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Today in Health & Wellness
HEALTH CONDITIONS

Inflammatory Bowel Disease

Overview
Symptoms
Risk Factors
Commonly Prescribed Drugs
Treatment and Management
Doctors to Consult
Overview

Inflammatory bowel disease (IBD) involves the chronic inflammation of the gastrointestinal tract. It may affect the whole GI tract or only parts of it. Symptoms of IBD vary and depend on the severity and location of the inflammation. Patients usually experience periods of active disease followed by periods without any symptoms. The cause of IBD remains unknown. Some of the possible causes include an abnormal immune response that attacks the GI tract and heredity.

Forms of Inflammatory Bowel Disease:

  • Ulcerative colitis causes inflammation and ulcer formation in the innermost linings of the large intestine and/or rectum. It has different types depending on the location and severity of the inflammation.
  • Crohn’s disease affects the linings of the different areas of the GI tract. The inflammation can spread into the deeper tissues. The most common parts of the GI tract affected include the last part of the small intestine and the large intestine. Inflammation of the tissues can lead to the narrowing or scarring leading to blockage of the GI tract. In some cases, ulcers extend through the intestinal wall and create a connection with the skin or another body organ known as fistula.

Diagnosis of IBD involves several tests and elimination of other possible conditions. Colonoscopy allows the physician to see inside the large intestine. Crohn’s disease is confirmed with the presence of clusters of inflammatory cells. An alternative is capsule endoscopy which is done by swallowing a capsule containing a camera. CT scan is also used as an imaging test on the entire bowel and outside the bowel.

Symptoms
  • Diarrhea
  • Fatigue and low energy
  • Abdominal pain
  • Abdominal cramping
  • Low-grade fever
  • Blood in the stool
  • Decreased appetite
  • Unintended weight loss
  • Severe urgency for bowel movement
Risk Factors
  • Age. Most cases occur before 30 years old
  • Family history. An immediate relative has IBD
  • Smoking. It is a risk factor for Crohn’s disease but provides protection against ulcerative colitis
  • NSAIDs. Nonsteroidal anti-inflammatory drugs can increase the risk or worsen an existing IBD.
  • Environmental factors. Increased when living in an urban area or industrialized country
Commonly Prescribed Drugs
  • Anti-inflammatory drugs are the first line of treatment for IBD.

o   Aminosalicylates include sulfasalazine, mesalamine, balsalazide, and olsalazine. Sulfasalazine is shown to be an effective treatment for treating inflammation of the large intestine and rectum. Some anti-inflammatory drugs are available in oral, enema, and suppository forms. Side effects: headache, digestive distress

o   Corticosteroids are used to treat unresponsive forms of IBD. These include prednisone and hydrocortisone. Corticosteroids are not always used due to its numerous side effects. Side effects: excessive facial hair, night sweats, insomnia

  • Immunosuppressant drugs reduce the inflammation by inhibiting the release of chemicals that cause inflammation in the linings of the GI tract. Azathioprine and mercaptopurine are the most widely used immunosuppressants. Cyclosporine is the reserved drug for unresponsive ulcerative colitis. Infliximab, adalimumab, and golimumab are tumor necrosis factor-α inhibitors effective for patients with moderate to severe IBD. Complications: increased risk of infection, risk for cancer
  • Antibiotics are given to patients who show signs of infection like fever. In some cases, these drugs reduce bad intestinal bacteria and act as immunosuppressants in the GI tract. Commonly used antibiotics for IBD are metronidazole and ciprofloxacin. Side effects: tingling of hands and feet, muscle weakness, muscle pain
 
Treatment and Management
  • IBD remains incurable but several treatment approaches are available to reduce the inflammation and its signs and symptoms. Effective treatments may lead to long-term episodes without any symptoms.
  • Maintain a food diary to determine which foods worsen the symptoms.
  • Eat low-fat foods and avoid food high in fat like butter, margarine, and fried foods. Patients with Crohn’s disease do not digest fats causing worse diarrhea.
  • High-fiber foods might worsen symptoms of IBD. Patients are advised to steam, bake, or stew raw vegetables to lessen the severity of symptoms.
  • Try eating five or six small meals throughout the day instead of three big meals.
  • Hydrate frequently with water.
  • Vitamins and supplements can be prescribed by the physician if the patient cannot absorb enough nutrients from food.
  • Even though smoking prevents ulcerative colitis, it increases the risk and worsens Crohn’s disease. Quit or avoid smoking to improve the overall health of the GI tract.
  • If stress worsens the symptoms of IBD, manage stress by doing mild exercise, relaxation techniques, and slow breathing.

 

Surgery

  • Surgery for ulcerative colitis known as proctocolectomy involves the removal of the large intestine and rectum. Most cases involve the use of an internal pouch that connects the end of the small intestine and the anus for collection of waste (ileoanal anastomosis). Some patients who cannot have the pouch placed inside their abdomen uses a bag placed on their abdomen to collect stool (ileostomy).
  • Surgery for Crohn’s disease involves the removal of the damaged parts of the GI tract and then reconnection of the healthy sections. Another procedure is the widening of a narrowed portion of the intestine which is known as strictureplasty. Patients with Crohn’s disease who undergo surgery are not cured of the disease.  The disease often recurs near the reconnected tissues. A colonoscopy should be done 6 to 12 months after the surgery to look for signs of the disease.
Home Remedies
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