Inflammatory Bowel Disease
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The digestive system plays a huge role in the survival in all living animals and our digestive system, through a series of physical and chemical changes, breaks down the food we eat into molecules that are absorbed and used by the cells in our bodies. Like many things in life, we often take advantage of the systems in our body and do not take proper care of our bodies. We only seem to pay attention to them when something is going wrong. Inflammatory bowel disease, also known as IBD, is one of many common diseases that affect hundreds of thousands of people in North America every year. Inflammatory bowel disease is not a disease in itself; rather it is a name for a group of similar disorders. The two main types of inflammatory bowel disease are known as Crohn's disease and Ulcerative colitis. Both disorders cause parts of the digestive tract (most commonly the large or small intestines) to become inflamed. This paper will outline some details about inflammatory bowel disease including its causes, diagnoses treatment, life style changes made when diagnosed, and some other issues.
Causes of IBD
Doctors and scientists have been researching the cause, but they are still not certain as to what exactly causes them. It is believed that the inflammation caused by IBD is contributed to by three main factors. These factors are the genes one inherits, ones immune system, and a foreign substance (an antigen) in the environment. It is believed that this foreign substance is either directly causing the inflammation or the antigen triggers the body's immune system. Once the immune system is triggered it begins to produce inflammation as an attempt to destroy the antigen, but in cases of IBD inflammation can not be controlled. Though the patient's immune system begins to defend the body, it does not know how to properly stop at the correct time which may cause extreme damages to the digestive tract due to inflammation and eventually will cause ulcers (sores) 1.
Other causes of IBD have to do with ones genetic make up. It is believed that IBD can be linked to ones race, family history and genes. IBD can affect some ethnic groups more than others. IBD was first believed to only affect Caucasians but recent reports have changed that view. There is a rate of 149/100,000 Caucasians that are infected in America, but Jews of European descent living in North America are 4-5 times more likely to contract the disease than people of other ethnicities2. There are also reports of higher cases of IBD in those of African descent, but there are lower infection rates in Asians and Hispanics. Studies also show that 10-20% of people who are affected by IBD will have a family history of having the disease. This means that greatest possible risk to contracting IBD is if someone in your family has been diagnosed with it before. Those who have family members who have been affected are 10 times more likely to be infected and if the infected relative is a brother or sister, chances of getting IBD increases 30 fold3. Scientists also have come to believe that the NOD2 gene may be linked with IBD
Inflammatory bowel disease is not curable and will affect patients sporadically through out their lives. Symptoms vary from person to person when it comes to IBD and will flare up and die down at different times in a patients life. The most common symptoms are diarrhea, cramps and rectal bleeding. IBD can also affect ones joints, eyes, and skin and some children who suffer from Crohn's may experience delayed growth and sexual development. IBD is a disease that will affect a patient for many years and symptoms will come and go, sometimes more severe than other times. Along with typical symptoms patients may feel other complications as well. Common complications in patients of IBD include intestinal blockages caused by swelling. The blockage will lead to narrower intestinal passages and thicker bowel walls. Medication can be used to remove these blockages, but if they are serious they may need surgery. Nutrional deficiencies may also be a complication often occurring in those who have been diagnosed with IBD for a very long time. Their bodies will have troubles with absorbing proteins and vitamins, which may lead to a deficiency. Vitamin supplements may be needed in these cases. Sores and ulcers are also a common complication. The ulcers may cause a fistula (a hole that leads from one loop of the intestine to another) to develop. These holes may lead to the bladder, vagina or skin and may become infected. If small enough, fistulas may be treated with drugs, but if serious enough surgery may be required.5
There are 5 main types of Crohn's disease based on the general area that is being affected. The complications and symptoms of Crohn's are different depending on what area of the intestines are inflamed.
- Ileocolitis: This is the most common form of Crohn's disease that affects the ileum. The symptoms that come with ileocolitis include pain in middle of the abdomen, cramping, and diarrhea. Ileocolitis can also cause weight loss.
- Ileitis: This form of Crohn's only affects the ileum, but results in the same symptoms as ileocolitis.
- Gastroduodenal Crohn's disease: Occurs in the stomach the duodenum. Symptoms may include loss of appetite, nausea, and weight loss
- Jejunoilletis: Jejunoiletis causes patchy areas of inflammation in the jejunum. Symptoms include cramps following meals, diarrhea and include pain in the abdominal region that ranges from mild to severe.
- Crohn's colitis: This form of Crohn's only affects the colon and causes diarrhea, rectal bleeding, and other diseases around the anus including ulcers.6
There are also many form of ulcerative colitis, but they have almost the exact same symptom as some forms of Crohn's disease.
- Ulcerative Procitis: The inflammation in located in the rectum and in mild cases, rectal bleeding may be the only symptom. In more serious cases one may feel sudden urges to go to the bathroom and tenesumus which is a term describing painful and ineffective bowel movements.
- Proctosigmoiditis: Inflammation is located in the rectum and the last section of the colon (sigmoid colon). The symptoms are the same of those that come with ulcerative procitis.
