The ABC’s of IBD

Inflammatory Bowel Disease (IBD) is a chronic medical condition composed of Crohn’s Disease (CD) and Ulcerative colitis (UC). Both of these entities share a common aspect, which is inflammation. This inflammation appears to be due to an abnormal response of the immune system to bacteria in our gastrointestinal tract. This is influenced by our intestinal flora, environment and certain genetic predispositions. This inflammatory cascade leads to the development of patient symptoms. The estimated prevalence of IBD is 1.4 million people in the USA. Therapies range from topical anti-inflammatories which coat the colon to medications which regulate the immune system.

Crohn’s Disease can affect any part of the gastrointestinal tract, although it more commonly affects the small intestine and colon. The symptoms can include diarrhea, abdominal pain, fever and intestinal bleeding. Poor appetite and weight loss also can occur, the latter from decrease caloric intake and intestinal malabsorption. Symptoms may also extend outside of the intestinal tract to include the skin, joints, eyes and the liver. The diagnosis involves a combination of history and physical examination, blood tests, x-rays and endoscopic evaluation of the intestine. Medications aim to suppress the inflammation and improve symptoms. Complications can include obstruction or blockage of the intestine. Smoking may worsen CD and increase the need for surgery. When surgery is needed, the goal is always to preserve as much intestine as possible and improve the patient’s quality of life.

Ulcerative Colitis is again also characterized by chronic inflammation but is limited to the colon or large intestine. The inflammation usually commences in the rectum and can involve the entire large intestine. Approximately 20% of patients with UC have a close relative with IBD. The first symptom is usually diarrhea, which can be bloody. Abdominal pain, weight loss and rectal discomfort can also occur. As with CD, symptoms can also extend outside of the intestinal tract. Besides a history and physical exam, the diagnosis may include blood tests, stool studies and an endoscopy to look at the colon and sometimes obtain biopsies. Medical therapies again aim to decrease inflammation and improve symptoms. Complications can include severe gastrointestinal bleeding. In approximately 1/3 of patients there is a need for a surgery, which is usually removal of the colon. However, unlike CD the surgery is “curative” as the inflammation is limited to the colon. Colorectal cancer incidence is increased in UC, and to a lesser extent in CD.

IBD is a chronic condition that affects millions of individuals in the United States leading to significant detriment in their daily lives. The goal of therapy is to limit the inflammation and improve the quality of life in our patients. Through research and advances seen in clinical trials this field is rapidly moving forward and novel new medications and treatment options are on the horizon. For further information regarding IBD please refer to the Crohn’s & Colitis Foundation of America at www.ccfa.org.

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