Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn’s disease and ulcerative colitis.

The main difference between Crohn’s disease and UC is the location and nature of the inflammatory changes. Crohn’s can affect any part of the gastrointestinal tract, from mouth to anus, although a majority of the cases start in the terminal ileum (a portion of the small intestine). Ulcerative colitis, in contrast, is restricted to the colon and the rectum.

Accounting for far fewer cases are other forms of non IBD colitis, which represent separate types of colitis.

  • Collagenous colitis is an inflammatory colonic disease with peak incidence in the 5th decade of life, affecting women more than men. Its clinical presentation involves watery diarrhea, usually in the absence of rectal bleeding. It is often classified under the umbrella entity microscopic colitis.On colonoscopy, the mucosa of the colon typically looks normal, but biopsies of affected tissue usually show deposition of collagen in the lamina propria, which is the area of connective tissue between colonic glands. Radiological tests, such as a barium enema are typically normal.
  • Lymphocytic, a subtype of microscopic colitis, is a rare condition characterized by chronic non-bloody watery diarrhea. The colonoscopy is normal but the mucosal biopsy reveals an accumulation of lymphocytes in the colonic epithelium and connective tissue (lamina propria). Collagenous colitis shares this feature but additionally shows a distinctive thickening of the subepithelial collagen table. The peak incidence of lymphocytic colitis is in persons over age 50; the disease affects women more than men.
  • Ischaemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia.
    • Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure) or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified.Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed via endoscopy or by using sigmoid or endoscopic placement of a visible light spectroscopic catheter.
    • Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically ill.Patients with mild to moderate ischemic colitis are usually treated with IV fluids, analgesia, and bowel rest (that is, no food or water by mouth) until the symptoms resolve. Those with severe ischemia who develop complications such as sepsis, intestinal gangrene, or bowel perforation may require more aggressive interventions such as surgery and intensive care. Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a stricture or chronic colitis
  • Diversion colitis an inflammation of the colon which can occur as a complication of ileostomy or colostomy, often occurring within the year following the surgery. It can also occur in a neovagina created by colovaginoplasty, sometimes several years after the original procedure. Despite the presence of a variable degree of inflammation the most suggestive histological feature remains the prominent lymphoid aggregates. The diagnosis cannot be safely reached without knowing the clinical story. In many milder cases after ileostomy or colostomy, diversion colitis is left untreated and disappears naturally. If treatment is required, possible treatments include short-chain fatty acid irrigation, steroid enemas and mesalazine.
  • Behcet’s disease, also called Behcet’s syndrome, is a rare disorder that causes chronic inflammation in blood vessels throughout your body. The exact cause of Behcet’s is unknown, but it may be an autoimmune disorder, which means the body’s immune system mistakenly attacks some of its own healthy cells. Both genetic and environmental factors may be responsible for Behcet’s disease.The inflammation of Behcet’s disease leads to numerous symptoms that may initially seem unrelated. The signs and symptoms of Behcet’s disease which may include mouth sores, eye inflammation, skin rashes and lesions, and genital sores vary from person to person and may come and go on their own. Treatment aims to reduce the signs and symptoms of Behcet’s disease and to prevent serious complications, such as blindness.

Research isn’t conclusive on the causes inflammatory bowel disease, but experts believe that many factors might be involved, including the environment, diet, and genetics.Current evidence suggests that in people with IBD, a genetic defect affects how the immune system works and how inflammation is triggered in response to an offending agent, like bacteria, a virus, or a protein in food. The evidence also indicates that smoking can enhance the likelihood of developing Crohn’s disease.

The most common symptoms of both ulcerative colitis and Crohn’s disease are diarrhea and abdominal pain. Diarrhea can range from mild to severe (as many as 20 or more trips to the bathroom a day). If the diarrhea is extreme, it can lead to dehydration, rapid heartbeat, and a drop in blood pressure. And continued loss of small amounts of blood in the stool can lead to anemia.

At times, those with IBD may also be constipated. With Crohn’s disease, this can happen as a result of a partial obstruction (called stricture) in the intestines. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum (known as proctitis).

The loss of fluid and nutrients from diarrhea and chronic inflammation of the bowel can also cause fever, fatigue, weight loss, and malnutrition. Pain is usually from the abdominal cramping, which is caused by irritation of the nerves and muscles that control intestinal contractions.

And IBD can cause other health problems that occur outside the digestive system. Although experts don’t understand why, some people with IBD can show signs of inflammation elsewhere in the body, including the joints, eyes, skin, and liver. Skin tags that look like hemorrhoids or abscesses may also develop around the anus.

Inflammatory bowel disease can be hard to diagnose because there may be no symptoms, even if the bowel has been damaged over many years. And IBD symptoms often resemble those of other conditions, which may make it difficult for your physician to diagnose.

If you begin to lose weight quickly, or have repeated bouts of diarrhea, or have abdominal cramping, IBD may be the cause. Call your board certified physician if you notice any of these symptoms to ensure that you get proper evaluation and treatment.

If IBD is suspected, your physician might order blood tests to look for signs of the inflammation that often accompanies IBD, and to check for anemia and for other causes of symptoms, like infection. A stool test might also be done to check for the presence of blood.

Your physician might do a high definition colonoscopy, which will let the physician see inflammation, bleeding, or ulcers on the wall of the colon. This can be performed in our Premier Endoscopy Center located on the second floor of our offices.

The physician also might order an upper endoscopy to check the esophagus, stomach, and upper small intestine for inflammation, bleeding, or ulcers. During either of these exams, the doctor might do a biopsy, taking a small sample of tissue from the intestinal tract lining to be viewed under a microscope or sent to a laboratory for testing.

The doctor also might order a barium study of the intestines. You will be asked to drink a thick white solution (barium), which shows up white on an X-ray film. This lets the doctor see parts of the intestines not reachable by an endoscope. Another way to view the intestines is via an MRI (magnetic resonance imaging), a special radiology test that involves no radiation.