inflammatory bowel disease
| Dictionary: inflammatory bowel disease |
n. (Abbr. IBD)
A chronic disorder of the gastrointestinal tract, especially Crohn's disease or an ulcerative form of colitis, characterized by inflammation of the intestine and resulting in abdominal cramping and persistent diarrhea.
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| Sci-Tech Encyclopedia: Inflammatory bowel disease |
Inflammatory bowel disease is a general term for two closely related conditions, ulcerative colitis and Crohn's disease. The diseases can affect the colon, distal, small intestine and sometimes other portions of the gastrointestinal tract as well as several sites outside the gastrointestinal tract. In 15–25% of cases limited to the colon, ulcerative colitis and Crohn's disease cannot be distinguished by clinical manifestations, x-ray examination, or even pathology. For this reason the broad term inflammatory bowel diseases is useful. The cause of these diseases is unknown.
Ulcerative colitis, an inflammatory condition limited to the colon, primarily affects the mucosa or lining of the colon. Marked inflammation gives rise to small ulcerations and microscopic abscesses that produce bleeding. The condition tends to be chronic, alternating between periods of complete remission and episodes of active and even life-threatening disease.
Crohn's disease, also known as regional enteritis, granulomatous colitis, and terminal ileitis, affects the colon and small intestine, and rarely the stomach or esophagus. Like ulcerative colitis, it is chronic and of unknown etiology. See also Digestive system.
| Alternative Medicine Encyclopedia: Inflammatory Bowel Disease |
Definition
Inflammatory bowel disease (IBD) is the general name for ulcerative colitis and Crohn's disease. The disease is characterized by swelling, ulcerations, and loss of function of the intestines.
Description
The primary problem in IBD is inflammation, as the name suggests. Inflammation is a process that often occurs to fight off foreign invaders in the body, including viruses, bacteria, and fungi. In response to such organisms, the body's immune system begins to produce a variety of cells and chemicals intended to stop the invasion. These immune cells and chemicals, however, also have direct effects on the body's tissues, resulting in heat, redness, swelling, and loss of function. No one knows what starts the cycle of inflammation in IBD, but the result is a swollen, boggy intestine.
In ulcerative colitis, the inflammation affects the lining of the rectum and large intestine. It is thought that the inflammation typically begins in the last segment of large intestine, which empties into the rectum (sigmoid colon). This inflammation may spread through the entire large intestine, but only rarely affects the very last section of the small intestine (ileum). The rest of the small intestine remains normal.
Crohn's disease is a form of IBD that affects both the small and large intestines. The inflammation of ulcerative colitis occurs only in the lining of the intestine (unlike Crohn's disease which affects all of the layers of the intestinal wall). As the inflammation continues, the tissue of the intestine begins to slough off, leaving pits (ulcerations) that often become infected.
IBD can occur in all age groups, with the most common age of diagnosis being 15–35 years of age. Men and women are affected equally. Whites are more frequently affected than other racial groups, and people of Jewish origin have three to six times greater likelihood of suffering from IBD. IBD is familial; an IBD patient has a 20% chance of having other relatives who are fellow sufferers.
Causes & Symptoms
No specific cause of IBD has been identified. Although no organism (virus, bacteria, or fungi) has been found to set off the cycle of inflammation, some researchers continue to suspect that an organism is responsible. Other researchers are concentrating on identifying some change in the cells of the colon that would make the body's immune system accidentally begin treating those cells as foreign. Additional evidence for a disorder of the immune system includes the high number of other immune disorders that frequently accompany IBD. The condition has also been linked to physical, mental, and emotional stress.
The first symptoms of IBD are abdominal cramping and pain, a sensation of urgent need to have a bowel movement (defecate), and blood and pus in the stools.
Some patients experience diarrhea, fever, and weight loss. If the diarrhea continues, signs of severe fluid loss (dehydration) begin to appear, including low blood pressure, fast heart rate, and dizziness.
Severe complications of IBD include perforation of the intestine, toxic dilation (enlargement) of the colon, and the development of colon cancer. Intestinal perforation occurs when long-standing inflammation and ulceration of the intestine weaken the wall to such an extent that a hole occurs. This is a life-threatening complication, because the contents of the intestine (which contain a large number of bacteria) spill into the abdomen. The presence of bacteria in the abdomen can result in a massive infection called peritonitis.
Toxic dilation of the colon is thought to occur because the intestinal inflammation interferes with the normal function of the muscles of the intestine. This allows the intestine to become lax, and its diameter begins to increase. The enlarged diameter thins the walls further, increasing the risk of perforation and peritonitis. When the diameter of the intestine is quite large and infection is present, the condition is referred to as "toxic megacolon."
Patients with IBD have a significant risk of developing colon cancer. This risk seems to begin around 10 years after diagnosis. The overall risk of developing cancer seems to be greatest for those patients with the largest extent of intestine involved. The risk becomes statistically greater every year:
- At 10 years, the risk of cancer is about 0.5–1%.
- At 15 years, the risk of cancer is about 12%.
- At 20 years, the risk of cancer is about 23%.
- At 24 years, the risk of cancer is about 42%.
Patients with IBD also have a high chance of experiencing other disorders, including inflammation of the joints (arthritis), inflammation of the vertebrae (spondylitis), ulcers in the mouth and on the skin, the development of painful, red bumps on the skin, inflammation of several areas of the eye, and various disorders of the liver and gallbladder.
Diagnosis
IBD is first suspected based on the symptoms that a patient is experiencing. Examination of the stool will usually reveal the presence of blood and pus (white blood cells). Blood tests may show an increase in the number of white blood cells, which is an indication of inflammation occurring somewhere in the body. The blood test may also reveal anemia, particularly when a great deal of blood has been lost in the stool.
The most important allopathic method of diagnosis is endoscopy, during which a doctor passes a flexible tube with a tiny fiberoptic camera device through the rectum and into the colon. The doctor can then examine the lining of the intestine for signs of inflammation and ulceration. A tiny sample (biopsy) of the intestine will be removed through the endoscope, which will be examined under a microscope for evidence of IBD. X-ray examination is helpful to determine the amount of affected intestine. However, x-ray examinations requiring the use of barium should be delayed until treatment has begun. Barium is a chalky solution that the patient drinks or is given through the rectum and into the intestine (enema). The presence of barium in the intestine allows more detail to be seen on x ray films.
Treatment
Treatment for IBD targets the underlying inflammation, as well as the problems occurring due to continued diarrhea and blood loss. The use of alternative medicines in the treatment of IBD is common. IBD sufferers have used a variety of treatments; however, few controlled studies of their effectiveness have been performed.
Chamomile tea is used to treat IBD. Chamomile is known to have anti-inflammatory, antispasmodic, and antibacterial properties. The patient should steep dried flowers for 10 to 15 minutes and drink three to four cups daily. Chamomile can cause allergic reactions in those who are allergic to other daisies. Other antispasmodics include valerian, wild yam, and cramp bark.
There is some preliminary evidence that alteration of the kinds of bacteria in the intestine prevents or controls colitis. Intestinal bacteria can be manipulated through use of probiotics or prebiotics. Probiotics refers to treatment with beneficial microbes either by ingestion or through a suppository. Prebiotics refers to dietary changes that favor the overgrowth of beneficial microbes. Preliminary animal and human studies have shown that Lactobacilli and related bacteria can control colitis and prolong remission. Ingestion of the nondigestable carbohydrates inulin or lactulose as prebiotics stimulates growth of these beneficial bacteria.
In a related treatment, preliminary evidence suggests that ingestion of parasitic worm eggs eases the symptoms of IBD. Within two to three weeks, five out of the six IBD patients who ingested the eggs went into complete remission which lasted one month. The tiny, harmless worms cannot reproduce in humans and are passed out within a few months.
