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Inflammatory Bowel Disease (IBD) (cont.)

What Are the Signs and Symptoms of Inflammatory Bowel Disease (IBD)?

Inflammatory bowel disease is a chronic disease (lasting a long time), and a person has periods of time in which the disease flares up and causes symptoms. These periods are followed by remission, in which symptoms disappear or decrease and good health returns.

Symptoms may range from mild to severe and generally depend upon the part of the intestinal tract involved. Signs and symptoms of IBD include:

  • Abdominal cramps and pain
  • Bloody diarrhea
  • Severe urgency to have a bowel movement
  • Fever
  • Loss of appetite
  • Weight loss
  • Anemia (due to blood loss)

What Causes Inflammatory Bowel Disease (IBD)?

Researchers do not yet know what causes inflammatory bowel disease. Therefore, IBD is called an idiopathic disease (disease with an unknown cause).

An unknown factor/agent (or a combination of factors) triggers the body's immune system to produce an inflammatory reaction in the intestinal tract that continues without control. As a result of the inflammatory reaction, the intestinal wall is damaged leading to bloody diarrhea and abdominal pain.

Genetic, infectious, immunologic, and psychological factors have all been associated with influencing the development of IBD.

There is a genetic predisposition (or perhaps susceptibility) to the development of IBD, but the triggering factor for the activation of the body's immune system has yet to be identified. Factors that can turn on the body's immune system include an infectious agent (as yet unidentified), an immune response to an antigen (for example, protein from cow milk), or an autoimmune process. As the intestines are always exposed to things that can cause immune reactions, more recent thinking is that there is a failure of the body to turn off the normal immune responses.

What Are the Intestinal Complications of Inflammatory Bowel Disease (IBD)?

Intestinal complications of inflammatory bowel disease include the following:

  • Profuse bleeding from the ulcers
  • Perforation (rupture) of the bowel
  • Strictures and obstruction: In persons with Crohn's disease, narrowing of the intestines due to inflammation occurs, and frequently resolves with medical treatment. Fixed or fibrotic (scarring) strictures may require endoscopic or surgical intervention to relieve the obstruction. In ulcerative colitis, colonic strictures should be presumed to be malignant (cancerous).
  • Fistulae (abnormal passage) and perianal disease: These are more common in persons with Crohn's disease. They may not respond to vigorous medical treatment. Surgical intervention often is required, and there is a high risk of recurrence.
  • Toxic mega-colon (acute without obstructive dilation of the colon): Although rare, toxic mega colon is a life-threatening complication of ulcerative colitis and requires urgent surgical intervention.
  • Malignancy: The risk of colon cancer in ulcerative colitis begins to rise significantly above that of the general population after approximately 8 to 10 years of diagnosis. The risk of cancer in Crohn's disease may equal that of ulcerative colitis if the entire colon is involved. The risk of small intestine malignancy is increased in Crohn's disease.

Extraintestinal Complications

  • Extraintestinal involvement of IBD refers to complications involving organs other than the intestines. These affect only a small percentage of people with IBD.
  • Persons with IBD may have:
    • Arthritis
    • Skin conditions
    • Inflammation of the eye
    • Liver and kidney disorders
    • Bone loss
  • Of all the extraintestinal complications, arthritis is the most common. Joint, eye, and skin complications often occur together.

When to Seek Medical Care for Inflammatory Bowel Disease (IBD)

If a person has the previously mentioned symptoms and signs, a visit to a doctor is warranted. Although those symptoms can suggest that the person may have inflammatory bowel disease, tests must first be performed to see if they do have IBD. The same symptoms are seen in several other disorders as well, and so the symptoms alone do not necessarily mean a person has IBD. Irritable bowel syndrome (IBS) is a different disorder that may have symptoms similar to those of IBD.

Is There a Test to Diagnose Inflammatory Bowel Disease (IBD)?

A health care professional makes the diagnosis of inflammatory bowel disease based on the patient's symptoms and various diagnostic procedures and tests.

Stool Examination

  • A stool examination is done to eliminate the possibility of bacterial, viral, or parasitic causes of diarrhea.
  • A fecal occult blood test is used to examine stool for traces of blood that cannot be seen with the naked eye.

Complete Blood Count

Both the above tests are not diagnostic of IBD, as they may be abnormal in many other diseases.

Barium X-Ray

  • Upper gastrointestinal (GI) tract: This exam uses X-rays to find abnormalities in the upper GI tract (esophagus, stomach, duodenum, sometimes the small intestine). For this test, you swallow barium (a chalky white substance), which coats the inside of the intestinal tract, and can be documented on X-rays. If a person has Crohn's disease, abnormalities will be seen on barium X-rays.
  • Lower gastrointestinal (GI) tract: In this exam, barium is given as an enema that is retained in the colon while X-rays are taken. Abnormalities will be noted in the rectum and colon in persons with Crohn's disease and ulcerative colitis.

Sigmoidoscopy

  • In this procedure, a doctor uses a sigmoidoscope (a narrow, flexible tube with a lens and a light source) to visualize the last one-third of the large intestine, which includes the rectum and the sigmoid colon. The sigmoidoscope is inserted through the anus and the intestinal wall is examined for ulcers, inflammation, and bleeding. During this procedure, the doctor may take samples (biopsies) of the lining of the intestine.

Colonoscopy

A colonoscopy is an examination similar to a sigmoidoscopy, but with this procedure, the entire colon can be examined.

Upper Endoscopy

If you have upper GI symptoms (nausea, vomiting), an endoscope (narrow, flexible tube with a light source) is used to examine the esophagus, stomach, and the duodenum. The endoscope is inserted through the mouth, and the stomach and duodenum are examined for ulceration. Ulceration occurs in the stomach and duodenum in 5% to 10% of persons with Crohn's disease.

Medically Reviewed by a Doctor on 1/6/2017

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