The intestines, sometimes called the bowel, can be injured in many different ways. The bowel may be infected by a wide variety of viruses, bacteria, or parasites. It may be damaged by chemical poisoning, radiation exposure, surgery, physical injury, or disturbances of its blood supply. Any of the above may cause acute or chronic inflammation.
In addition, there are other mysterious diseases that attack the bowel wall, causing chronic intestinal inflammation and bringing misery and disability to hundreds of thousands of people throughout the world. These bewildering and stubborn illnesses of unknown cause are called inflammatory bowel disease.
What is IBD?
Inflammatory bowel disease is a name given to a group of chronic digestive diseases of the small and large intestines. Your doctor may refer to your particular condition by any one of several terms including colitis, proctitis, enteritis, and ileitis. Most often, doctors divide IBD into two groups: ulcerative colitis and Crohn's disease.
Ulcerative colitis causes ulcers and inflammation of the lining (mucosa) of the colon (large intestine). It almost always involves the rectum and usually causes bloody diarrhea.
Crohn's disease is an inflammation that extends into the deeper layers of the intestinal wall. The disease is either limited to one or more segments of the small intestine (30 percent), usually the ileum (ileitis), or involves both the ileum and the colon (ileocolitis) (50 percent). In the remaining 20 percent, Crohn's disease is confined to the colon (Crohn's colitis). Sometimes, inflammation may also affect the mouth, esophagus, stomach, duodenum, appendix, or anus.
Both ulcerative colitis and Crohn's disease are chronic conditions and may recur over a lifetime. On the other hand, many people will have long periods, sometimes years, when they will be free of symptoms. Unfortunately, doctors cannot predict with certainty when the disease will go into remission or when the symptoms will return.
What Are The Symptoms Of IBD?
The most common symptoms of IBD are diarrhea and abdominal pain. In either disease, inflammation, fever, and bleeding may be serious and persistent, leading to weight loss and anemia (low red blood cell count). Children may also suffer stunted growth and delayed development.
What Causes IBD?
There are many theories about what causes IBD, but none has been proven. The current leading theory suggests that some agent, possibly a virus or an atypical bacterium, interacts with the body's own immune defense system to trigger an inflammatory reaction in the intestinal wall. Although there is much scientific evidence that patients with IBD have abnormalities of the immune system, doctors do not know whether these abnormalities are a cause or a result of the disease. Doctors do believe, however, that there is little basis for the idea that Crohn's disease and ulcerative colitis are caused by emotional distress or are the product of an unhappy childhood.
How Common Is IBD?
It is estimated that between 2.4 and 3 million Americans suffer from IBD. Men and women are affected about equally. Some people seem to be more likely targets for these diseases. In recent years, an increase in frequency has been observed in developing nations throughout the rest of the world.
Does IBD Run In Families?
About 5 to 20 percent of people with Crohn's disease or ulcerative colitis have a blood relative with some form of IBD, most often a brother or sister, and sometimes a parent or child. Studies have not yet answered the question of whether this tendency is due primarily to heredity or to environment.
How Is IBD Diagnosed?
Ulcerative colitis is usually relatively easy for the doctor to recognize. If bloody diarrhea is what caused you to go to the doctor's office, the doctor will probably examine your rectum with an instrument called a flexible sigmoidoscope. In many instances the doctor will obtain a culture of the stool and order a colonoscopy or barium enema x-ray.
Crohn's disease is not so easily diagnosed because the symptoms are not always so dramatic, and because the affected part of the intestine may not be within the easy reach of a sigmoidoscope. However, if you have experienced chronic abdominal pain, diarrhea, fever, weight loss and anemia, the doctor may examine you for signs of Crohn's disease. The diagnosis can usually be established by a good medical history and a thorough x-ray examination of the digestive tract.
Can IBD Be Cured?
No medicine has yet been found to cure Crohn's disease or ulcerative colitis, but several drugs are helpful in controlling the disease processes and symptoms. Your doctor will work with you to find which treatments will work best for you.
Abdominal cramps and diarrhea may be alleviated by medication. Sulfasalazine or one of its derivatives often lessens the inflammation. More serious cases may require cortisone-related medication.
