Irritable Bowel Syndrome (IBS)
Inflammatory Bowel Disease affects 1.4 million Americans, with the onset of symptoms observed between ages 15-80, with a bimodal distribution. While research has not found an exact cause of IBD, it is thought to be a result of a combination of genetics, environmental factors and abnormal mucosal immune response.
We hear of IBD (Inflammatory Bowel Disease) and IBS (Irritable Bowel Syndrome) interchangeably, but these two words have very different meanings, symptoms, causes and treatments. We also hear these two diagnoses with words like intestinal granulomas, strictures, fistuals, and Transmural inflammation, but what does it all mean?
Definitions Inflammatory Bowel Disease (IBD) is differentiated from Irritable Bowel Syndrome (IBS) by recurring symptoms of abdominal pain, bloating, and altered bowel function due to inflammation in some part of the intestines. IBD affects the digestive tract, or the part of the body that takes in and breaks down food.
When the body is working normally, the immune system kills germs and “bad” cells that could turn into cancer, but with Inflammatory Bowel Disease, the body attacks the healthy cells of the lining in the digestive tract. This is called “autoimmune response,” and causes inflammation, leading to sores (ulcers), bleeding, strictures, obstruction, and abscesses requiring surgical resection.
Crohn’s disease is a form of IBD that can involve any part of the gastrointestinal tract, but most commonly affects the end of the small bowel and the beginning of the colon, affecting the deeper layers of the digestive lining.
Symptoms of Crohn’s disease include:
- Abdominal pain
- Weight Loss
- Mouth sores
- Eye inflammation
- Skin rash
- Fistula (abnormal connection between an organ, vessel or intestine and another structure)
Like Crohn’s disease, Ulcerative Colitis (UC) is an autoimmune response dveloping from inflammation in the digestive tract. However, UC almost always affects the rectum and lower part of the colon, but can affect the entire colon called pancolitis. This inflammation causes ulcers, or open sores, leading to bleeding and diarrhea.
Symptoms of Ulcerative Colitis include:
- Bloody diarrhea (typically small volume)
- Mucus discharge from the rectum
- Mild, crampy abdominal pain
- Incomplete sensation of bowel evacuation
- Inflammation of large joints such as the hips of knees causing swelling and pain
- Inflammation of the eyes and skin
- Weight loss
Both Crohn’s Disease and Ulcerative Colitis are diagnosed based on symptoms, a physical examination, and laboratory tests. In addition, most physicians will suggest one of two procedures; a colonoscopy or sigmoidoscopy. Using a camera on the end of a flexible tube inserted into the rectum, physicians examine the inside of the colon and take tissue samples to confirm for Ulcerative Colitis while the patient is sedated. A sigmoidoscopy examines the rectum and lower part of the colon, whereas a colonoscopy examines the entire colon.
While physicians are not sure what cause IBD, there are treatments to help symptoms and prevent symptoms from coming back, or maintaining remission.
Treatments vary on which part of the digestive tract is causing symptoms, but commonly used medications include 5-aminosalicylates (5-ASA), antibiotics, steroids (topical and systemic), immunomodulators, and biologic agents. 5-aminosalicylates are a group of medications that reduce inflammation in the digestive tract. Antibiotics work by reducing the number of bacteria in the intestines, thus easing inflammation. Steroids may be prescribed if the above medications do not help with symptoms; however steroids are only used for a limited time because of the side effects. If you have severe symptoms, immunomodulators are prescribed which also reduce inflammation. Biologic agents are medications given through an IV such as Remicade, or through injection such as Humira and Cimzia.
Patients with Crohn’s disease and Ulcerative Colitis will most likely need lifelong treatments, however they are able to live fairly normal lives. Recommendations for patients with IBD are to eat well, avoiding processed food, fried foods, and high sugar because they are associated with increased risk of developing Crohn’s and possibly Ulcerative Colitis. Patients should avoid stress, smoking, nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin and Advil) and naprosyn (Aleve) as they can worsen symptoms. Most importantly, keep your Gastroenterologist informed of any changes in symptoms.
While physicians are not sure what cause IBD, there are treatments to help symptoms. If you suffer from one or more of these symptoms and would like more information, please contact us.
Find out more information about IBD in Dr. Fleisher’s article.