Ingestion of enteric coated fish oil capsules may reduce the IBD relapse rate. A small study found that patients taking fish oil supplements had a lower relapse rate (59%) than those on placebo (90%).
Seventy-two percent of ulcerative colitis patients taking a Kui Jie Qing enema (alum, Halloysite, Calamine, Indigo naturalis, and plum-blossom tongue-pointing pills) daily were considered cured, as compared with 5% of those who were taking anti-inflammatory drugs. Fifty-three percent of ulcerative colitis patients taking Jian Pi Ling tablet and root of Sophorae flavescentis plus the flower of sophora enema were considered cured, as compared with 28% of those taking sulfasalazine and dexamethasone and 19% of those taking a placebo tablet and the enema. There are many other Chinese herbs that are useful in treating diarrhea and mucus in the bowel. Sometimes these are effective when drugs are not.
Forty-five percent of ulcerative colitis patients on an enzyme-potentiated hyposensitization protocol (B-glucuronidase enzyme and 1,3-cyclohexanediol with egg, milk, wheat, potato, and yeast) were improved, as compared with 6% of those on placebo.
Nutritionists often recommend changes in the diet for patients with inflammatory bowel disease. Food allergies and certain kinds of food are linked with the increased incidence of the disease. Eliminating diary and wheat products, common allergens, often alleviates symptoms. The incidence of Crohn's disease is increasing in areas where people consume a diet high in refined sugars and carbohydrates and saturated fats and low in dietary fiber. Elimination diets or those restricted in refined foods have sometimes proved successful in the alleviation of inflammatory bowel disease.
Dietary supplements are generally beneficial in the treatment of digestive disorders. Some typical recommendations include:
- vitamin C: 4000 mg daily
- vitamin B6: 250 mg daily
- magnesium (aspartate): 400 mg daily
- vitamin E: 800 IU daily
- glutamine: 3000 mg daily, taken between meals
- garlic, deodorized: 2000 mg daily
- deglycyrrhizinated licorice: chew as needed.
Other treatments for IBD include acupuncture, macrobiotics, cat's claw (Uncaria tomentosa), slippery elm, acupressure, biofeedback, relaxation techniques, and hypnotherapy.
Allopathic Treatment
Inflammation is often treated with an immune-suppressive drug called sulfasalazine. Because of poor absorption, sulfasalazine stays primarily within the intestine, where it is broken down into its two components: an antibiotic and an anti-inflammatory. It is believed to be primarily the anti-inflammatory component, salicylic acid, that is active in treating IBD. For patients who do not respond to sulfasalazine, steroid medications (such as prednisone) are the next choice.
Depending on the degree of blood loss, a patient with IBD may require blood transfusions and fluid replacement through a needle in the vein (intravenous or IV). Medications that can slow diarrhea must be used with great care, because they may actually cause the development of toxic megacolon.
A patient with toxic megacolon requires close monitoring and care in the hospital. He or she will usually be given steroid medications through an IV, and may be put on antibiotics. If these measures do not improve the situation, the patient will have to undergo surgery to remove the colon. This is done because the risk of death after perforation of toxic megacolon is greater than 50%.
A patient with proven cancer of the colon, or even a patient who shows certain precancerous signs, will need a colectomy (colon removal). When a colectomy is performed, a piece of the small intestine (ileum) is pulled through an opening in the abdomen and fashioned surgically to allow attachment of a special bag to catch the body's waste (feces). This opening, which will remain for the duration of the patient's life, is called an ileostomy.
Expected Results
Remission refers to a disease becoming inactive for a period of time. The rate of remission of IBD (after a first attack) is nearly 90%. Those individuals whose colitis is confined primarily to the left side of the large intestine have the best prognosis. Those individuals with extensive colitis, involving most or all of the large intestine, have a much poorer prognosis. Recent studies show that about 10% of these patients have died within 10 years after diagnosis. About 20–25% of all IBD patients will require colectomy. Unlike the case for patients with Crohn's disease, however, such radical surgery results in a cure of the disease.
