Inflammatory bowel disease affects predominantly young adults, sometimes with dramatic effects. They can suffer acute toxic dilatation of the colon (large bowel), or become painfully thin and ill as a result of complications of Crohn's disease.

For this reason treatment of this distressing group of illnesses continues to attract intense interest among GIT specialists.

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is a collective term for a group of chronic inflammatory conditions of unknown cause which affect the gastrointestinal tract.

They are generally divided into two main groups:

  • Ulcerative colitis — regarded as a chronic non-specific entity affecting the gastrointestinal tract from the mouth to the small bowel. It can also affect the anal region where it is known as ulcerative proctitis.

  • Crohn's disease — usually affecting only the small bowel, but can exist in the colon or large bowel, where it is called Crohn's disease of the colon. Another name for this disease is regional enteritis.

    The clinical pattern in these disorders is of a recurrent inflammatory process involving different parts of the intestine with diverse clinical patterns which result in a chronic and unpredictable course.

    Who gets inflammatory bowel disease?

    There is no real difference in the pattern of incidence of Crohn's disease and ulcerative colitis.

    Both are more common in people of Caucasian origin than in black people and Asians. Those of Jewish origin are six times more likely to cotract inflammatory bowel disease.

    Men and women are equally affected.

    Ulcerative colitis is slightly more common than Crohn's disease, affecting between 70 to 150 people per 100 000. Crohn's disease affects between 20 and 40 people per 100 000.

    The peak incidence of the disease is between the ages of 15 and 35, but it has been reported in every decade in life.

    Both Crohn's disease and ulcerative colitis can run in families with estimates that between 2 and 5 percent of people with either disease will have others in the family similarly affected. However, these family clusters suggest either a genetic or an environmental relationship, and most people think that there is a combination of hereditary and environmental factors involved.

    What causes inflammatory bowel disease?

    No cause is yet known for these diseases. However, the relationship of IBD to certain things may suggest certain predisposing factors.

    Inflammatory bowel disease is a lot more common in Caucasians and Jews, and occurs in clusters in families. This suggests that there may be a genetic predisposition to developing the disease. So far no search for a genetic marker has been successful.

    Some people think that there may be an infectious cause, although no organism, bacterial or fungal, has yet been identified.

    There are a number of other problems which occur in conjunction with inflammatory bowel disease such as arthritis and eye problems, which suggest that there may be an auto-immune component to the disease. That is, the body is using its own immune defences against itself.

    There definitely seems to be a psychological component to these disease as well, with many people experiencing either their first episode or a flare up at the same time as extreme emotional stress. There is no evidence that directly implicates possible emotional factors in the cause of this disease. However, experiencing a chronic disease of unknown cause, often in the most productive years of life, will definitely take its toll of anyone. Emotional responses to the illness are bound to affect both the course of the disease and the response to treatment.

    Ulcerative colitis

    The main symptoms of ulcerative colitis are bloody diarrhoea and stomach pain often with fever and weight loss in the more severe cases. In mild disease there may be loose stools containing little blood, with no systemic symptoms such as fever.

    In severe cases of the disease the patient may have frequent bowel actions containing blood and pus, severe stomach cramps and be dehydrated, anaemic, and suffer fevers and weight loss.

    In cases in which mainly the rectum is involved, constipation rather than diarrhoea may be the main feature.

    Sometimes the disease may present mainly with fever, weight loss and one or more of the non-instestinal manifestations of the disease.

    Non-intestinal manifestations of ulcerative colitis include arthritis, skin changes, or evidence of liver disease.

    The clinical course is variable. Most people will relapse within one year of the first attack. However, some may have long periods of remission with only minimal symptoms. Generally the more severe the symptoms, the worse the inflammation in the gut.

    Most (85 percent) patients with ulcerative colitis have a fairly mild disease, occuring intermittently, which can be managed without hospital care. In about 15 percent of cases the disease is more severe, involving the whole colon. These patients are at risk of developing toxic dilatation of the colon which is an emergency.

    Crohn's disease

    The area of the gut in which Crohn's disease occurs will determine what type of symptoms are associated with it.

    The main clinical features of Crohn's disease are fever, stomach pain, diarrhoea, often without blood, and generalised tiredness and malaise.

    If the large bowel, or colon, is involved, then the main feature is bloody diarrhoea and pain. Rectal bleeding is less common than with those with ulcerative colitis. However, there may be major anorectal complications such as fissures and fistulas (effectively holes from the rectum to the surrounding skin), and abscesses. These features may occur before the inflammation in the rest of the bowel and should raise the suspicion that Crohn's disease is present.

    The non-abdominal manifestations which occur with ulcerative colitis also occur with Crohn's disease, and are more common when the inflammation involves the large bowel.

    Complications of Crohn's disease include intestinal obstruction, fistula formation and occasionally perforation, although this is uncommon.

    How is inflammatory bowel disease diagnosed?

    A diagnosis of inflammatory bowel disease should be suspected in anyone with diarrhoea, with or without blood, persistent infections in the perianal area and abdominal pain. The non-abdominal manifestations such as fever and weight loss may also be useful.

    Actual examination and biopsy of the gut is the most important part of diagnosis, and will allow a distinction between ulcerative colitis and Crohn's disease since the characteristic pathology of both is different.

    Contrast X-ray techniques are also used.

    Complications of inflammatory bowel disease

  • Perforation of the bowel is more common in ulcerative colitis than in Crohn's disease because of the different way in which the bowel is affected.

  • Cancer of the colon is more common in those with inflammatory bowel disease than in the general population, particularly in those with extensive involvement of the bowel and who have had the disease for a long time. The incidence of colon cancer arising along with long standing inflammatory bowel disease is less in those with Crohn's disease than in those with ulcerative colitis. Patients with severe, extensive and/or longstanding inflammatory bowel disease, are generally screened for possible cancer. If precancerous signs are found then the colon is be removed.

    Non-intestinal signs of inflammatory bowel disease

    Why people get other symptoms along with inflammatory bowel disease is unknown. However, they are common with both Crohn's disease and ulcerative colitis and may occur in conjunction with the symptoms of bowel inflammation or on their own, which can sometimes complicate diagnosis.

  • Joint problems are common, occuring in about 25 percent of patients. They may range from mild aches and pains to acute arthritis with painful, swollen joints. The milder form of the arthritis correlates with the activity of the underlying bowel disease. However,a particular type of ankylosing spondylitis may be associated with inflammatory bowel disease, which may occur many years before the bowel disease shows itself, and persist when the bowel disease is in remission.

  • Skin manifestations are more common with disease of the large bowel. These occur in about 15 percent of people and occurrence is a reflection of the activity of the bowel disease. They consist of the characteristic rashes of chronic illness, such as erythema nodosum, which are also seen in other types of illness.

  • Eye problems are found in about 5 percent of patients, and are generally a sign of severe disease, and often improve when the bowel problems are treated.

  • Abnormal liver function is common in inflammatory bowel disease, but will often have no effect on the patient, except in severe disease.

    How is inflammatory bowel disease treated?

    In such a complex constellation of disease treatment is obviously complicated, and ranges from medical to surgical treatment.


    RSS
    Digg
    de.li.cious
    facebook


    Print this page
    Send this article to a friend