INFLAMMATORY BOWEL DISEASE (IBD)

Inflammatory bowel disease involves the inflammation of all or part of the digestive tract. There are several causes of IBD but the two most common are the Crohn’s disease and the Ulcerative Colitis. These conditions are usually inherited, that one of the parents and your siblings can have the disease.

The factors that increases the likelihood of inflammatory bowel disease are the following:

  • Age.  Those diagnosed before they are 30 usually develop IBD.
  • Race or ethnicity. The whites have the highest risk, but everyone can have it.
  • Family history. Since this is genetic, there is a higher risk of developing the disease if a patient has a close relative who also have the disease.
  • Cigarette smoking. This is the most important risk factor.
  • Nonsteroidal anti-inflammatory medications. This may increase risk and may worsen existing IBD.

The two most common types of IBD are the following:

  1. Crohn’s disease- This type is the inflammation any portion of the gastrointestinal tract (from mouth to intestines) that involves all layers of the bowel, and is discontinuous with skip areas between 2 or more involved part. The large intestine is usually not affected in this type. Late in the disease, this will have a cobblestone appearence of the affected area.
  1. Ulcerative Colitis- This type involves the inflammation of the large intestine, from the colon to the rectum, that is continuous. As it progress, the rectume may shorten and lose its usual markings, called the haustral markings.

The symptoms similar to both Crohn’s disease and ulcerative colitis include:

  • Belly pain. The pain often is described as cramping and intermittent. Belly pain may turn to a dull, constant ache as the condition gets worse.
  • Diarrhea. Some people may have diarrhea 10 to 20 times a day. Crohn’s disease may cause blood in stools, but not always.
  • Loss of appetite.
  • Fever. In severe cases, fever or other symptoms that affect the entire body may develop. A high fever may mean that you have an infection, such as an abscess.
  • Weight loss. Ongoing symptoms, such as diarrhea, can lead to weight loss.
  • Too few red blood cells (anemia). Some people with Crohn’s disease develop anemia because of low iron levels caused by bloody stools or the intestinal inflammation itself.
  • Small tears in the anus (anal fissures) that may go away, but come back again.

To help confirm a diagnosis of IBD, you may have one or more of the following tests and procedures:

Blood tests

  • Tests for anemia or infection. Your doctor may suggest blood tests such as complete blood count to check for anemia (too few red blood cells) and infection.
  • Fecal occult blood test. This detects any hidden blood in stool.

Endoscopic procedures

  • Colonoscopy. This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera.
  • Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the last section of your colon (sigmoid).
  • Upper endoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the esophagus, stomach and first part of the small intestine (duodenum).
  • Capsule endoscopy. This test is used to help diagnose Crohn’s disease.
  • Double-balloon endoscopy. For this test, a longer scope is used to look further into the small bowel where standard endoscopes don’t reach.

Imaging procedures

  • X-ray. If you have severe symptoms, your doctor may use a standard X-ray of your abdominal area to rule out serious complications, such as a perforated colon.
  • Computerized tomography (CT) scan. You may have a CT scan — a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel. CT enterography is a special CT scan that provides better images of the small bowel. This test has replaced barium X-rays in many medical centers.
  • Magnetic resonance imaging (MRI). MRI is particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MR enterography). Unlike CT, there is no radiation exposure with MRI.
  • Small bowel imaging. This test looks at the part of the small bowel that can’t be seen by colonoscopy.

RECOMMENDED MEDICATIONS

Medicines usually are the treatment of choice for IBD. They can control or prevent inflammation in the intestines and help to:

  • Relieve symptoms.
  • Promote healing of damaged tissues.
  • Put the disease into remission and keep it from flaring up again.
  • Postpone the need for surgery.

Medicine choices

The choice of medicine usually depends on how severe the disease it, what part of the intestine is affected, and whether complications are present. Medicines for Crohn’s disease include:

  • Aminosalicylates (such as mesalamine or sulfasalazine). These medicines help manage symptoms.
  • Antibiotics (such as ciprofloxacin or metronidazole). These may be tried if aminosalicylates aren’t helping. They are also used to treat fistulas and abscesses.
  • Corticosteroids (such as budesonide or prednisone). These steroid medicines usually stop symptoms and put the disease in remission.
  • Medicines that suppress the immune system (such as azathioprine and methotrexate). You may take these if the medicines listed above don’t work, if your symptoms come back when you stop taking steroid medicines, or if your symptoms come back often, even with treatment.
  • Biologics (such as infliximab or adalimumab). Your doctor may have you try these medicines if other medicines for Crohn’s disease haven’t worked for you. In some cases, biologics are tried before some of the other medicines listed above. They are also used to treat fistulas.
  • Cyclosporine and intravenous (IV) corticosteroids, which may be needed for severe cases.

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