Inflammatory bowel disease itself is not an emergency situation, but prolonged diarrhea, a common symptom, can result in serious dehydration or complications. Seek immediate medical care (call 911) for serious symptoms, such as severe abdominal pain, inability to pass gas or stool, and vomiting or vomiting blood.
Seek prompt medical care if you are being treated for inflammatory bowel disease, but mild symptoms recur or persist.
What are the symptoms of inflammatory bowel disease?
Symptoms of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, primarily affect the digestive tract and include appetite loss, diarrhea, weight loss, rectal bleeding, nausea, and abdominal cramping. Persistent diarrhea can cause malnutrition, weakness, and electrolyte imbalances; younger individuals may be small or experience delayed growth.
Common symptoms of IBD
- Bloody stool (the blood may be red, black, or tarry in texture)
- Loss of appetite
- Low red blood cell count (anemia)
- Nausea with or without vomiting
- Skin lesions
- Unexplained weight loss
Extraintestinal symptoms of IBD
A small percentage of people who have IBD will have symptoms involving other organs or areas of the body including:
Serious symptoms that might indicate a life-threatening condition
In some cases, inflammatory bowel disease can produce continuous diarrhea that can cause severe and sometimes life-threatening dehydration or other serious symptoms. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
- Inability to pass gas or stool
- Severe abdominal pain
- Vomiting or vomiting blood
What causes inflammatory bowel disease?
The exact cause of inflammatory bowel disease (IBD) is not known. It is known to run in families and is more prevalent in certain groups, such as people of Ashkenazi Jewish descent. It may have an autoimmune component, in which the immune system, which normally protects us from harmful invaders, interprets foods and other substances as “foreign” and launches an immune response. This reaction results in the release of antibodies and white blood cells into the intestines, which leads to inflammatory symptoms and ulcerations. It is not known why the immune system perceives food as an invader, but high levels of the tumor necrosis factor (TNF), a protein released by the immune system, are found in people with Crohn’s disease.
What are the risk factors for inflammatory bowel disease?
A number of factors increase the risk of developing inflammatory bowel disease (IBD). Not all people with risk factors will get IBD. Risk factors for IBD include:
- Family history of IBD
- Consumption of excess dietary fats, protein and refined sugar
- Family history of IBD
- Jewish ancestry
- Previous bout of acute bacterial gastroenteritis (Crohn’s disease)
- Retention of appendix (appendectomy is protective for ulcerative colitis)
- Smoking (Crohn’s disease)
- Use of NSAIDs (ulcerative colitis)
How is inflammatory bowel disease treated?
Currently, there is no cure for inflammatory bowel disease (IBD). The goal of treatment is to ease the symptoms, remedy the nutritional deficiencies, and reduce the number of recurrences, or flare-ups. Medication and surgery are used to manage the symptoms of IBD.
Medications include steroids to reduce the inflammation. These are often combined with immunosuppressants, which are drugs that suppress the immune response. This combination can be effective and enhances the efficacy of steroids, reducing the dosage required. However, immunosuppressants can limit your body’s ability to fight infections.
Medications for IBD
Medications used to treat IBD include:
Anti-inflammatory agents, such as sulfasalazine (Azulfidine) and mesalamine (Pentasa, Asacol)
Anti-TNF antibody such as infliximab (Remicade), which helps suppress the immune system
Fluid and nutritional supplements
Immunosuppressants, such as azathioprine (Imuran) and 6-mercaptopurine (Purinethol)
Surgery for IBD
Surgery is performed in more advanced cases of IBD or in patients whose symptoms cannot be controlled by medication. Two-thirds of patients with Crohn’s disease will need surgery at some point.
Surgical procedures include:
Bowel resection, in which the diseased section is removed
Colectomy, in which one segment or the entire colon is removed
Some complementary treatments may help some people in their efforts to deal with IBD. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.
Complementary treatments may include:
Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
What are the potential complications of inflammatory bowel disease?
Complications of untreated or poorly controlled inflammatory bowel disease (IBD) can be serious. You can help minimize your risk of serious complications by following the treatment plan that you and your health care professional design specifically for you.
Gastrointestinal complications of IBD include:
Dehydration and electrolyte imbalance due to long-term diarrhea
Fissures (tears in the rectum)
Fistula (abnormal hole or tube between organs or tissues, which can become seriously infected and cause other problems)
Skin ulcerations around the anus and colon
Other complications of IBD include: