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Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of the digestive tract. The two main disorders within the umbrella term of IBD are Ulcerative colitis and Crohn’s disease. Patients with IBD can experience severe symptoms such as gastrointestinal tract (GI) tract inflammation, abdominal pain and cramping, and irregular bowel movements among other symptoms. It is estimated that 1 million Americans suffer from IBD.
To learn more about Crohn’s disease, visit the Crohn’s disease condition center, or check out our slideshow about Crohn’s and the microbiome.
To learn more about ulcerative colitis, visit the ulcerative colitis condition center.
Though there is not yet a definitive cause of Crohn’s disease, recent research suggests that it is caused by an immune response to the body’s natural digestive bacteria, which may be triggered by a combination of environmental factors and genetic disposition.
A healthy gastrointestinal (GI) tract is lined with a mucosal membrane filled with bacteria that assist in digestion and absorption. It is believed that in individuals with Crohn’s disease, there is an abnormal immune response against the gut bacteria, interfering with their ability to aid in digestion and compromising the integrity of the protective mucus membrane in which they exist. The immune response attracts immune cells to the affected area in the gastrointestinal tract, causing chronic inflammation and potentially permanent damage to the tissue of the affected areas. Research has shown that this may be caused by a genetic mutation that decreases the natural defense mechanisms of the bacteria or by a genetic pre – disposition to auto – immune diseases. Crohn’s can occur anywhere in the digestive tract.
In ulcerative colitis, sores known as ulcers develop on the innermost lining of the colon, interfering with its ability to absorb liquid. This can cause diarrhea, and, as the ulcers worsen, bleeding, pus production, abdominal discomfort, and complete destruction of the inner lining of the colon. Medical experts are unsure of the exact cause of the ulcers and colon inflammation, but they are focusing on these factors:
UC is not caused by emotional distress, but the stress of living with UC may worsen symptoms. In addition, while sensitivity to certain foods or food products does not cause UC, it may trigger symptoms in some people. UC usually occurs in the large intestines.
There are several risk factors known to contribute to the likelihood of developing Crohn’s disease. These include:
Risk factors for ulcerative colitis include:
There is no single test to diagnose Crohn’s disease. To make a diagnosis, doctors most commonly rely on a combination of diagnostic tests, including:
Ulcerative colitis (UC) can be difficult to diagnose because it has symptoms similar to those of other intestinal disorders, especially Crohn’s disease. The NDDIC says Crohn’s disease differs from UC in that Crohn’s disease causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system, including the small intestine, mouth, esophagus, and stomach, while ulcerative colitis affects only continuous stretches of the inner most colon lining.
Your doctor will make a diagnosis of ulcerative colitis based on the following:
During these procedures, your doctor may wish to obtain a sample of affected tissue, called a biopsy. Biopsied tissues are then sent to a laboratory to help confirm a diagnosis and to rule out other diseases such as colon cancer.
The symptoms of Crohn’s disease vary in severity and can be different based on where the inflammation is located in the GI tract.
The main symptoms of Crohn’s are:
The severity of ulcerative colitis symptoms can vary from patient to patient.
Common UC symptoms include:
About 10% of people with ulcerative colitis experience severe symptoms. These include:
The prognosis for Crohn’s disease varies from case to case. Some people experience only one episode (flare – up), and others suffer continuously. Up to 20 percent of patients experience chronic Crohn’s disease. In rare cases, disease – free periods last for years or decades. Although Crohn’s cannot be cured even with surgery, treatments are available that can offer significant help to most patients. Crohn’s disease is rarely a direct cause of death, and most people can have a normal lifespan with this condition. [NOTE: hyperlink to medications and treatments section]
Ulcerative colitis tends to go between periods of flare – ups and periods of remission. About 10 percent of people have serious complications (such as perforation or massive bleeding) after their first flare – up, and approximately 10 percent of people never have another flare – up after their first. Anywhere from 10 percent to 40 percent of patients with ulcerative colitis will require surgery to treat their disease. Surgery always involves the complete removal of the colon; partial removals are not done because the colitis will recur in the portion of the colon that remains.
