Inflammatory Bowel Disease

Overview of inflammatory bowel disease

Autoimmune disorders are mainly triggered by genetic factors.They adversely impact different essential organs of the body. The gastrointestinal tract, in particular, is severely affected due to the disorders of the immune system.A common disease of the above category is the “Inflammatory Bowel Disease”. According to the statistics of the World Gastroenterology Organization, nearly 1-1.3 million people are suffering from inflammatory bowel disease at present (USA). This disease has increased the global burden of gastrointestinal disorders.

What is inflammatory bowel disease?

Inflammatory Bowel Disease is a collective term for a group of disease in which the immune system of the body attacks the digestive tract. Acute inflammation of the gastrointestinal tract occurs in this condition. The parts of the GI tract that are commonly affected are- the beginning of the large intestine and the end of the small intestine. All the layers of the aforementioned sections of the GI tract may be infected. The onset of the Inflammatory Bowel Disease is marked by bowel incontinence and associated gastrointestinal disorders.

Difference between inflammatory bowel disease and irritable bowel syndrome

Inflammatory Bowel Disease is often confused with Irritable Bowel Syndrome due to the occurrence of similar symptoms. Medically, these two are different.

Inflammatory Bowel Disease arises from immune systems disorders of the gastrointestinal tract.

On the contrary, Irritable Bowel Syndrome arises due to altered contraction and relaxation of the intestine that disturbs the bowel movements.

Causes of inflammatory bowel disease

Inflammatory Bowel Disease is caused by multiple factors. The common causes are listed below-

• Immune system disorders that result in inflammation of the gastrointestinal tract (the immune system mistakes benign substances present in the intestine for harmful foreign bodies)
• Familial history of immune disorders that causes a defective or mutated gene (Eg: a mutated NOD2/CARD15 gene) to be passed onto the next generations.
• Addictive practices like smoking and alcoholism that has detrimental effects on the immune system of the body.
• Taking antibiotics for a long time that may alter the functioning of the immune system
• Non-steroidal Anti Inflammatory Drugs (NSAIDs) such as ibuprofen, naproxen or aspirin (can cause flares)
• Recent or past occurrence of Appendectomy (removal of the vermiform appendix) for the treatment of appendicitis
• Consumption of certain food items through regular diet which may affect the immune system (exact cause not determined)
• Abnormal variations in bacterial count in the small intestine (triggers improper reactions from the immune system)
• Being a Caucasian (increases risks of IBD manifold)
• Existing bowel diseases

Symptoms of Inflammatory Bowel Disease

Following are the common symptoms of inflammatory bowel disease-

• Abdominal pain, discomfort, and cramps
• Diarrhoea-like symptoms
• Bowel incontinence (Diarrhoea or Constipation)
• Presence of blood in stool
• Pain and discomfort during bowel movements
• Unpleasant odor from stool
• Nausea and vomiting
• Fever and fatigue

In the following sections, the two categories of Inflammatory Bowel Disease, that is, Crohn’s disease and Ulcerative Colitis will be discussed separately.

Crohn’s disease

Crohn’s disease is a kind of inflammatory bowel disease that mainly affects the end portion of the small intestine (ileum) at the junction of the small intestine and the colon.

In general, Crohn’s disease can occur in any region of the gastrointestinal tract (mouth to the perianal region).

It is usually manifested as irregular reddish or greyish patches in some specific regions of the gastrointestinal tract.

In the severe cases of Crohn’s disease, the patches may appear along the entire thickness of the wall of the bowel.

Nearly one-third of the patients with Crohn’s disease have granulomatous inflammation.

Causes of Crohn’s disease

Crohn’s disease is caused when the immune system of the body responds abnormally to the bacteria present on the surface of the gut. A bacterial imbalance may precipitate this condition. Poor dietary habits and excessive smoking are also believed to be the major contributors to Crohn’s disease.

