Inflammatory Bowel Diseases

Inflammatory Bowel Diseases ( IBD )

Inflammatory bowel disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract.

Overview

The human digestive tract comprises the mouth, esophagus, stomach, small intestine, and large intestine. It’s responsible for breaking down food, extracting the nutrients, and removing any unusable material and waste products.  Inflammation anywhere along the digestive tract disrupts this normal process. IBD can be very painful and disruptive, and in some cases, it may even be life-threatening.

Symptoms

Symptoms vary according to the location and severity of the disease, as well as the type of disease. The following symptoms are common to both types of IBD:

  • Blood in the stool.
  • Diarrhea.
  • Fatigue.
  • Fever.
  • Appetite loss.
  • Nausea.
  • Painful bowel movements.
  • Pus or mucus in the stool.
  • Stomach pain and cramps.
  • Vomiting.
  • Night sweats.
  • Weight loss.

Causes

It is not known what causes IBD exactly, but many experts believe several factors may play a role:

  • Immune function: IBD may result when an abnormal immune system response to bacteria, viruses, or food particles, triggers an inflammatory reaction in the gut.
  • Genetics: Links have been discovered between IBD and certain gene mutations. Upto 20 percent of those with ulcerative colitis have a close relative with IBD, but no specific pattern to heredity has been established.
  • Bacteria or viruses: Research has linked both E.coli and enteroviruses to Crohn's disease.
  • Environmental: Factors such as smoking, oral contraceptives, diet, breastfeeding, vaccinations, antibiotics, and others have been investigated as potential causes..

Diagnosis

In order to diagnose IBD, a doctor will take a full medical history before ordering one or more diagnostic tests. Types of tests include:

  • Stool samples.
  • Blood tests to test for anemia or infection.
  • X-rays, if a serious complication is suspected.
  • CT scan.
  • MRI scans, to detect fistulas in the small intestine or anal area.
  • Endoscopic procedures may also be used. A flexible probe with a camera attached is inserted through the anus. These procedures help uncover intestinal damage and allow the doctor to take a small sample of tissue to examine.

Types of endoscopic procedures typically used include:

  • Colonoscopy - to examine the entire colon.
  • Flexible sigmoidoscopy - to examine the last section of the colon.
  • Upper endoscopy - to examine the food pipe, stomach, and the anterior part of the small intestine.
  • Capsule endoscopy is another option. This procedure requires a person to swallow a capsule that has a camera inside, enabling the doctor to examine the small intestine.

Treatment

  • Anti-inflammatory drugs are the first step in IBD treatment. These drugs decrease inflammation of the digestive tract. However, they have many side effects.
  • Lifestyle choices are important when you have IBD. Drinking plenty of fluids helps to compensate for those lost in your stool. Avoiding dairy products and stressful situations also improves symptoms. Exercising and quitting smoking can further improve your health.
  • Vitamin and mineral supplements can help with nutritional deficiencies. For example, iron supplements can treat anemia.

Surgery can sometimes be necessary for people with IBD. Some IBD surgeries include:

  • Strictureplasty to widen a narrowed bowel.
  • Closure or removal of fistulas.
  • Removal of affected portions of the intestines, for people with Crohn’s disease.
  • Removal of the entire colon and rectum, for severe cases of ulcerative colitis.
  • Routine colonoscopy is used to monitor for colon cancer, since those with IBD are at a higher risk.

Medication

  • Anti-inflammatory drugs used for IBD include standard-dose mesalamine, sulfasalazine and its byproducts, and corticosteroids.
  • Immunosuppressants (or immunomodulators) prevent the immune system from attacking the bowel and causing inflammation. This group includes drugs that block TNF. TNF is a chemical produced by the immune system that causes inflammation. Excess TNF in the blood is normally blocked, but in people with IBD, higher levels of TNF can lead to more inflammation.
  • Another medication, tofacitinib (Xeljanz), is a newer option that works in a unique way to reduce inflammation.
  • Antibiotics are used to kill bacteria that may trigger or aggravate IBD symptoms.
  • Antidiarrheal drugs and laxatives can also be used to treat IBD symptoms.
CROHN'S DISEASE

Crohn's Disease

 

What is Crohn's disease?