Colon cancer develops in about 5% of people with UC. Risk of colon cancer is increased when the entire colon is affected over a period of years. According to the NDDIC, if only the lower colon and rectum are involved, the risk of cancer is no higher than that of a person without UC. Dysplasia, the accelerated growth of a concentration of abnormal cells, is often a precursor to colon cancer in patients with UC. UC patients are regularly monitored for dysplasia, and the removal of polyp growths can prevent the development of cancer in some cases.
Living with IBD can be stressful. Developing strategies to help you cope with your disease can make life easier. Here are some tips:
Because IBD is relatively rare and symptoms themselves early on, screening for IBD is not regularly done. If you experience any of the symptoms of IBD, schedule a visit with your doctor. He or she will be able to conduct several diagnostic tests to see if your symptoms are indeed a result of IBD.
The exact causes of IBD are not known, so there is no prevention. However, it does appear that flare-ups might be related to stress. Dealing with stress through methods such as meditation, biofeedback, deep breathing, and yoga, may help prevent flare – ups.
Crohn’s disease cannot be cured, but appropriate treatment can help suppress the inflammatory response and manage symptoms. The risk of side effects for each medication is generally proportional to the degree of the disease’s severity. Drugs with relatively few side effects are used in the earliest stages of treatment, with the aim of not worsening a patient’s condition with medication-related side effects at the risk of a slightly less effective Crohn’s treatment. Stronger drugs with more risky side effects are used to treat later stages of the disease.
Intestinal inflammation can interfere with the absorption of nutrients, causing various deficiencies. Because of this, nutritional therapy is often part of Crohn’s treatment, especially in pediatric cases where regular development depends on proper nutrition. The Crohn’s and Colitis Foundation of America (CCF) reports that supplements such as vitamins and minerals should only be used in addition to conventional medical treatment. Registered dietitians can assist you in building a proper supplement and diet regimen that ensures proper nutrition without worsening digestive symptoms. Vitamin and mineral deficiencies are among the most common nutritional deficits that Crohn’s patients suffer. The following supplements may be considered:
In addition to recommending the proper supplements, your dietitian will be able to help you build a diet plan that avoids foods that exacerbate your Crohn’s symptoms. Typical inflammatory foods that you may want to avoid include:
Nutritional therapy can be a critical part of treatment no matter what stage of your condition is in. Make sure that your doctor and dietitian are in communication about what supplements you are taking in order to avoid medication interference.
Medications for mild to moderate Crohn’s:
Medications for moderate to severe Crohn’s:
Medications for severe or fulminate Crohn’s:
70-80% of Crohn’s disease patients will eventually need some type of surgery. Surgical options are considered when symptoms have not responded to medications or when there is a physical obstruction to the digestive tract. Surgeries may be be helpful in relieving symptoms connected with intestinal blockages, bowel perforations, fistulas, and rectal bleeding.
Common surgical procedures used to treat Crohn’s disease patients include:
Even though there’s no known cure for UC, a combination of treatments including medications may be able to help you stay in control of the disease. These are the major classes of medication used to treat ulcerative colitis:
About one-quarter to one-third of patients with UC are unresponsive to medical therapy or complications from treatment arise. Under these circumstances, surgery may be considered. This operation involves the removal of the colon (colectomy).
Certain mind-body practices have been shown to reduce stress in some patients with Crohn’s disease, which may help control the severity of symptoms. These practices include:
According to the National Center for Complementary and Alternative Medicine (NCCAM), the following alternative treatments are available to help with ulcerative colitis:
Though some of the disruptive symptoms of IBD can be out of your control, there are things you can do to try to minimize the severity and impact of the symptoms. These include:
If you suffer from IBD, call your doctor if you experience:
Based on your symptoms, your primary doctor will refer you to a gastroenterologist. This is a doctor who specializes in digestive disorders. If your condition requires surgery, you will be seen by a surgeon. A nutritionist or dietician can help with a dietary plan.
If your doctor has diagnosed you with IBD, these general questions can help you understand your overall condition:
According to Johns Hopkins University, 70 million Americans suffer with gastrointestinal disorders. If you’re one of them, these organizations can help you:
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