Symptoms of Crohn’s disease

Crohn’s disease is usually manifested through the following symptoms-

• Abdominal pain and cramps (after a meal)
• Diarrhoea
• Presence of blood and mucus in stool
• Soreness and redness of eyes
• Joint pain
• Skin Rashes
• Weight loss

Types of Crohn’s disease

Based on the part of the small intestine affected, Crohn’s disease has the following subtypes-

• Crohn’s granulomatous colitis: Here granulomatous inflammation is found in some parts of the colon.
• Gastroduodenal Crohn’s disease: In this disease, the patches are found in the duodenum and the stomach.
• Ileitis: Only the ileum is affected in this case.
• Ileocolitis: The colon and the ileum are affected.
• Jejunoileitis: Inflammatory patches occur in the upper part of the small intestine (jejunum)

Based on the pattern of the disease, Crohn’s disease has the following subtypes-

• Luminal fibrostenosing Crohn’s disease: It is a recurrent form of Crohn’s disease, characterized by narrowing of the small intestine.
• Luminal Crohn’s disease: Inflammation occurs in the lumen or the tube of the intestine.
• Fistulizing Crohn’s disease: Formation of abnormal channels (fistula) in the intestine, vagina and the bladder occurs in this condition.

Ulcerative colitis

Ulcerative colitis is defined as the inflammatory bowel disease marked by inflammatory patches in parts of the colon and the rectum. It is caused by overactivation of the intestinal immune system. Existing ulcerative colitis conditions are aggravated by colonic bacteria, defective genes, and other environmental factors. Ulcerative colitis is characterized by rectal bleeding, anemia, and abdominal pain.

Types of ulcerative colitis

Ulcerative colitis has four subtypes-

• Ulcerative proctitis: Inflammation occurs only in the rectum.
• Proctosigmoiditis: The rectum and the lower part of the colon (sigmoid colon) are affected in this case. The common symptoms are- Diarrhoea with blood, the frequent urge for bowel movements and abdominal cramps.
• Left-sided colitis: It originates at the rectum and extends up to the splenic flexure.
• Pan-ulcerative colitis: It is the most severe form of colitis wherein the entire colon is affected. It may lead to dilation of the colon and excessive bleeding.

Diagnosis

The following tests are carried out-

• Blood test
• Stool test
• Capsule endoscopy
• CT scan and MRI scan

Low FODMAP for IBD

A low FODMAP diet is a diet that is prescribed to those who have chronic gastrointestinal symptoms such as gas, bloating, cramps, diarrhea or constipation. FODMAP is an acronym for :

• Fermentable – These can be broken down in the large intestine by bacteria.
• Oligosaccharides – These are individual sugars that are joined in a chain. ‘Oilgo’ meaning ‘few’ and ‘saccharide’ meaning ‘sugar’.
• Disaccharides – Double sugar molecules. ‘Di’ meaning two.
• Monosaccharides – ‘mono’ meaning single. These are single sugar molecules.
• And Polyols – These are sugar alcohols.

The issue with a high FODMAP diet is that it tends to put stress on the gastrointestinal tract, especially on the large intestine. People with digestive issues such as IBS, IBD, Crohn’s Disease etc find it difficult to digest such foods. It causes painful symptoms such as gas and bloating. Thus, a low FODMAP diet is inherently beneficial for such individuals. Since the FODMAP diet has shown positive results in easing symptoms of IBS, it is being considered as a Crohn’s disease management. That is because it shares similar symptoms with IBS.

Treatment & Prevention

The first step in treating IBD is to take anti-inflammatory drugs which help in reducing the infection of the GI tract. Certain immunosuppressants are also used to treat this condition. If the cause of the infection is a bacterial infection, then antibiotics may be prescribed. Prevention of IBD requires a complete overhaul of lifestyle habits especially quitting smoking and drinking. It is important to stay hydrated and reduce stress. Refrain from consuming dairy products. Essential vitamins and minerals in diet can help prevent IBD. Also, having a physically active lifestyle is important in addressing issues of the digestive system.

Severe cases of inflammatory bowel disease may necessitate surgeries. Improving overall health and hygiene conditions is preferred over unnecessary medications for preventing gastrointestinal disorders in general.

References