Inflammatory Bowel Disease

Description

Ulcerative Colitis and Crohn’s Disease are the two main types of inflammatory bowel disease (IBD). Although the symptoms of the diseases are similar, they are distinct conditions affecting different parts of the gastrointestinal tract. Both bowel diseases course of illness are characterized by flare-ups and relapses of inflammation.

Ulcerative Colitis

Inflammation is confined to the rectum and colon (large intestine). The lining of the large intestine becomes inflamed. Tiny sores called ulcers develop that excrete pus and mucus. This ulceration and inflammation causes abdominal pain and frequent emptying of the bowels.

Crohn’s Disease

Inflammation can affect the entire thickness of the bowel, not just the lining. Unlike ulcerative colitis, inflammation can occur in any part of the gastrointestinal (GI) tract, from mouth to anus.

Causes

Ulcerative Colitis

The exact cause of the disease is unknown, although research has identified certain risk factors. Genetics are considered important, with a family history of ulcerative colitis being the most important risk factor. Environment is also relevant. The incidence is higher in developed countries where improved sanitation reduces exposure to infections during childhood. This causes the cells in the large intestine to develop a restricted maturity, resulting in an inappropriate response to outside microorganisms later in life. Previous infections to the GI tract, such as salmonella, double the risk of development. The previous infection causes changes to the natural bacteria in the gut, inducing the chronic inflammatory process.

Crohn’s Disease

Development is not determined by a cause and effect. In a healthy GI tract, cell lining can control inflammation. It can respond to diet and bacteria appropriately, as well as protect against any threats to immunity. In Crohn’s disease, the GI tract experiences uncontrolled inflammation. The body has an immune response to its own tissue. This is caused by a complex interaction of genetic disposition, bacteria presence, and immune dysfunction.

Treatment

Ulcerative Colitis

Primary treatment addresses the symptoms of the disease. Treatment is then planned and managed to prevent future flare-ups, hospital admissions, and surgery. Intestinal healing is given a high priority, as it greatly affects the patient's quality of life.

• Pharmacological Management
  

  The typical drugs used to treat ulcerative colitis are mesalamine (Lialda*), corticosteroids, immunosuppressive drugs, and monoclonal antibody drugs. Drug selection varies greatly as symptoms, disease, and prognosis differ considerably between individuals.

• Surgical Management
  

  Although ulcerative colitis can be managed successfully with medication alone, approximately 20-30% of people will need surgery. Indications for surgery are divided into emergency, urgent, and elective. Emergency surgery is needed when the person’s life is threatened. Urgent surgery is needed when the ulcerative colitis is not responding to intense medical treatment. Elective surgery is usually needed for colorectal cancers. Surgery aims to improve the person’s quality of life, by removing the part of the large intestine that is inflamed.

Crohn’s Disease

Treatment approach is similar to ulcerative colitis.

• Pharmacological Management
  

  Common drugs used are aminosalicylates, corticosteroids, immunomodulators, antibiotics, and biologic therapies. Drug choice will depend on each individual case of Crohn’s disease. Creating a drug protocol to suit everyone is difficult, as disease advancement varies.

• Surgical Management
  

  As surgery cannot cure Crohn’s disease, its use is restricted. It can be effective for those who have flare-ups of Crohn’s disease confined to one area of the GI tract.

• Lifestyle
  

  Smokers are encouraged to give up smoking, as it aggravates the disease.