Some cases of IBD have improved with certain very potent anti-infective agents or with drugs that suppress the body's immune system.
Can Diet Control IBD?
No special diet has been proven effective for preventing IBD or helping most IBD patients. Some patients find their symptoms are made worse by milk, alcohol, hot spices, or roughage. But there are no hard and fast rules for the majority of IBD patients. Let your common sense tell you if you need to avoid any foods that seem to make your symptoms worse. Maintaining good general nutrition and adequate caloric intake is far more important than emphasizing or avoiding any particular food.
Can Surgery Cure Ulcerative Colitis?
Surgery can cure ulcerative colitis. Although most patients cope effectively with this disease for many years, about one-third will eventually require the removal of the colon. In the standard form of this operation the entire colon and rectum are removed.
Your doctor will explain the possibilities and recommend which form of surgery is best for you.
Does Surgery Cure Crohn's Disease?
Crohn's disease can be helped by surgery, but it cannot be cured by surgery. The inflammation tends to return in areas of the intestine immediately next to the area that has been removed. Even so, about 50% of Crohn's disease patients require surgery, either to provide relief from chronic disability or to correct specific complications.
What Are the Complications Of IBD?
Most people with IBD never suffer from any complications, but some do. For example, dangerous complications may arise when severe ulcerative colitis is progressing rapidly, with ulceration extending deep into the bowel wall. In such cases, paralysis and distention of the colon (toxic dilatation), bleeding, perforation, or peritonitis (inflammation of the lining of the abdominal cavity) may occur. These uncommon problems often require surgery.
If the disease is sufficiently widespread throughout the colon, and lasts for many years, patients with ulcerative colitis may be at increased risk of cancer of the colon or the rectum. Since these cancers have a more favorable outcome when caught in the early stages, patients should see their doctors for regular colon examinations.
Crohn's disease affects deeper layers of the bowel wall than those affected by ulcerative colitis. It often involves the small intestine but frequently spares the rectum. For these reasons, frank rectal bleeding is less common in Crohn's disease than in ulcerative colitis. Because of the tendency of Crohn's disease to thicken the bowel wall with swelling and fibrous scar tissue, intestinal obstruction or 'blockage' is the principal complication of long-standing cases. Crohn's disease may also cause deep ulcer tracts to burrow all the way through the bowel wall into surrounding tissues, into adjacent segments of intestine, or into other nearby organs such as the urinary bladder or vagina. These abnormal tunnels or passageways between the inflamed intestine and adjoining tissues are called fistulas. They are a complication of Crohn's disease and are often associated with pockets of infection or abscesses in this region, which are often a hallmark of the diagnosis. Fistulas can sometimes be treated with medication, but in many cases they must be treated surgically.
In addition to the damage IBD produces in and around the intestine, there are complications that may affect more distant parts of the body. These systemic complications include various forms of arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system. Some of these problems respond to the same treatment as the intestinal symptoms of IBD, but others require separate management.
Suggestions For The Newly Diagnosed Patient
You probably have many questions about your disease, your symptoms, and your treatment that cannot be answered in this short fact sheet. You should seek this information from your doctor. You may find it useful to write down some of your questions and concerns before your next visit. This list will help you organize your thoughts and ensure that you obtain the information you need.
Some symptoms of IBD, such as abdominal pain and diarrhea, can make you feel alone and isolated. Discussing concerns and trading coping tips with other IBD patients may be helpful. Knowing what to expect can help you explain your illness to family members and friends and can make living with the disease and its treatments a little more bearable.
Remember, most people with IBD continue to lead useful, productive lives. Between periods of disease activity, patients may feel quite well and remain relatively free of symptoms. Even though there may be long-term needs for medication, and even periods of hospitalization, most IBD patients hold productive jobs, marry, raise families, and function successfully at home and in society.
Note: The materials presented in this section are for general information and do not substitute for medical advice. Patients have the right to receive accurate, easily understood information about their health plans, professionals, and facilities, and to a choice of health care providers sufficient to ensure access to appropriate high-quality health care.