Inflammatory bowel disease (IBD) is a general term to relapsing, chronic (occurs for a long period of time) inflammatory diseases in the gastrointestinal tract. Its two major types are ulcerative Colitis and Crohn’s Disease. The latter is named after one of the authors of the original description presented in 1932.  In the United States, about 600,000 people have IBD.

What causes inflammatory bowel disease?

The specific cause of inflammatory bowel disease remains unknown although it is confirmed that it is an autoimmune disease. Autoimmunity is where the body’s own immune system targets its own, healthy cells.  One hypothesis suggests that certain antigens that may be triggered by mycobacterium, paramyxovirus, or some cigarette components produce cytokines. Cytokines are low-molecular weight peptides that are very reactive in small amounts. Once bound to specific receptors, they could produce autocrine, paracrine and endocrine effects. A cytokine called interleukin-1 (IL-1) causes diarrhea. Another effect of cytokines is the differentiation of lymphocytes into helper T cells. These helper T cells, TH1 and TH2, are principally associated with Crohn’s disease and ulcerative colitis. They induce the immune system to react, resulting to inflammation of the gastrointestinal tract.

What are the difference between ulcerative colitis and Crohn’s disease?

Ulcerative colitis and Crohn’s disease differ primarily in the area of the inflammation. Ulcerative colitis affects the inner lining of the colon whereas Crohn’s disease may affect the mouth to the gut.  Usually, it is the small intestine that is affected with Crohn’s disease. Diarrhea and abdominal pain are present in both inflammatory bowel diseases but have different set of symptoms altogether perhaps due to the difference in location and behavior of the inflammation.

What are the symptoms of inflammatory bowel disease?

Patients with ulcerative colitis usually have rectal bleeding, diarrhea, abdominal pain and tenesmus (urgent desire to evacuate but have little stool) while those with Crohn’s disease experience weight loss and also diarrhea and abdominal pain. Bleeding may also be present in Crohn’s disease but less common.

If it occurs, it tends to be acute and sporadic. Ulcers that develop from ulcerative colitis are shallow and numerous while those from Crohn’s disease are deep and less numerous. Due to the nature of the ulcers in Crohn’s disease, fistulas, abcesses and strictures may result as a complication of the diseases.

How are inflammatory bowel diseases diagnosed?

There are a variety of diagnoses for inflammatory disease.  Endoscopy is a popular method for gastrointestinal (GI) infections. Depending on the suspected area of the inflammation, a particular kind of endoscopy may be applied. It may either be sigmoidoscopy (for the lower part of the GI tract), colonoscopy (for the entire colon) or EGD (for the upper part of the GI tract).   Capsule enterescopy and computerized tomography are used to detect smaller sized ulcers.

A capsule enterescope consists of a small capsule with a camera that feeds the images into a recorder that is tied around the patient’s waist. The capsule is then passed into the stool. Other methods are barium enema (where the barium is a contrast dye used to locate ulcer and fistula) and blood test (to check for vitamin deficiency and anemia).

How are inflammatory bowel diseases treated?

Treatment of inflammatory bowel disease mostly depends on the severity of the disease and their complications.  Mild cases are given mesalamine or sulfasalazine formulations. Moderate cases require drugs with immunosuppressant agents such as steroids. A new type of drug for relapsing diseases is also being developed over the years.

One example of such drugs is infliximab, which was found to be a monoclonal antibody for tumor necrosis factor (TNF) which is an inflammatory intermediate. Fistulas and stricture that do not pose infection nor discomfort to the patient need not be treated.

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