It is an inflammatory disease of the bowels. Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.
 

The inflammation caused by Crohn's disease often spreads deep into the layers of affected bowel tissue. Crohn's disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.

While there's no known cure for Crohn's disease, therapies can greatly reduce its signs and symptoms and even bring about long-term remission. With treatment, many people with Crohn's disease are able to function well.

Causes

Cause of Crohn's disease is unknown. There are diet habits and some external factors which can aggravate but they dont cause Crohn's disease. A number of factors such as heredity and malfunctioning immune system will play a role in development.
 
Immune system - It's possible that a virus or bacterium may trigger Crohn's disease. When the immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.
 
Heredity - Crohn's is more common in people who have family members with the disease, so genes may play a role in making people more susceptible.

Symptoms

The symptoms of Crohn's disease depend on where in the bowel the disease occurs. They also depend on its severity. Symptoms can include:

  • Abdominal pain and tenderness (often on the lower right side of the abdomen).
  • Chronic diarrhea.
  • Delayed development and stunted growth (in children).
  • Feeling of a mass or fullness in the lower right abdomen.
  • Fever.
  • Rectal bleeding.
  • Weight loss.

Other symptoms can develop, depending on complications related to the disease. It includes:

  • Arthritis.
  • Gallstones.
  • Inflammation of the eyes and mouth.
  • Kidney stones.
  • Liver disease.
  • Skin rashes or ulcers.

Diagnosis

There is no one step diagnosis  to Crohn's disease. Following are done to diagnose the disease : 
  • Blood tests are done to test for the infection and anaemia. 
  • Faecal occult blood test.
  • Colonoscopy.
  • Computerized tomography CT.
  • Magnetic Resonance Imaging MRI.
  • Capsule endoscopy.
  • Balloon assisted endoscopy.

Treatment

Most commonly used drugs are cortecosteroids which can control the flare from the Crohn's disease but because of the effects of steroids they are not the right choice for long term control. Treatment helps in easing or reducing the symptoms while maintaining the remission and hopefully no relapse.

Medication

REMICADE
CIMZIA
ENTYVIO
STELARA

ULCERATIVE COLITIS

Ulcerative Colitis

What is Ulcerative colitis ?

It is a form of Inflammatory bowel disease that causes long lasting inflammation and sores in the digestive tract. Symptoms usually develop  over time rather than suddenly.

Overview 

Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Ulcerative colitis can be debilitating and can sometimes lead to life-threatening complications. While it has no known cure, treatment can greatly reduce signs and symptoms of the disease and even bring about long-term remission.

Causes

Though the exact cause of Ulcerative colitis is unknown, the reason could be a part of the immune system.
 
1) Autoimmune conditions which causes the body's defence against infection.
2) Genetics which also seems inherited genes playing a major role in the development of ulcerative colitis.
3) Environmental factors.
4) Genes - Ulcerative colitis sometimes runs in families.

Symptoms

  • Abdominal pain/discomfort.
  • Blood or pus in stool.
  • Fever.
  • Weight loss.
  • Frequent, recurring diarrhea.
  • Fatigue.
  • Reduced appetite.

Diagnosis

To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:
  • Blood tests.
  • Stool sample.
  • Colonoscopy.
  • Flexible sigmoidoscopy.
  • X-ray.
  • CT scan.
  • Computerized tomography (CT) enterography and magnetic resonance (MR) enterography.

Treatment 

Several types of medicines are suggest to curb inflammation in your bowel , including sulfa drugs, corticosteroids and immunosupperssive agents and antibiotics. Other medicines which are used in treating ulcerative colitis are antibiotics. 5-aminosalicylic acid (5-ASA). balsalazide, mesalamine, olsalazine, and sulfasalazine.

Medication