- Left-sided Colitis: Inflamation in the left side of the colon (rectum, sigmoid colon, and descending colon). Also called limited or distal colitis. The symptoms caused by left-sided colitis are pain on the left side of the abdomen, weightloss and diarreah.7
According to the Crohn's & Colitis Foundation of Canada by fall of 2008, about 200 000 Canadian8 and according to the Crohn's & Colitis Foundation of America about 1.4 million Americans9 have been diagnosed with IBD. IBD tends to infect those who are between the ages 15-35 years of age, but is not limited to those few. It can also occur in younger children and people as old as 70. A staggering 10% of those who are affected by IBD are under the age of 18. Because of the high rate of IBD it is important to have the disease properly diagnosed. Inflammatory bowel disease's symptoms are very similar to many other diseases so doctors must be careful when diagnosing the disease and it may take a long time. Some common tests to diagnose IBD include endoscopies examining the colon, the sigmoid colon, esophagus, or the liver and pancreatic duct. Different types of radiology test can be used as well including x-rays, CT scans, MRI, white blood cell scans, and ultrasounds. Sometimes a small piece of tissue from the infected area may be cut out for closer analysis. This can further help doctors diagnose IBD.10
Treatment As of now, there isn't any known cure for IBD. Once a patient is diagnosed IBD it is important to properly treat the disorder in order to keep ones symptoms in check. The most common form of treatment is the usage of medication.
There are many types of drugs used to treat patients with IBD. Aminosalicylates are one type of drug used that are meant to subside inflammation caused by IBD and is usually used to treat mild symptoms. Asacol,® Colazal,.® Dipentum,® orPentasa,® are all examples of aminosalicylates. Corticosteroids, the second type of drug which is usually used in moderate to severe cases, are given to patients to suppress ones immune system. Prednisone and methylprednisolone are the types of corticosteroids and they can be dangerous because they may cause some long-term side effects. The third type of drug used to treat IBD are immune modifiers. These are used to heal fistulas in the intestinal tract and to help reduce ones dosage of corticosteroids. Azathioprine (Imuran®), 6-MP (Purinethol®), and methotrexateImmune modifiers are some examples of this. Just like many other diseases IBD can also be treated with the use of Antibiotics. Antibiotics like metronidazole, ampicillin, and ciprofloxacin, are just a few of the types that can be used. Also biological therapies can be used to treat IBD. There are many types and each serves a different purpose. For example Inflixmiab (Remicade®) is a drug made of 75 percent human, 25 percent mouse protein and is an antibody. This antibodies function is to block ones immune system. This blockage stops the immune system from making a chemical called tumor necrosis factor-alpha (TNF-alpha), a chemical that is made by the body's immune system to intensify inflammation within the body. By stopping the immune system from making TNF-alpha, inflammation caused by IBD can be prevented.11
Eventually medicine will not be enough to control the symptoms of IBD. 66%-75% of people diagnosed with Crohn's will eventually need surgery in their lives. Surgery may be needed to repair a fistula, clear blockage in the intestines, or to remove a section of the intestines. In cases of IBD, surgery's main function is to try and keep as much as the bowels intact and helps patients live a high quality life.12
Societal issues and Life Style Changes Along with proper medication certain lifestyle changes can be made in order to reduce ones symptoms and improve overall health. Special care should be taken to make sure one is receiving a healthy diet. Often those who are diagnosed with IBD have a loss of appetite because of nausea which may lead to an improper amount of food intake. The disease also increases the amount of calories needed by the body. Also IBD causes diarrhea and is linked to problems with absorption of protein, fat, carbohydrates and water. All of these take away essential nutrients from the body and proper nutrition can help return those nutrients to the body. Also when experiencing some of the symptoms of IBD one should avoid eating any high-fiber and spicy foods because they may cause even more discomfort.13
Inflammatory bowel disease is very common among people in North America and because of this people may feel emotionally stressed when they find out they are diagnosed with IBD. This is a major societal issue because of how common IBD is. People may struggle to cope with the chronic pain accompanied with IBD. It will begin to really affect ones quality of life. Ones physical and emotional well being, self-esteem, and ability to function in social groups may be affected. Patients who are diagnosed with IBD should try to receive emotional support from their families and doctors. Though psychiatric help is not mandatory it may also be a good idea to talk to a therapist. Stress plays a role in IBD. One should try reducing stress to help avoid a flare in their symptoms. Regular Exercise, yoga, and listening to music are just a few ways to relieve stress.14
Researches do not know why, but IBD is more common in areas that are more developed. Cases of IBD are usually found in the U.S. and Europe. IBD is more common in northern climate and in urban areas, rather than southern climates and rural areas.15
As previously stated Crohn's and Ulcerative Colitis do not have a known cure and are a life long disease. IBD is treated with numerous types of medications and surgery. The problem with this is that those who are uninsured and are diagnosed with IBD must pay thousands of dollars over the courses of their life in order to pay for medicine and surgery. In fact reports from the market research firm GlobalData states that in 2008 $1.4 billion in revenue was made from sales of medication related to Crohn's That number is expected to go up to $2.1 billion by 2015.16
There have been cases where people with Crohn's have received stem-cell transplantation. One boy was diagnosed with Crohn's disease when he was 13 and had received regular treatment for Crohn's. He eventually developed non-Hodgkin's lymphoma when he was 20 and received a stem cell transplantation to fight the lymphoma.. He did not receive the stem cell for his Crohn's, but for 7 years after the transplantation he did not have any symptoms for Crohn's17.This raises a question whether or not stem cell research should be used to treat IBD. Stem cell research has raised many debates on how ethical it is. There have been many debates whether or not stem cell research should be allowed or not.
There currently is not a cure for IBD, but those who have been diagnosed should be aware of symptoms, causes, and the all the possible things they can do to improve their lives. Research is being done and scientists have been working hard to try and improve treatment for IBD and eventually find the cure. People who have been diagnosed will face some challenges, but they should go on to live long healthy and happy lives.
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