What Is Inflammatory Bowel Disease?

Ulcerative colitis and Crohn's disease are incurable chronic diseases of the intestinal tract. The two diseases are often grouped together as inflammatory bowel disease (IBD) because of their similar symptoms. As many as 4 million people (including one million Americans, 23,000 Australians, and 250,000 Canadians) worldwide suffer from a form IBD. The cost of lost productivity to U.S. businesses due to IBD is estimated to be as much as $.8 billion a year.

Symptoms

Crohn's disease and ulcerative colitis have similar symptoms, but are different in the manner in which they affect the digestive tract. Each disease also has different surgical options, and may be treated with a spectrum of diverse medications. The most common symptoms of IBD include, but are not limited to:

• Abdominal pain
• Weight loss
• Fever
• Rectal bleeding
• Skin and eye irritations
• Diarrhea

Treatment

Intervals of active disease, or "flares," and periods of remission characterize IBD. Prescription drugs are frequently used to prevent inflammation (known as maintenance drugs) or to control an existing flare. Conventional medicines used to treat IBD include:

• Sulfa drugs (sulfasalazine)
• Corticosteriods (prednisone)
• 5-Aminosalicylates (Asacol, Pentasa, Rowasa, or 5-ASA)
• Immunosuppressives (Imuran, Cyclosporine, 6-MP, and Methotrexate)
• Anti-TNF (Remicade)

Diagnosis

Several diagnostic tests are normally completed and studied by a digestive specialist (a gastroenterologist) before a diagnosis of IBD is made. The "gold standard" for diagnosis of IBD is considered the colonoscopy. During this test a fiber optic tube is inserted into the rectum while the patient is sedated to allow the doctor to inspect the lining of the large intestine.

Irritable bowel syndrome (IBS) is often confused with ulcerative colitis, making diagnosis difficult. The inflammation typical of Crohn's disease and ulcerative colitis is not present in IBS. The most common symptoms of IBS are alternating diarrhea and constipation, abdominal pain, bloating, spasms and nausea. IBS is treated with fiber, reduction of stress levels, proper rest and exercise.

Crohn's Disease

Crohn's disease can affect the small and large intestine as well as other organs in the digestive tract. Unlike ulcerative colitis, which only affects the inner layer, Crohn's disease commonly involves all layers of the intestinal wall. Some complications that can occur in Crohn's disease include:

• Strictures - a narrowing of part of the intestine.
• Fistulas - abnormal tunnels that connect two organs.
• Fissures - cracks in the anal skin.

Several different types of surgery can be used to treat the symptoms and complications of Crohn's disease, yet none are a cure. The most common is the resection, during which surgeons remove a diseased piece of the intestine and reconnect the two cut ends. Surgeons use stricturplasty to open up narrowed sections of the intestine by making an incision lengthwise along the stricture and closing it in the opposite direction. A colostomy, removal of part of the large intestine, or an ileostomy, removal of the entire large intestine are other surgical procedures.

Ulcerative Colitis

In ulcerative colitis, the inner lining of the large intestine (colon) and rectum are inflamed. The disease does not affect the small intestine. A serious complication of ulcerative colitis is toxic megacolon, when gases collect in the colon and cause it to inflate.

There are several surgical options for the ulcerative colitis patient. Surgery for ulcerative colitis always involves removal of the entire colon, or a colectomy. With no colon, an alternative method of collecting stool must be utilized. In an ileostomy the end of the small intestine is connected to an opening (stoma) in the abdomen where stool is collected in an ostomy appliance worn on the outside of the abdomen. Fashioning a pouch from small intestine to collect waste, and connecting it to the rectum creates an ileoanal anastomosis (j-pouch).

Unfortunately the cause of each of these intestinal disorders is poorly understood, and none of them has a cure. The symptoms are distressing, embarrassing and even debilitating. Research and awareness are necessary in the fight to overcome IBD.