Inflammatory Bowel Disease

Inflammatory bowel disease is a collective term for a group of conditions which affect both the large and small intestines. It is distinct from irritable bowl syndrome which is a less serious condition. Inflammatory bowel disease is often simply referred to as IBS

The two main types of inflammatory bowel disease are ulcerative colitis and Crohn’s disease, but other, less, common types d occur. Including, but not limited to: diversion colitis, infective colitis, collagenous colitis, ischaemic colitis, indeterminate colitis and lymphocytic colitis.

The primary difference between the two main forms of inflammatory bowel disease, ulcerative colitis and Crohn’s disease, is the the location of the problem and the nature of the inflammation in each case. Crohn’s disease can affect anywhere along the intestinal tract from the mouth to the anus, although in most cases it begins in an area called the terminal ileum.

Ulcerative colitis on the other hand, occurs exclusively in the colon and anus, and particularly to the epithelial lining of the gut, commonly referred to as the mucosa. Crohn’s disease, in contrast, may effect the entirety of the wall of the bowel.

Additionally, Ulcerative colitis and Crohn’s disease tend to present with different additional symptoms in differing degrees of seriousness, including liver problems, eye problems, skin conditions and sometimes arthritis.

Rarely, an unlucky patient will suffer from both ulcerative colitis and Crohn’s disease simultaneously, an incidence which is referred to as Crohn’s colitis.
Crohn’s disease is chronic, meaning that there is no cure. Patients may experience remission, but the symptoms will always return after a period of time. In this sense then, it is also episodic.

A patient with Crohn’s disease will suffer from an inflammation of the gastrointestinal tract which affects the whole of the bowel wall. Because it can affect any part of the gastointestinal tract, from the mouth to the anus, symptoms of Crohn’s disease can vary a great deal. But the main warning signs are abdominal pain (which may be serious), diarrhea (often bloody) and weight loss. It can also lead to external complications such as eye inflammation or skin rash, and to arthritis.

Crohn’s disease is so named because it was popularized by the gastroenterologist Burrill Bernard Crohn in America in 1932, although a Polish scientist observed and described the same disease in 1904.

Crohn’s disease sufferers are currently thought to number anywhere between 25 and 48 per hundred thousand people in the developed world. It usually manifests during a person’s teenage years or early twenties, but the elderly are also at increased risk of developing the disease. There is also known to be a genetic risk, with Crohn’s being passed down generationally and affecting both men and women equally.

Although the exact cause of Crohn’s disease is not yet known, it is thought to be an autoimmune disease with a genetic component, caused by a person’s own immune system causing inflammation in the gastrointestinal tract, and thereby damaging it.

There is no current cure for Crohn’s disease, either medically or surgically, and treatment is focussed around the relief of symptoms and managing the disease to hopefully keep it in remission for as long as possible. In order to achieve this aim, immunomodulators such as methotrexate or azathioprine may be deployed, as well as newer drugs like infliximab.

Ulcerative colitis is a specific form of colitis, which is a disease of the intestine, and particularly the colon, which is characterized by open sores or ulcers in the large intestine. The characteristic symptom of ulcerative colitis is bloody diarrhea, which may begin mildly and become more severe as the disease flares up. Despite the localization of ulcerative colitis, the condition can affect a variety of other parts of the body in different ways.

Like Crohn’s disease, it is a relapsing remitting condition, and patients who are not completely cured will usually experience long periods free of symptoms, punctuated by relatively short periods of inflammation. Ulcerative colitis can often go into remission by itself, but in many cases medical assistance may be needed. In any case of experiencing diarrhea with blood, a patient should go to their healthcare provider as a matter of urgency, as bloody diarrhea may be indicative of a number of other conditions, including bowel cancer.

Ulcerative colitis is a relatively rare condition, and it is thought that around one person in every ten thousand in the developed word suffers from the disease. It has a genetic component, and is more prominent in white people and particularly people of Jewish descent. There is no known cause which is thought to bring about the onset of ulcerative colitis, but it is generally accepted that environmental factors, including diet, may contribute to the onset of the disease in patients who are already susceptible genetically.

Ulcerative colitis is broadly treated as though it were an autoimmune disease and using immunosuppressant and anti-inflammatory drugs, but there is no agreement on the notion that it can be classified as an autoimmune disease as such.

Drug therapy targets different components of the body’s immune response in an attempt to control symptoms and bring about remission. In more severe cases, surgery may be required in the form of a colectomy, which is when either part or the entirety of the colon is removed and replaced with an artificial system of bodily waste removal. After surgery has been undertaken, the patient is considered to be ‘cured’ of the disease.

Inflammatory bowel disease, whether in the form of ulcerative colitis, Crohn’s disease, or any of the other forms of IBD, are not usually fatal illnesses, but complications may occur that can make them very dangerous, including tearing or perforation of the colon, or toxic megacolon, a condition where the entire colon begins to straighten itself out.

Toxic megacolon will lead to death if not treated immediately. Generally speaking though, inflammatory bowel diseases will be limited to unpleasant symptoms such as abdominal pain, vomiting and bloody diarrhea.

Sufferers of inflammatory bowel diseases are at increased risk of developing colorectal cancer, but this risk is offset somewhat by the fact that they will probably be receiving regular screening and monitoring of their existing medical condition, and so any signs of cancer are likely to be spotted early and dealt with safely.

Recent thoughts about inflammatory bowel disease are that it may be caused by over-active immune systems attacking the body’s own tissue because they lack traditional targets such as worms and parasites, due to modern diet, lifestyle and levels of hygiene. In support of this theory, the disease becomes roughly proportionally less common in countries where the prevalence of worms and parasites is higher.

Prebiotic and probiotic treatments, such as those available over the counter or in popular foodstuffs, are thought to have a beneficial effect in cases of IBD, and there are some recent studies to support this theory.