Inflammatory Bowel Disease
Inflammatory bowel disease and it's treatment.
What is it?
There are two main disorders that are referred to as inflammatory bowel disease (IBD): ulcerative colitis (UC) and regional enteritis, or Crohn's disease (CD). UC typically affects the lining of the colon. CD can affect any part of the GI tract, but usually involves the small intestine or colon. It can also involve the entire bowel wall, not just the intestinal lining.
How bad is it?
The course of IBD is rather unpredictable in any single patient. The initial attack can be followed by a long period of remission lasting many years. In other cases, the remission is brief and the course of disease is characterized by intermittent flares of disease activity throughout many years. In the most severe cases, the disease never goes into remission and is continually active.
What causes it?
IBD is an autoimmune disease where the body's immune system inappropriately attacks its own tissues. No one knows what triggers the immune system to do this.
How do I know I have it?
Symptoms of IBD include diarrhea sometimes bloody, that may be accompanied by fever, abdominal pain, loss of appetite and a general feeling of not being well. There may be symptoms outside the bowel like skin rash, oral ulcers, arthritis, or liver and eye inflammation. In addition, there are numerous complications associated with IBD. These include severe hemorrhage, narrowing of the intestinal lining leading to obstruction, and perforation of the intestinal wall leading to a localized abscess or generalized peritonitis. Management of these complications may require surgery. The long-term risk of IBD is colon cancer. At eight to 10 years after the diagnosis, surveillance via colonoscopy must be performed on a regular basis.
What can I do about it?
Almost all patients diagnosed with the disease are followed on a long-term basis by a gastroenterologist, there are many medications used to treat this disease depending on its severity. Milder cases may be treated with a medication that is a combination of aspirin and a sulfa drug called sulfasalazine. More severe cases require immunosuppressant agents such as corticosteroids, azathioprine and cyclosporine (also used in transplant recipients to prevent rejection). New classes of medications for refractory IBD have been developed within the past several years. One such medication, Remicade (infliximab), is a monoclonal antibody to tumor necrosis factor (TNF). TNF is an inflammatory mediator in CD. Clinical trials have shown infliximab to be highly effective in the treatment of refractory cases of IBD.
Points to remember
- Bleeding from the bowel must always be taken seriously and evaluated by a physician.
- Severe abdominal pain and/or repeated vomiting needs urgent evaluation, either by your doctor or in an emergency department.
- IBD can usually be controlled with medication, but severe cases that may also have complications usually require surgery.
- There is a long-term risk of colon cancer in patients with IBD, and regular colonoscopy is required to determine the optical timing of surgery.