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Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) refers to a group of inflammatory disorders mostly of the large intestine including ulcerative colitis and Crohn’s disease, that cause the intestines to become inflamed.
Although ulcerative colitis and Crohn’s disease have some features in common, there are some important differences.
Crohn’s disease (CD) can involve ongoing (chronic) inflammation of the gastrointestinal tract, from the mouth to the anus, with ulceration and formation of fistulas and perianal abscesses. Five types are recognized, depending on the affected region:
Ulcerative colitis typically involves continuous inflammation from the rectum to the entire colon. The disease usually begins in the rectal area and may eventually spread to the entire large intestine. Repeated inflammation thickens the wall of the intestine and rectum with scar tissue.
More than 600,000 Americans are diagnosed every year with some type of inflammatory bowel disease. Ulcerative colitis may affect any age group, although there are peaks at ages 15 to 30 and at ages 50 to 70. Crohn’s disease may occur at any age, but it commonly affects persons between ages 15 and 35. Risk factors include a family history of Crohn’s disease, Jewish ancestry, and smoking. Men and women appear to be at equal risk of developing IBD. According to the Crohn’s and Colitis Foundation of America, two- thirds to three-quarters of patients with Crohn’s disease will need bowel surgery at some time.
The exact causes of IBD are unknown. The disease may be caused by a germ or by an immune system problem. It is known that IBD is not contagious and it seems to be hereditary. In the case of ulcerative colitis, symptoms vary in severity and may start gradually or suddenly. They usually include all or some of the following:
The exact cause of Crohn’s disease is also unknown, but it has been linked to a problem with the body’s immune system (autoimmune disease). The immune system helps protect the body from harmful foreign substances and pathogens. But in patients with Crohn’s disease, the immune system can no distinguish between the body’s own cells and foreign invaders. The result is an overactive immune response that leads to chronic inflammation. Since Crohn’s Disease can affect any part of the gastrointestinal tract, symptoms can vary greatly between affected individuals. The following may be observed:
The primary goal of treatment is to control inflammation and reduce the symptoms of pain, diarrhea, and bleeding when present. Many types of medicine can reduce inflammation, including antiinflammatory drugs such as sulfasalazine (Azulfidine), corticosteroids such as prednisone, and immune system suppressors such as azathioprine (Imuran) and mercaptopurine (Purinethol). An antibiotic, such as metronidazole (Flagyl), may also be helpful for destroying germs in the intestines, especially for Crohn’s disease. Anti-diarrheal medication, laxatives, and pain relievers may also be prescribed. If symptoms are severe, such as diarrhea, fever or vomiting, hospitalization may be required to administer intravenous fluids and medicines.
In the case of severe ulcerative colitis that can not be helped by medications, a type of surgery called bowel resection may be performed to remove a damaged part of the intestine or to drain an abscess. If a part of the bowel is removed, a procedure is done to connect the remaining two ends of the bowel (anastomosis). In very severe cases, removal of the entire large intestine (colectomy) is required. Bowel resections may also be performed for Crohn’s disease patients.
An exact IBD diet does not actually exist, since no specific diet has been shown to improve or worsen bowel inflammation. However, eating a diet sufficient in energy and balanced in macronutrients and essential micronutrients is important to avoid malnutrition and weight loss. Foods that worsen diarrhea should also be avoided. People who have blockage of the intestines may need to avoid raw fruits and vegetables. Those who have difficulty digesting lactose (lactose intolerance) also need to avoid milk products. The following guidelines, upon approval by the treating physician or a registered dietician, can help prevent malnutrition and extreme weight loss:
The management of IBD depends on the type diagnosed and pharmacologic and other therapies are accordingly tailored to individual cases, depending on severity and patient history. This also requires careful selection of therapeutic agents based on symptom severity and drug side effects. Since IBD is a chronic illness with an important and unpredictable impact on a person’s life, an effective therapy usually requires much more than the simple treatment of symptoms. Patient cooperation is crucial for improvement, as dietary and lifestyle changes have been shown to be beneficial. Whatever the symptoms, patients also need to get enough rest while learning to manage the stress in their lives, as intestinal problems tend to get worse in overly stressed persons. The Crohn’s and Colitis Foundation of America (CCFA) can provide patient information on IBD and support groups that can often help with the stress of dealing with IBD, with useful tips for finding the best treatment and coping with the disease.
The outcome of the ulcerative colitis is variable. It may be dormant and then worsen over a period of years, or progress quickly. The risk of colon cancer increases after ulcerative colitis is diagnosed.
There is no cure for Crohn’s disease, but it is not a deadly illness. Periods of improvement are often followed by flare-ups of symptoms. People with Crohn’s disease have an increased risk of small bowel or color-ectal cancer.
IBD is not considered preventable, and once it occurs it is a lifelong disease. However, it is possible to prevent IBD secondary complications. For instance, depression is a common problem in people diagnosed with IBD. This may be the result of the underlying diagnosis or the medications used to treat these chronic inflammatory processes. Specific information is available for patients and their families about ways to manage their condition and treatment and prevent themselves against becoming depressed.
Sklar, J. The First Year: Crohn’s Disease and Ulcerative Colitis: An Essential Guide for the Newly Diagnosed. New York, NY: Marlowe and Company, 2007.
Dalessandro, T. M. What to Eat with IBD: A Comprehensive Nutrition and Recipe Guide for Crohn’s Disease and Ulcerative Colitis. New York, NY: iUniverse (Barnes and Noble), 2006.
Zonderman, J., Vender, R. S. Understanding Crohn Disease and Ulcerative Colitis. Jackson, MS: University Press of Mississippi, 2006.
Targan, R. T., Shanahan, F., Karp, L. C., eds. Inflammatory Bowel Disease: From Bench to Bedside. New York, NY: Springer, 2005.
Kane, S. V., Dubinsky, M. C., eds. Pocket Guide to Inflammatory Bowel Disease. Cambridge, UK: Cambridge University Press, 2005.
Scala, J. The New Eating Right for a Bad Gut : The Complete Nutritional Guide to Ileitis, Colitis, Crohn’s Disease, and Inflammatory Bowel Disease. London, UK: Plume Books (Penguin Group), 2000.
Hanauer, S. B. Inflammatory Bowel Disease: A Guide for Patients and Their Families. Philadelphia, PA: Lippin-cott Williams & Wilkins, 1999.
American Gastroenterological Association. 930 Del Ray Avenue, Bethesda, MD 20814. (301)654-2055. <www.gastro.org>.
Cleveland Clinic Foundation. 9500 Euclid Ave. NA31 Cleveland, OH 44195. Department of Patient Education and Health Information: 1-800-223-2273). <www.clevelandclinic.org/health/>.
Crohn’s and Colitis Foundation of America. 386 Park Avenue South, 17th Floor, New York, NY 10016. 1-800-932-2423. <www.ccfa.org>.
International Foundation for Functional Gastrointestinal Disorders Inc. P.O. Box 170864, Milwaukee, WI 53217-8076. 1-888-964-2001. <www.iffgd.org>.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 31 Center Drive, MSC 2560, Bethesda, MD 20892-2560. 1-800-891-5389. <digestive.niddk.nih.gov/ddiseases/pubs/facts/index.htm>.
Monique Laberge, Ph.D.