An Overview

Inflammatory bowel disease (IBD) is a term used to describe a series of conditions that create chronic inflammation in part or all of the digestive tract. Ulcerative colitis and Crohn’s disease are the most common conditions known under this umbrella term.

The causes of IBD are unknown. While it was once believed that stress and diet were the causes, it is now shown that these factors aggravate but do not cause IBD.

What Is Ulcerative Colitis?

Ulcerative colitis is a condition that causes chronic inflammation, forcing the colon to empty frequently and resulting in diarrhea. Cells from the lining of the colon slough off in the process, creating tiny open sores known as ulcers. The ulcers cause pus, mucus and bleeding. Ulcerative colitis occurs most frequently in patients between 15 and 40 years of age (though children and patients over 50 may develop it as well).

There are four types of ulcerative colitis, each of which is categorized by their location and the severity of symptoms:

• Acute severe ulcerative colitis: A rare condition that affects the entire colon, resulting in violent episodes of diarrhea, intense abdominal pain and bleeding. Fever usually accompanies these symptoms and there is a loss of appetite.
• Left-sided colitis: With this condition, inflammation runs up to the sigmoid (low end of the colon) and descending colon. Symptoms include diarrhea, unintentional weight loss and pain/cramping on the left side of the abdomen.
• Proctosigmoiditis: This condition is an inflammation of the rectum and sigmoid colon with symptoms including pain/cramping, bloody diarrhea and the urge to constantly have a bowel movement (known as tenesmus).
• Ulcerative proctitis: Ulcerative proctitis is the mildest form of ulcerative colitis confined to the rectum. Rectal bleeding is the only symptom.

What Is Crohn’s Disease?

Crohn’s disease is an autoimmune disease in which inflammation occurs in sections of the large and small intestines that spreads into affected tissues. The inflammation is the result of the body’s immune system recognizing the cells in the digestive tract as a foreign body and attacking them.

While the causes are unknown, it is believed that those with a family history of the condition have an increased risk of developing it.

Crohn’s disease shares many symptoms with ulcerative colitis and the severity of symptoms hinge upon the severity of inflammation. Shared symptoms include:

• Abdominal pain and cramping
• Bloody stool
• Reduced appetite
• Diarrhea
• Fatigue
• Fever
• Unintended weight loss

In addition, Crohn’s disease and ulcerative colitis cause similar symptoms found in other conditions such as irritable bowel syndrome.

What Are the Treatments for IBD?

Though there is no cure for IBD, symptoms can be managed by controlling the inflammation. It may be recommended to begin with milder drugs and move to stronger ones or start stronger and move to milder, depending on individual needs.

Medicinal treatments for the disease include:

• 5-ASA anti-inflammatories (e.g., aminosalicylates and corticosteroids)
• Biologics such as adalimumab (Humira®) and infliximab (Remicade®)
• Immune system suppressors like azathioprine and mercaptopurine

Medications to manage symptoms include:

• Antibiotics such as metronidazole and ciprofloxacin
• Other medications such as anti-diarrheal and acetaminophen for pain

In addition, lifestyle changes may be recommended to help control symptoms. These include:

• Dietary changes
• Smoking cessation
• Stress reduction

Surgery may also be recommended if all other conservative methods of treatment have failed. Surgical procedures differ depending upon the type of IBD:

• Surgery for ulcerative colitis: During a procedure known as a proctocolectomy, the colon and rectum are surgically removed and a pouch is created from the end of the small intestine. The pouch is then attached directly to the anus to allow for normal excrement.
• Surgery for Crohn’s disease: For a bowel resection, the damaged portion of the digestive tract is removed and then the healthy ends are attached to one another. In some cases, a stricturoplasty may also be performed. During this procedure, the narrowed areas of the intestine are surgically opened.