Resources
Books
Glickman, Robert. "Inflammatory Bowel Disease: Ulcerative Colitis and Crohn's Disease." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.
Long, James W. The Essential Guide to Chronic Illness. New York: HarperPerennial, 1997.
Saibil, Fred. Crohn's Disease and Ulcerative Colitis. Buffalo, NY: Firefly Books, 1997.
Periodicals
"Alternative Therapies Commonly Used by Patients with Inflammatory Bowel Disease." Nutrition Research Newsletter 18 (June 1999):13+.
Campieri, Massimo and Paolo Gionchetti. "Probiotics in Inflammatory Bowel Disease: New Insight to Pathogenesis or a Possible Therapeutic Alternative?" Gastroenterology 116 (1999):1246-1249.
Coghlan, Andy. "Wonderful Worms." New Scientist 163 (August 7, 1999):4.
Hilsden, Robert J. and Marja J. Verhoef. "Complementary and Alternative Medicine: Evaluating its Effectiveness in Inflammatory Bowel Disease." Inflammatory Bowel Diseases 4 (1998):318-323.
Martin, Frances L. "Ulcerative Colitis." American Journal of Nursing 97 (August 1997): 38+.
Peppercorn, Mark A., and Susannah K. Gordon. "Making Sense of a Mystery Ailment: Inflammatory Bowel Disease." Harvard Health Letter 22 (December 1996): 4+.
"Ulcerative Colitis: Manageable, With a Brighter Outlook." Mayo Clinic Health Letter 13 (December 1995): 1+.
Organizations
Crohn's and Colitis Foundation of America, Inc. 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 932-2423.
[Article by: Belinda Rowland]
| Veterinary Dictionary: IBD |
1. infectious bursal disease of chickens.
2. inflammatory bowel disease.
| Wikipedia: Inflammatory bowel disease |
Not to be confused with irritable bowel syndrome.
| Inflammatory bowel disease | |
|---|---|
| Classification and external resources | |
| DiseasesDB | 31127 |
| eMedicine | med/1169 emerg/106 oph/520 |
| MeSH | D015212 |
In medicine, 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.[1][2][3]
Contents |
Forms
The main forms of IBD are Crohn's disease and ulcerative colitis (UC).
Accounting for far fewer cases are other forms of IBD:
- Collagenous colitis
- Lymphocytic colitis
- Ischaemic colitis
- Diversion colitis
- Behçet's syndrome
- Infective colitis
- Indeterminate 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 (skip lesions), although a majority of the cases start in the terminal ileum. Ulcerative colitis, in contrast, is restricted to the colon and the rectum.[4]
Microscopically, ulcerative colitis is restricted to the mucosa (epithelial lining of the gut), while Crohn's disease affects the whole bowel wall.
Finally, Crohn's disease and ulcerative colitis present with extra-intestinal manifestations (such as liver problems, arthritis, skin manifestations and eye problems) in different proportions.
Rarely, a definitive diagnosis of neither Crohn's disease nor ulcerative colitis can be made because of idiosyncrases in the presentation. In this case, a diagnosis of indeterminate colitis may be made. Although a recognised definition, not all centres refer to this.
Symptoms and diagnosis
Although very different diseases, both may present with any of the following symptoms: abdominal pain, vomiting, diarrhea, hematochezia (bright red blood in stools), weight loss and various associated complaints or diseases like arthritis, pyoderma gangrenosum, and primary sclerosing cholangitis. Diagnosis is generally by colonoscopy with biopsy of pathological lesions.
