Slideshow: Inflammatory Bowel Disease - A Visual Guide to IBD
Reviewed by Andrew Seibert, MD on Wednesday, October 19, 2011
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What Is Inflammatory Bowel Disease?
Inflammatory bowel disease (IBD) refers to chronic conditions that cause inflammation in some part of the intestines. The intestinal walls become swollen, inflamed, and develop ulcers, which can cause discomfort and serious digestive problems. The exact symptoms depend on which part of the digestive tract is involved.
Types of IBD: Crohn's Disease
Crohn's disease is a form of IBD that can occur anywhere along the digestive tract -- from the mouth to the anus. It affects the deeper layers of the digestive lining and can occur as "skip lesions" between healthy areas. Crohn's often involves the small intestine, the colon, or both. Internal tissues may develop shallow, crater-like areas or deeper sores and a cobblestone pattern, as seen here.
Types of IBD: Ulcerative Colitis
Unlike Crohn's disease, ulcerative colitis only involves the colon and rectum. Inflammation and ulcers typically affect only the innermost lining in these areas, compared with the deeper lesions seen in Crohn's disease. Often only the lower (sigmoid) colon is affected, but it can occur higher up, too. The more of the colon that is affected, the worse the symptoms will be.
Symptoms of IBD
The symptoms of ulcerative colitis and Crohn's disease are similar:
- Abdominal pain or cramping
- Diarrhea multiple times per day
- Bloody stools
- Weight loss
Other Symptoms of IBD
People with IBD may have symptoms outside the digestive tract,
- Mouth sores and skin problems
- Eye problems that affect vision
What Causes IBD?
Doctors aren't sure what causes IBD. Most believe something triggers
the body's immune system to produce an unhealthy inflammatory reaction
in the digestive tract. Ongoing research has uncovered specific
genes linked to ulcerative colitis and Crohn's disease.
Who Gets IBD?
IBD strikes men and women equally. It most often begins during the teenage years or early adulthood, but can develop at other times, too. People with a family history of IBD are at least 10 times more likely to develop the condition than those with no history. Caucasians and people of Jewish descent also have an increased risk.
IBD Is not IBS
IBD is sometimes confused with IBS, which stands for irritable
bowel syndrome. Both conditions can cause chronic digestive
problems, but there are significant differences between the two.
People with IBD have inflammation, ulcers, and other damage visible
inside the digestive tract. In contrast, there is no damage in IBS,
despite symptoms such as cramping, diarrhea, and constipation. IBS
is much more common but less serious than IBD.
Conditions that Mimic IBD
There are other digestive disorders that may initially be mistaken for IBD. The symptoms of diverticulitis are belly pain, bloating, and diarrhea -- much like IBD -- but this condition involves inflamed or infected pouches along the colon wall. Another example is celiac disease, which causes cramping and frequent diarrhea, but the trigger is a protein in food called gluten. Testing can help rule out these conditions before a diagnosis of IBD is made.
Diagnosing IBD: Barium X-ray
There are several tests that can help diagnose IBD. One of the most common is a barium X-ray. Barium is a chalky fluid that may be given by mouth or as an enema. As it flows through the intestines, barium shows up on the X-ray. This helps doctors spot problem areas, such as ulcers, swelling, narrowing (seen here), or intestinal blockages. If there are abnormalities, your doctor may request additional imaging, such as a CT scan.
Diagnosing IBD: Colonoscopy
Colonoscopy is the most important test for diagnosing IBD. This procedure uses a thin tube with a camera to give doctors a direct view of the inside of the colon. Even small ulcers and mild inflammation can be seen this way. If any areas look unusual, the doctor may take a tissue sample (biopsy) for further investigation. Other tests for IBD include blood work to look for signs of inflammation or infection.
Choosing a Doctor for IBD
Doctors who specialize in the treatment of digestive disorders are called gastroenterologists. Ask your primary care doctor for the names of several gastroenterologists and hospitals with access to the latest therapies for IBD. You may also want to learn whether there are clinical trials in your area. Clinical trials offer the possibility of trying experimental drugs that are not yet on the market.
IBD: What to Expect
The symptoms of IBD range from mild to severe and may come and go over time. Most people have flare-ups followed by long periods without symptoms. This is called remission, and it can last for months or even years. In ulcerative colitis, about 5% to 10% of patients have symptoms all the time. Chronic belly pain and urgent trips to the bathroom can interfere with work, child care, and social life.
