Inflammatory bowel disease (IBD)
Overview of Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a heterogeneous group of bowel disorders characterized by inflammation or ulcerations in the small and/or large intestine.1 Inflammatory bowel disease encompasses two diseases crohn’s disease (CD) and ulcerative colitis (UC). As many as 1.4 million people in the United States and 2.2 million people in Europe suffer from these diseases.2
Both ulcerative colitis and crohn’s disease are heterogeneous disorders of multifactorial etiology in which hereditary and a host of environmental factors interact to produce the disease.3 The disease occurs most commonly in the 20–40 year age group.
Inflammatory bowel disease is generally diagnosed through clinical, endoscopic and histological findings. Management strategies in Inflammatory bowel disease are targeted at reducing or eliminating symptoms, thereby improving the patient’s quality of life. Therapy is tailored to the disease severity, extent and presence of nutritional deficiencies.
Ulcerative colitis: Ulcerative colitis (UC) is a condition in which the inflammatory response and morphologicchanges confined to the colon and the rectum with variable degrees of proximal extension.It typically involves only the innermost GI lining, manifesting as continuous areas of inflammation and ulceration, with no segments of normal tissue.
The histological findings are inflammation of themucosa by polymorphonuclear leukocytes and mononuclear cells,crypt abscesses, distortion of the mucosal glands and gobletcell depletion.
Read more details about ulcerative colitis disease
Crohn’s disease: In contrast, crohn’s disease can involve any part of the GItract from the oropharynx to the perianal area, but is predominantly seen in the terminal ileum and/or colon. The inflammation and ulceration occurs in patches with interspersed areas of healthy tissue leadingto the term ‘skip areas’. Inflammation oftenextends through the serosa, leading to formation of perianal sinus tracts orfistula.
Histological findings include small superficialulcerations and focal inflammation extending to the submucosa, occasionally accompanied by non caseating granuloma.
Read more details about crohns disease
Symptoms of inflammatory bowel disease
The cardinal symptom of ulcerative colitis is bloody diarrhea, whereas patients with crohn’s disease usually present with non-bloody diarrhea.
Other associated symptoms include colicky abdominal pain and tenesmus. As the inflammation increases, systemic symptoms including low-grade fever, malaise and anorexia develop. A severe presentation of ulcerative colitis carries a high mortality and morbidity.1
Symptoms of crohn’s disease are more heterogeneous, but typically include abdominal pain, diarrhea and weight loss. Systemic symptoms are more common with crohn’s disease than ulcerative colitis. Crohn’s disease may cause intestinal obstruction due to strictures, fistulae or abscesses. Both types of inflammatory bowel disease are associated with an increased risk of colonic carcinoma.1
The clinical course of inflammatory bowel disease is marked by exacerbation and remission. Weight loss is more common in crohn’s disease than in ulcerative colitis because of the associated malabsorption.
Both ulcerative colitis and crohn’s disease are associated with
- Extra intestinal manifestations such as delayed growth and sexual maturation in children
- Mucocutaneous lesions
- Arthralgia and arthritis
- Hepatobiliary disease
- Ophthalmologic complications
- Renal disease
Causes of inflammatory bowel disease
Both crohn’s disease and ulcerative colitis result from an inappropriate immune response that occurs in genetically susceptible individuals as the result of a complex interaction among environmental, microbial factors and the intestinal immune system.3
The inflammatory process leads to the mucosal damage and subsequent disturbance of the epithelial barrier function, resulting in an increased influx of bacteria into the intestinal wall.
The onset and reactivation of inflammatory bowel disease triggered by the environmental factors, which transiently break the mucosal barrier and alter the balance between the beneficial and pathogenic enteric bacteria.
The role of two environmental factors has been clearly established. Smoking has been identified as a risk factor for crohn’s disease and a protective factor for ulcerative colitis.2 Appendectomy is a protective factor for ulcerative colitis .3
Other environmental factors, which trigger inflammatory bowel disease include
- Several infectious agents
- Drugs such as nonsteroidal antiinflammatory drugs (NSAIDs) and antibiotics
- Stress and social status (Western lifestyle)
Among above of them, atypical Mycobacteria, oral contraceptives and antibiotics could play a role in the pathogenesis of crohn’s disease .3 Genetic factors seem to have a stronger influence in crohn’s disease than ulcerative colitis.
Diagnosis of inflammatory bowel disease
The diagnosis of Inflammatory bowel disease is confirmed by clinical evaluation and a combination of biochemical, endoscopic, radiological or histological investigations.
The diagnosis of ulcerative colitis is based on
- Clinical suspicion along with appropriate macroscopic findings on sigmoidoscopy or colonoscopy
- Histological findings on biopsy and
- Negative stool examinations for infectious agents
The diagnosis of crohn’s disease depends on
- Demonstrating focal
- Asymmetric and
- Often granulomatous inflammation
Management of inflammatory bowel disease
Treatment of inflammatory bowel disease
The two main goals in the treatment of active Inflammatory bowel disease are the induction and maintenance of long-term remission.
Written by: Healthplus24 team
Date last updated: September 29, 2012