Inflammatory bowel disease

In medicine, inflammatory bowel disease (IBD) is a group of inflammatoryconditions of the large intestineand, in some cases, the small intestine. It should not be confused with IBS, irritable bowel syndrome, which is an inconvenient yet more innocent disease.

Forms

The main forms of IBD are Crohn's diseaseand ulcerative colitis(UC).

Accounting for far fewer cases are other forms of IBD:

• Collagenous colitis
• Lymphocytic colitis
• Ischaemic colitis
• Diversion colitis
• Behçet's syndrome
• Infective colitis
• Indeterminate colitis

The main difference between Crohn's disease and UC is the location and nature of the inflammatory changes in the gut. Crohn's can affect any part of the gastrointestinal tract, from mouthto anus(skip lesions), although a majority of the cases start in the terminalileum. Ulcerative colitis, in contrast, is restricted to the colon, and spares the anus.

Microscopically, ulcerative colitis is restricted to the mucosa(epithelial liningof the gut), while Crohn's disease affects the whole bowel wall.

Finally, Crohn's disease and UC present with extra-intestinal manifestations (such as liver problems, arthritis, skin manifestations and eye problems) in different proportions.

In rare cases, a patient has been diagnosed with both Crohn's disease and Ulcerative Colitis, though whether it is a combination or simply unidentifiable as one or another is uncertain.

Diagnosis

Although very different diseases, both may present with any of the following symptoms: abdominal pain, vomiting, diarrhea, hematochezia, weight lossand various associated complaints or diseases (arthritis, pyoderma gangrenosum, primary sclerosing cholangitis). Diagnosis is generally by colonoscopywith biopsyof pathological lesions.

Treatment

All forms of IBD may require immunosuppressionto control the symptoms. This consists of mesalazine, steroids, and later of steroid-sparing agents(such as azathioprineor methotrexate) or biologicals. Severe cases may require surgery, such as bowel resection, strictureplastyor a temporary or permanent colostomyor ileostomy.

Diet

The addition of fatty acids from fish oil, antioxidants, and short-chain fatty acids (SCFAs) produced during the fermentation of soluble fiber foods (acacia, FOS) may attenuate inflammation associated with IBD (Seidner, 2005). The dietary guidelines for Irritable Bowel Syndromecan also be helpful for symptoms of IBD such as diarrhea and abdominal cramps, and dietary changes can significantly increase patient comfort. Having a dietary foundation of soluble fiber foods, substituting soy or rice products for dairy, being careful with fresh fruits and vegetables that are high in insoluble fiber and can contribute to bowel impactions, and eating regular small amounts can all help (Van Vorous 2000). Foods and beverages to be avoided or minimized include red meat, oily or fatty (and fried) products, dairy (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages (especialy those also containing sorbitol) and artificial sweeteners (Van Vorous 2000).

Prognosis

While IBD can limit quality of life due to pain, vomiting, diarrhea, and other socially unacceptable symptoms, it is rarely fatal on its own. Fatalities due to complications such as toxic megacolon, bowel perforationand surgical complications are also rare.

While patients of IBD do have an increased risk of colorectal cancerthis is usually caught much earlier than the general population in routine surveillance of the colon by colonoscopy, and therefore patients are much more likely to survive.

Recent findings

A recent hypothesis posits that some IBD cases are caused by an overactive immune systemattacking various tissues of the digestive tract because of the lack of traditional targets such as parasitesand worms. The number of people being diagnosed with IBD has increased as the number of infections by parasites, such as roundwormand human whipworms, has fallen, and the condition is still rare in countries where parasitic infections are common. This is similar to the hygiene hypothesisapplied to allergies.

Initial reports (Summers et al 2003) suggest that "helminthic therapy" may not only prevent but even cure (or control) IBD: a drink with roughly 2500 ova of the Trichuris suis helminth taken twice monthly decreased symptoms markedly in many patients. It is even speculated that an effective "immunization" procedure could be developed - by ingesting the coctail at an early age.

Prebiotics and probiotics are showing increasing promise as treatments for IBD (Furrie, 2005) and in some studies have proven to be as effective as prescription drugs (Kruis, 2004).

References

• Furrie, E. Biotic Therapy Cuts Inflammation in Ulcerative Colitis. Gut 2005;54:242-249.
• Kruis, W., P Fric, J Pokrotnieks, M Lukás, B Fixa, M Kascák, M A Kamm, J Weismueller, C Beglinger, M Stolte, C Wolff, and J Schulze. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 2004; 53: 1617-1623.
• Seidner, D. Fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis. Clinical Gastroenterology and Hepatology, April 2005, Volume 3, Number 4.
• Summers RW, Elliott DE, Qadir K, Urban JF Jr, Thompson R, Weinstock JV. Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease. Am J Gastroenterol 2003;98:2034-41. PMID 14499784.
• Van Vorous, Heather. Eating for IBS. 2000. ISBN 1569246009.

External links

• CrohnsZone.org- Self-help organisation for sufferers of colitis and Crohn's disease- UK
• Crohn's and Colitis Foundation of America
• Help for Irritable Bowel Syndrome- Patient education, treatments, and community for IBD patients with concommitant IBS
• National Association for Colitis & Crohn's disease (NACC)- UK

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This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Inflammatory+bowel+disease Wikipedia article Inflammatory bowel disease.