Overview:
- Inflammatory bowel disease includes many chronic infections in digestive tract, especially colons such as Crohn’s disease and ulcerative colitis
- This disease is very debilitating and has many life-threatening complications
Crohn’s disease:
- Inflammatory disease that affects entire intestinal wall intermittently
- It is usually happened in colon, but can affect any part of the intestine
Ulcerative colitis:
- As its name indicates, it is a disease that affects mucosa of colon and rectum, which leads to inflammation and ulceration
- Usually happened in form of a continuous injury at colon rectal mucosa
Etiology:
- Uncontrolled activation of the immune system (T cells; specially T Helper cells) causes chronic inflammation leading to significant tissue damage of mucosa and other colon wall layers
Symptoms:
Symptoms are usually in the form of sudden episode followed by a period of remission
Symptoms vary depending on:
- Type of disease: Crohn’s, ulcerative colitis
- Severity of disease: mild, moderate, severe symptoms
- Place of disease: right Colon, left colon, Sigmoid, rectum
Symptoms include:
- Severe abdominal pain
- Diarrhea
- Weight loss
- Loss of appetite
- Bloody stool
- fatigue
- We may see extra-digestive injuries such as dermatitis, arthritis, eye injury, blood clots
- Sclerosing cholangitis may be seen
- Increased risk of colon cancer
Complications of inflammatory bowel disease may include:
Crohn’s disease:
- bowel obstruction due to stenosis caused by chronic inflammation of the entire intestinal wall
- Anemia and malnutrition due to malabsorption of inflamed mucosa and diarrhea
- Fistulas:
- between bowel and skin
- between bowel and other organs (bladder, vagina)
- between bowel and bowel
- Abdominal abscess
- Anal fissure
Ulcerative colitis:
- Toxic mega colon: swelling and severe expansion of colon which becomes non-functional
- malnutrition due to malabsorption of inflamed mucosa and diarrhea
- Perforation of the colon
Causes:
Inflammatory bowel disease is completely idiopathic
but it is more likely that immune disorder is reason of these diseases
inflammatory bowel disease risk factors include:
- Family history
- Age: usually occurs at young ages (under thirty)
- white people
- stress
- diet
- non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac
- Smoking (in Crohn’s disease only)
Diagnosis:
- Careful clinical examination
- Laboratory testing: includes tests for anemia, screening for blood in stool, and evaluation of inflammatory status
- Radiologic investigations:
X-ray: in case of perforation
CT
MRI
- Colonoscopy with biopsies, where biopsy is considered to be the confirmation of diagnosis
- Upper gastrointestinal endoscopy in specific cases
- Imaging of bowel by swallowing capsule with a camera
Treatment:
Treatment of inflammatory bowel disease aims to reach remission and relieve symptoms only
Treatment includes:
- Antibiotics: Ciprofloxacin and Metronidazole for treatment of abscesses or prevention of secondary infection
- Anti-inflammatory drugs: Olsalazine, Mesalamine
- Immune system inhibitors: Azathioprine, Methotrexate to reduce immune response toward bowel inflammation
- Infliximab (Remicade) is a drug used in treatment of autoimmune diseases
- Pain killer: Acetaminophen (do not use NSAIDs)
- Vitamins and supplements to compensate malnutrition
- Surgery:
Crohn’s disease:
surgery here is common to treat complications of disease (stenosis, fistulas)
- Stenosis and bowel obstruction:
surgery is based on resection of the narrowed section and reconnection two healthy edges of bowel
- Fistulas:
treatment is difficult and involves trying to close fistulas and drain abscesses
Ulcerative colitis:
- colon and rectal resection in the most severe cases and connection of small intestine with anus through the formation of an anal reservoir as J shape (J pouch)
- or ileostomy (a permanent opening in abdominal wall) in difficult cases.