Treatment
Depending on the level of severity, IBD may require immunosuppression to control the symptom, such as prednisone, TNF inhibition, azathioprine (Imuran), methotrexate, or 6-mercaptopurine. More commonly, treatment of IBD requires a form of mesalamine. Often, steroids are used to control disease flares and were once acceptable as a maintenance drug. In use for several years in Crohn's disease patients and recently in patients with ulcerative colitis, biologicals have been used such as TNF inhibitors. Severe cases may require surgery, such as bowel resection, strictureplasty or a temporary or permanent colostomy or ileostomy. Alternative medicine treatments for bowel disease exist in various forms, however such methods concentrate on controlling underlying pathology in order to avoid prolonged steroidal exposure or surgical excisement.[5]
Usually the treatment is started by administering drugs with high anti-inflammatory effects, such as prednisone. Once the inflammation is successfully controlled, the patient is usually switched to a lighter drug to keep the disease in remission, such as Asacol, a mesalamine. If unsuccessful, a combination of the aforementioned immunosuppression drugs with a mesalamine (which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.
Histoplasma produces toxins that cause intestinal disease called histoplasmosis that is a “serious consideration” in an immunocompromised patient with signs and symptoms of IBD. Antifungal drugs such as Nystatin (a broad spectrum gut antifungal) and either itraconazole (Sporanox) or fluconazole (Diflucan) have been suggested as a treatment for IBD disorders such as Crohn’s disease and ulcerative colitis that all share the same symptoms such as diarrhea, weight loss, fever, and abdominal pain.[6]
Prognosis
While IBD can limit quality of life because of pain, vomiting, diarrhea, and other socially unacceptable symptoms, it is rarely fatal on its own. Fatalities due to complications such as toxic megacolon, bowel perforation and surgical complications are also rare.
While patients of IBD do have an increased risk of colorectal cancer this is usually caught much earlier than the general population in routine surveillance of the colon by colonoscopy, and therefore patients are much more likely to survive.
New evidence suggests that patients with IBD may have an elevated risk of endothelial dysfunction and coronary artery disease[7]
The goal of treatment is toward achieving remission, after which the patient is usually switched to a lighter drug with fewer potential side effects. Every so often an acute resurgence of the original symptoms may appear: this is known as a "flare-up". Depending on the circumstances, it may go away on its own or require medication. The time between flare-ups may be anywhere from weeks to years, and varies wildly between patients - a few have never experienced a flare-up.
Recent findings
A recent hypothesis posits that some IBD cases are caused by an overactive immune system attacking various tissues of the digestive tract because of the lack of traditional targets such as parasites and worms. The number of people being diagnosed with IBD has increased as the number of infections by parasites, such as roundworm, hookworm and human whipworms, has fallen, and the condition is still rare in countries where parasitic infections are common. This is similar to the hygiene hypothesis applied to allergies.[citation needed]
Initial reports[8] suggest that "helminthic therapy" may not only prevent but even cure (or control) IBD: a drink with roughly 2,500 ova of the Trichuris suis helminth taken twice monthly decreased symptoms markedly in many patients. It is even speculated that an effective "immunization" procedure could be developed—by ingesting the cocktail at an early age.
Prebiotics and probiotics are showing increasing promise as treatments for IBD[9] and in some studies have proven to be as effective as prescription drugs.[10]
More recently[when?], research[11] has shown that IL-23 is overexpressed in tissues taken from Mouse models of IBD. The group showed that knocking out IL-23 (heterodimer of IL-12p40 and IL-23p19) sharply reduced inflammation of the bowel, both in terms of cells and proinflammatory cytokine production. Also, they found that a novel group of CD4+ T lymphocytes, Th17 T cells, are highly unregulated in bowels of diseased mice. Taken together, the group shows that IL-23 but not IL-12 (IL-12p40 and IL-12p35; share a subunit) drives innate and T cell mediated intestinal inflammation.
