Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) involves inflammation of the intestines and is a chronic (long-lasting) illness. The two major types of IBD are ulcerative colitis and Crohn's disease. Ulcerative colitis affects the lining of the large intestine (colon) and/or the rectum. Crohn's disease affects deeper layers of tissue and can occur in any part of the digestive system, although it occurs most commonly in the lower part of the small intestine (ileum).

What Is Inflammatory Bowel Disease?

Inflammatory Bowel Disease (IBD) encompasses several diseases caused by inflammation ^* of the intestinal tract. The different types of IBD have many symptoms in common, including abdominal pain, frequent diarrhea

(sometimes with blood and mucus), constipation, weight loss, fatigue, and fever.

Why some people get IBD is not clear. What is known is that IBD is not passed from person to person. However, up to 25 percent of people with IBD have a relative with the disease, suggesting that genetic factors play a role in its development. Some researchers believe that IBD occurs because a virus or bacterium triggers an inappropriate response from the immune system in people who have a genetic tendency for the disease. This response causes the digestive tract to become inflamed.

What Are the Different Types of IBD?

The two major types of inflammatory bowel disease are ulcerative colitis and Crohn's disease.

Ulcerative Colitis

Ulcerative colitis is sometimes referred to as colitis or proctitis. Ulcerative colitis is a disease that occurs when the lining of the large intestine and/or rectum become inflamed. Usually tiny open sores, or ulcers, develop on the intestine or rectum wall. These sores often result in bloody diarrhea. Substantial blood loss can occur. People with ulcerative colitis often have symptoms that affect other areas of the body. These may include inflammation of the joints (arthritis) or the eye, skin rashes and mouth ulcers, liver disease, osteoporosis ^* , and anemia ^* caused by blood loss.

Most people who develop ulcerative colitis are between the ages of 15 and 40. The severity of the disease varies from person to person. Some people seldom have an attack of symptoms. Others have almost continuous attacks that interfere with their daily activities.

Experts agree that having ulcerative colitis increases the risk of getting colon cancer. The longer a person has ulcerative colitis and the larger the part of the digestive system involved, the greater the risk of developing colon cancer.

Crohn's Disease

Crohn's disease is sometimes referred to as ileitis or enteritis. Crohn's disease is an inflammation that extends deep into the tissues of the digestive system. Although this inflammation can be found anywhere in the digestive tract, most often it is found in the lower end of the small intestine where the small intestine connects to the large intestine. Ulcers often appear in patches separated by stretches of normal tissue.

There are many conflicting theories about what causes Crohn's disease. Men and women seem to get Crohn's disease in equal numbers, and about 20 percent of people with the disease have a relative who also has it. Many people with Crohn's disease have abnormalities in their immune system, but it is not known if these abnormalities are the cause of the disease or the result of it.

Crohn's disease is a chronic condition that varies from person to person in severity. In severe cases, the disease can cause major loss of blood, and it can interfere with food intake and absorption of nutrients ^* from the intestine. Children with Crohn's disease may develop slowly and not reach their full growth potential because their bodies do not get enough nourishment for normal growth. Adults also may have problems with getting adequate nutrition because of the disease.

The most common complication of Crohn's disease is a blockage of the intestine. Crohn's disease causes the intestinal walls to swell and thicken with scar tissue that may eventually prevent the movement of materials through the intestine. In some people, the ulcers expand into the tissues that surround the digestive system, creating a high risk of additional infection. As with ulcerative colitis, Crohn's disease can affect other parts of the body with symptoms such as arthritis, skin rashes, mouth sores, eye problems, kidney stones, anemia, or liver diseases.

How Is IBD Diagnosed?

A medical history, physical examination, and diagnostic tests are problems required to diagnose IBD. Blood samples may be taken to look for evidence of anemia and infection. Examination of stool samples for the presence of blood also may help the doctor make a diagnosis.

Often the colon is examined through a procedure called a colonoscopy. An endoscope (a lighted flexible tube and camera attached to a television monitor) is inserted through the anus. This allows the doctor to see the inside lining of colon and rectum. Sometimes during the colonoscopy a tissue sample (called a biopsy) is taken from the intestine lining for further examination under a microscope.

Another diagnostic procedure a physician can use is a barium study. A person drinks a mixture of barium that is flavored with another liquid, and then the person is x-rayed. Because barium shows up on x-rays, the doctor can detect abnormalities as the mixture flows through the person's intestines. CT scans ^* may be useful in evaluating the progress of the disease once it has been diagnosed.

How Is IBD Treated?

Medication and diet are the two primary approaches to controlling IBD. They do not cure the disease, but are effective in reducing symptoms in the majority of people. In severe cases of IBD, surgery may be necessary. Anti-inflammatory drugs often are used to help control the inflammation caused by the disease. In some cases, immunosuppressant drugs may be helpful in controlling symptoms that do not respond to anti-inflammatory drugs. Antibiotics often are used to treat Crohn's disease. In addition, several experimental drug therapies are under investigation.

Many of the drugs used to treat IBD are powerful and may have undesirable side effects. The physician must balance the undesirable side effects against the positive benefits of the drugs, sometimes trying several different drug combinations before a successful balance is reached.

Diet

In addition to drug therapy, a special diet may be prescribed by the physician. Since IBD interferes with the absorption of nutrients from the intestines, people with the disease often must increase the amount of calories, vitamins, and minerals they consume. Some individuals find that they must avoid specific foods that aggravate their symptoms. Other people find a bland, low-fiber diet offers some relief. Because there is no cure for IBD, people with any form of the disease should receive regular medical examinations that include a review of their treatment and diet.

Surgery

In severe cases of IBD, when damage has occurred to parts of the intestinal tract, a person may need surgery to remove damaged sections of the intestines. About 20 percent of people with ulcerative colitis require surgery at some point in their lives. If necessary, ulcerative colitis may be treated by surgery that removes the entire colon and rectum. After this procedure, normal bowel movements are not possible, so the small intestine is given a surgically created opening (ostomy) through the lower abdomen. This opening is covered with a bag that collects waste and must be emptied several times a day.

About 70 percent of people with Crohn's disease eventually need to have damaged areas of the colon removed. Removing the damaged parts does not cure Crohn's disease, because the inflammation may return in other places in the colon. Many people with Crohn's disease need additional surgery because the symptoms reappear.

Living with IBD

There is no cure for inflammatory bowel disease, but people with IBD often go for substantial periods of time when they feel well and have few symptoms. During these times they are able to hold jobs, raise families, and participate in normal daily activities. Throughout the United States, there are support groups for people with IBD that help them learn to cope with their illness and maintain a normal, happy life.