Inflammatory Bowel Disease

Inflammatory Bowel Disease
J.F. del Rosario

Digestive problems are among the most common conditions affecting people
today. There are many different types of digestive problems, from
gastrointestinal infections that make a person miserable but pass quickly to
long-term illnesses like inflammatory bowel disease (IBD). IBD is a general
term that refers to illnesses that cause chronic inflammation in the
intestines. If you're having diarrhea, stomach cramps, and other symptoms
that make you question your digestion, you may want to learn more about the
digestive system and IBD, as well as other digestive conditions.

What Is IBD?
The digestive system is the set of organs that digest food and absorb the
important nutrients your body needs to stay healthy and grow. Two of the
major parts of the digestive system are the small and large intestines. Just
like other organs in your body, the intestines can develop problems or
diseases.
IBD (which is not the same thing as irritable bowel syndrome, or IBS), can
cause more serious problems than just diarrhea and pain. IBD may also cause
a delay in puberty or growth problems for some teens with the condition,
because it can interfere with a person getting nutrients from the foods he
or she eats.
The two major types of IBD are Crohn's disease and ulcerative colitis.
Crohn's disease occurs when the lining and wall of the intestines becomes
inflamed and ulcers develop. Although Crohn's disease can occur in any part
of the digestive system, it often occurs in the lower part of the small
intestine where it joins the colon. The intestine becomes inflamed, meaning
the lining of the intestinal wall reddens and swells. It can become
irritated, causing it to bleed and preventing it from properly absorbing the
nutrients from digested food.
People with Crohn's disease usually have these symptoms:
* abdominal cramps or pain
* diarrhea, sometimes with blood in the stool (bowel movements)
* fever
* weight loss
These symptoms often cause people with Crohn's disease to feel tired and
lose their appetites.
Some people with Crohn's disease have minor symptoms and hardly any
discomfort or pain. Their symptoms may only flare a few times. But others
may experience frequent diarrhea, intestinal ulcers, and problems in other
parts of their bodies, such as inflammation of the joints, skin rashes, and
eye problems. Crohn's disease can cause a person's intestines to become
blocked by swelling and scar tissue. People with the condition may also be
more susceptible to infections and developing abscesses in and around their
intestines.
In ulcerative colitis, the large intestine becomes inflamed and ulcers may
develop. Ulcerative colitis affects only the large intestine. The
inflammation begins in the rectum (the last few inches of the large
intestine where feces are stored before they leave the body) and can affect
only the rectum or the part of the large intestine that joins it. However,
most kids and teens who have ulcerative colitis have the condition
throughout their large intestines.
The most common symptoms of ulcerative colitis are abdominal pain and bloody
diarrhea. But some people also experience these symptoms:
* tiredness
* weight loss
* loss of appetite
* nausea
Some people with ulcerative colitis may experience periods of time when they
are free of symptoms (this is called remission) and other times when they
feel sick (called relapse).
Like Crohn's disease, ulcerative colitis can be associated with problems in
other parts of the body. These problems may include inflammation of the
joints, eye problems, and anemia due to blood loss.

Who Gets IBD?
IBD is most likely to occur in people in their late teens and twenties.
However, kids as young as 5 years old have been known to develop IBD. It
affects both guys and girls.
The exact cause of IBD is not known. Because it often runs in families,
genetic factors are probably involved. About 15% to 30% of people with IBD
have a relative with the disease. Research is being done to find out if a
certain gene or group of genes makes a person more likely to get the
disease.

What Do Family Doctors Do?
If you have any of the symptoms of IBD, it's important to see your family
doctor. In addition to doing a physical examination, the family doctor will
ask you about any concerns and symptoms you have, your past health, your
family's health, any medications you're taking, any allergies you may have,
and other issues. This is called the medical history.
After hearing your symptoms, if your family doctor suspects IBD, he or she
may suggest certain tests. Blood tests may be done to determine if there are
signs of inflammation in your body, which are often present with IBD. The
family doctor may also check for anemia and for other causes of your
symptoms, like infection.
The family doctor will examine your stool for the presence of blood. He or
she may look at your colon with an instrument called an endoscope, which is
a long, thin tube attached to a TV monitor. The tube is inserted through the
anus. This procedure is called a colonoscopy, which allows the family doctor
to see inflammation, bleeding, or ulcers on the wall of your colon. A family
doctor may also do a test called an upper endoscopy to check the esophagus,
stomach, and upper small intestine for inflammation, bleeding, or ulcers.
During the exam, the family doctor may perform a biopsy, which involves
taking a small sample of tissue from part of the colon so it can be viewed
with a microscope or sent to a laboratory for other kinds of analysis.
A family doctor may also order a barium study of the intestines. This
procedure involves drinking a thick white solution called barium. The barium
shows up white on an X-ray film, allowing a family doctor to get a better
look at what's going on in a person's intestines.

How Is IBD Treated?
There are a number of ways to manage the symptoms of IBD. Some treatments
include:

Nutritional Therapy
It is important for people with IBD to eat healthy foods and drink plenty of
fluids to replace those lost through diarrhea. People with IBD should work
with a family doctor or a dietitian to come up with an eating plan that is
best for their individual situation and symptoms.
For example, some people are told to cut down on the amount of fiber or
dairy products in their diets, whereas others find that their symptoms
improve if they cut back on foods that are high in fat or sugar. If you've
been diagnosed with IBD, your family doctor might ask you to keep a food
diary so that you can find out which foods make your symptoms worse.
If you're having trouble maintaining or gaining weight, your family doctor
may recommend that you take nutritional supplements or special drinks or
shakes that contain needed vitamins, minerals, and calories.

More Sleep and Less Stress
Besides watching the types of foods they eat, people with IBD need to get
enough sleep. It's also helpful to manage stress in a positive way. When you
get stressed out, your intestinal problems can flare. Some people find that
learning breathing and relaxation exercises can help.

Medications
Medications are also used to treat IBD. Anti-inflammatory drugs, including
corticosteroids, may be used to decrease the inflammation caused by IBD. If
symptoms don't go away after taking anti-inflammatory drugs, your family
doctor may prescribe other medications called immunosuppressants or
immunomodulators to reduce the inflammation.
Family doctors may prescribe antibiotics to prevent or treat bacterial
infections associated with Crohn's disease, and antidiarrheal drugs may be
prescribed for someone who has diarrhea a lot.

Surgery
Sometimes surgery is necessary to control the symptoms of IBD and to remove
damaged sections of the intestines. For people with Crohn's disease, surgery
may need to be performed more than once because the disease can involve
other parts of the intestine over time.
Removal of the large intestine can cure the bowel problems in people with
ulcerative colitis. However, this surgery is usually only done if medicines
have failed or if a person develops a perforation (a hole in the intestine),
uncontrollable bleeding, or has developed intestinal cancer.
Although it can be challenging and difficult to deal with the symptoms of
IBD, many people with IBD find that they are able to feel well and have few
symptoms for long periods of time. Talk to your family doctor about ways
that you can feel better during the times you have flares. If you feel sad
or anxious about your symptoms, it may also help to talk to a therapist or
other mental health professional.
If you don't get medical treatment, IBD can put a serious cramp in your
daily life. The good news? Getting treatment for IBD, managing your
symptoms, and keeping a positive attitude can help get you back on the fast
track. [AAFP]