IBD and Stress
Although stress does not cause IBD, some people report that their symptoms get worse in times of stress. At a biological level, stress can prompt the release of hormones that stimulate the immune system, resulting in increased inflammation. If your IBD is in remission, a big dose of stress may trigger a flare-up. The new round of symptoms can add to your stress, creating a vicious cycle.
In Crohn's disease, chronic inflammation can make the inside of the intestine so narrow that nothing can pass through. This is known as bowel obstruction, and it causes digesting food and gas to get stuck in the digestive tract. The symptoms include severe cramping, nausea, vomiting, and a swollen belly. Bowel obstructions are treated in the hospital. If the obstruction does not clear on its own, surgery may be required.
Complications: Abcess or Fistula
Deep ulcers sometimes create a pocket of pus, called an abscess. Symptoms include fever, pain, and swelling. If an ulcer breaks through to an adjacent organ, it creates a tunnel called a fistula. A fistula between the colon and the vagina can allow bacteria into the vagina. A fistula to the bladder can cause chronic urinary tract infections. One that reaches the skin can create external sores. Fistulas and some abscesses are treated with surgery.
Does IBD Cause Colon Cancer?
People who have had IBD for at least eight years have a higher risk of developing colon cancer. The risk is even greater when inflammation affects the entire colon. Ask your doctor about regular screening -- colorectal cancer is easiest to treat when it is found early. And remember, more than 90% of people with IBD do NOT get colon cancer.
Managing IBD: Foods to Watch
Food doesn't cause this disease, but specific items can make your symptoms worse. These trigger foods are different for each person, but some common culprits include alcohol, coffee, soda, spicy foods, beans, fatty foods, high-fiber foods, nuts and seeds, raw fruits and vegetables, red meat, and dairy products (if you're lactose intolerant).
Managing IBD: Low-Residue Diet
If Crohn's disease has caused a narrowing of your small intestine, your doctor may recommend a low-residue diet. This means avoiding foods that add bulk to the stool, including nuts, seeds, raw fruits, and raw vegetables. Usually diet changes are temporary. This diet may help reduce symptoms of belly pain, cramping, and diarrhea, although more research is needed..
Managing IBD: Nutritional Needs
When Crohn's disease attacks the small intestine, the body may not be able to absorb all the nutrients it needs. Poor absorption plus poor appetite can lead to malnutrition. To avoid this, try to eat a well-balanced diet with smaller meals more frequently throughout the day -- and drink enough fluids to avoid dehydration. A registered dietitian can help. Your doctor may recommend vitamin and mineral supplements as well.
Managing IBD: Stress Reduction
Learning stress management techniques may help you cope with IBD. Yoga, meditation, and exercise can all be beneficial. Talk therapy or group therapy can also be helpful to reduce the emotional stress of coping with a chronic condition.
Treating IBD: Medications
In mild to moderate cases of IBD, treatment typically begins with medications called aminosalicylates. These are anti-inflammatory drugs that can help treat IBD and keep it in remission. During a flare-up, corticosteroids may also be used to reduce inflammation and help bring a person into remission. Other medications for more severe IBD aim to stop the immune system from causing inflammation. These include immunomodulators and biologics.
Treating IBD: Combination Therapy
New research suggests the combination of an immunomodulator and a biologic may work best for people with moderate to severe Crohn's disease. Immunomodulators cause the immune system to be less active. Biologics, which are given by injection, block the action of proteins that are key in the immune response that causes inflammation. In one study, more than half of patients on the combination therapy achieved remission.
Treating IBD: Surgery
When IBD causes severe damage to the colon, it may need to be surgically removed. This can cure ulcerative colitis, because the condition only affects the colon. Surgery cannot cure Crohn's disease -- symptoms can continue in other parts of the digestive tract. Thanks to surgical advances, most patients who have their colons removed will be able to have normal bowel movements without the use an ostomy bag.
Exercising When You Have IBD
Doctors may recommend light exercises for people with IBD. This includes activities like yoga, tai chi, or walking, which don't involve a lot of jarring that could make digestive symptoms worse. Regular exercise may actually aid digestion. It can also promote feelings of well-being and reduce stress, which may keep symptoms in check.
Living Better with IBD
IBD may be a lifelong condition, but there are ways to reduce its impact on your day-to-day life. Through medications, lifestyle changes, and stress management, many people can keep IBD from interfering with the things they want to do. If you feel your treatment regimen is not working well enough, be sure to discuss your concerns with your doctor.
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