Inflammatory bowel disease (IBD)

Inflammatory bowel disease is an immune mediated chronic digestive disorder bothering individuals of almost all the age groups. It has two types; ulcerative colitis (UC) and Crohn’s disease (CD).

Common risk factors predisposing to the disease are;

• Genetic predisposition “ being a familial disease, there is strong genetic predisposition for the causation of this disease. Monozygotic twins have 6 % concordance for ulcerative colitis and 58 % concordance for Crohn’s disease, whereas dizygotic twins have 4 % concordance for Crohn’s disease. Inflammatory bowel disease is associated with certain genetic syndromes like Turner’s syndrome which provides an additional evidence for its genetic predisposition.
• Cigarette smoking “ there is two fold increase in Crohn’s disease where as 1.7 fold increase in ulcerative colitis.
• Oral contraceptives
• Appendectomy “ it increases the risk of Crohn’s disease but is protective against ulcerative colitis.
• 

Being an autoimmune disorder, pathogenesis of inflammatory bowel disease depends on the complex interaction between the endogenous, exogenous and environmental factors leading to a chronic state of inflammation of the digestive tract.

Although classified in one group, ulcerative colitis and Crohn’s disease have few differences which I feel to mention in my discussion. Ulcerative colitis, predominantly a mucosal disease commonly involves the rectum and colon (whole or partial). In almost half of the cases, disease is limited either to rectum or sigmoid colon. Crohn’s disease is a transmural disease (involving all the layers of the wall of digestive tract) and can affect any part of the gastrointestinal tract from mouth to the anus. Both small and large intestine is involved in almost half of the patients suffering from Crohn’s disease.

Clinical presentation of any of the types of inflammatory bowel disease depends predominantly on the site involved. For detailed review of symptoms if IBD please visit;

https://www.doctortipster.com

Major symptoms of ulcerative colitis are cramping abdominal pain, diarrhea, bleeding per rectum, tenesmus and passage of mucus. Although ulcerative colitis can present acutely, however the typical form of disease is chronic. In case of proctitis (inflammation of the anal canal and rectal lining) common symptoms are passage of fresh blood or blood stained mucus, tenesmus, constipation and urgency to evacuate with a permanent feeling of incomplete evacuation. Abdominal pain is not a major symptom in case of proctitis. If disease spreads beyond the rectum and involves the colon, blood mixed with stool or grossly bloody diarrhea becomes a major feature with other symptoms like severe cramping and abdominal pain, nocturnal or postprandial diarrhea, anorexia, nausea, vomiting, fever and weight loss. Physical examination of patients of ulcerative colitis reveals tenderness in anal canal and directly over the colon (on palpation). Blood is present on rectal examination.

The symptoms of Crohn’s disease depend on the site involved;

• Ileocolitis “ chronic history of recurrent lower abdominal pains and diarrhea. The character of pain is colicky and low grade fever is present in uncomplicated disease. Weight loss develops due to anorexia, diarrhea and fear of eating.
• Jejunoileitis “ predominant symptoms occur due to the loss of digestive and absorptive surface of the gastrointestinal tract due to chronic inflammation of the digestive tract. Malabsorption and steatorrhea are the predominant features. Patient may present with anemia, neuropathy, Pellagra and vertebral fractures due to malnutrition.
• Colitis and perianal disease “ common symptoms are fever of low grade type, diarrhea, cramping abdominal pain, generalized fatigue and passage of fresh blood through the anus. It affects almost 1/3^rd of the patients with this disease and may cause strictures, perirectal abscesses and anorectal fistulae.

After going through the details of inflammatory bowel disease incidence and the suffering cause by this disease in the human population, it is important o discuss the management of this disease. Certain home remedies are available that may help in alleviating the symptoms of the disease.

• Cessation of smoking “ as already discussed, smoking being a causative agent for both the Crohn’s disease and ulcerative colitis must be quitted.
• Diet “ although no specific diet is available for the prevention of this disease, however changing dietary habits can help in relieving the symptoms of inflammatory bowel disease.
  • Try eating small multiple meals instead of two or three heavy meals.
  • Drink enough fluids “ water should be preferred over all the fluids as it is best for the gastrointestinal tract. Caffeine containing fluids are not recommended as they can make the diarrhea worse.
  • Fiber intake “ although fiber is the best part of the diet but it should be avoided in the patients with inflammatory bowel disease because it may worsen the diarrhea
• Mental and emotional stress and strain “ it is one of the most important factor influencing the normal function of gastrointestinal tract. Stress can be acute or chronic and it is almost impossible to avoid the stress in our lives. Still we must find means and ways to lessen or reduce the stress by taking exercise regularly, hypnosis and breathing and relaxation exercises.

Home remedies are not sufficient to halt the disease process of the inflammatory bowel disease and for that certain drugs are used either alone or in combination to alleviate the symptoms and stop the disease process. Commonly used drugs are;

• 5-ASA (Amino salicylic acid)
• Glucocorticoids
• Antibiotics “ Metronidazole and Ciprofloxacin
• Azathioprine and 6-mercaptopurine
• Methotrexate
• Cyclosporine
• Anti TNF agents “ Infliximab and Adalimumab
• Monoclonal antibody – Golimumab

For detailed description of the mechanisms and side effects of the drugs please visit;

https://www.doctortipster.com

References:

1. https://www.cdc.gov/ibd/
2. https://womenshealth.gov/publications/our-publications/fact-sheet/inflammatory-bowel-disease.cfm