In 2005 New Scientist published a joint study by Bristol University and Bath University on the apparent healing power of cannabis on IBD. Reports that cannabis eased IBD symptoms indicated the possible existence of cannabinoid receptors in the intestinal lining, which respond to molecules in the plant-derived chemicals. CB1 cannabinoid receptors – which are known to be present in the brain – exist in the endothelial cells which line the gut, it is thought that they are involved in repairing the lining of the gut when damaged. The team deliberately damaged the cells to cause inflammation of the gut lining and then added synthetically produced cannabinoids; the result was that gut started to heal: the broken cells were repaired and brought back closer together to mend the tears. It is believed that in a healthy gut, natural endogenous cannabinoids are released from endothelial cells when they are injured, which then bind to the CB1 receptors. The process appears to set off a wound-healing reaction, and when people use cannabis, the cannabinoids bind to these receptors in the same way. Previous studies have shown that CB1 receptors located on the nerve cells in the gut respond to cannabinoids by slowing gut motility, therefore reducing the painful muscle contractions associated with diarrhoea. The team also discovered another cannabinoid receptor, CB2, in the guts of IBD sufferers, which was not present in healthy guts. These receptors, which also respond to chemicals in cannabis, appear to be associated with apoptosis – programmed cell death – and may have a role in suppressing the overactive immune system and reducing inflammation by mopping up excess cells.[12]
Genetics play a crucial role in Crohn's disease but environmental factors are also involved; smoking appears to increase the risk.[citation needed]
References
- ^ Baumgart DC, Carding SR (2007). "Inflammatory bowel disease: cause and immunobiology.". The Lancet 369 (9573): 1627–40. doi:. PMID 17499605.
- ^ Baumgart DC, Sandborn WJ (2007). "Inflammatory bowel disease: clinical aspects and established and evolving therapies.". The Lancet 369 (9573): 1641–57. doi:. PMID 17499606.
- ^ Xavier RJ, Podolsky DK (2007). "Unravelling the pathogenesis of inflammatory bowel disease.". Nature 448 (7152): 427–34. doi:. PMID 17653185.
- ^ "Crohn's & Colitis Foundation of America". http://www.ccfa.org.
- ^ A Phytotherapeutic Approach to Lower Bowel Disease Gaia Garden
- ^ Holland D. The Fungal Etiology of Inflammatory Bowel Disease .
- ^ Roifman I, Sun YC, Fedwick JP, Panaccione R, Buret AG, Liu H, Rostom A, Anderson TJ, Beck PL (February 2009). "[linkinghub.elsevier.com/retrieve/pii/S1542-3565(08)01109-9 Evidence of endothelial dysfunction in patients with inflammatory bowel disease]". Clin. Gastroenterol. Hepatol. 7 (2): 175–82. doi:. PMID 19121648. linkinghub.elsevier.com/retrieve/pii/S1542-3565(08)01109-9. Retrieved 2009-11-04.
- ^ Summers RW, Elliott DE, Qadir K, Urban JF, Thompson R, Weinstock JV (2003). "Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease". Am. J. Gastroenterol. 98 (9): 2034–41. doi:. PMID 14499784. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0002-9270&date=2003&volume=98&issue=9&spage=2034.
- ^ Furrie E, Macfarlane S, Kennedy A, et al. (2005). "Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial". Gut 54 (2): 242–9. doi:. PMID 15647189.
- ^ Kruis W, Fric P, Pokrotnieks J, et al. (2004). "Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine". Gut 53 (11): 1617–23. doi:. PMID 15479682.
- ^ Hue S, Ahern P, Buonocore S, et al. (2006). "Interleukin-23 drives innate and T cell-mediated intestinal inflammation" ([dead link] – Scholar search). J. Exp. Med. 203 (11): 2473–83. doi:. PMID 17030949. PMC 2118132. http://www.jem.org/cgi/content/abstract/203/11/247.
- ^ Wright K, Rooney N, Feeney M, et al. (2005). "Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing". Gastroenterology 129 (2): 437–53. doi:. PMID 16083701.
External links
- www.myibd.org
Inflammatory bowel disease at the Open Directory Project
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