A man in his forties experienced symptoms like severe abdominal pain with cramps, diarrhea, bleeding in the stools and weight loss. After performing diagnostic procedures like colonoscopy, and testing of stools the doctor confirmed that the man was suffering from ulcerative colitis (inflammation of large intestine) which is an inflammatory bowel disease.
Understanding Inflammatory Bowel Diseases
Inflammatory bowel disease (IBD) refers to two different but related conditions- ulcerative colitis and Crohn’s disease. IBD is characterized by chronic inflammation of the intestines- ulcerative colitis affects only the large intestine, however Crohn’s disease may affect any part of the intestine. Once you are affected, the condition lasts lifelong with recurrent exacerbations and intervals of asymptomatic controlled disease. It is reported that there are more than 600,000 people in the United States who are suffer every year from inflammatory bowel disease.
Inflammatory bowel disease may manifest as bleeding from rectum, diarrhea, abdominal pain with cramps, fever, loss of appetite, and weight loss. In addition, symptoms of Crohn’s disease may arise from the complications. Stricture or narrowing of intestine may result in blockage causing nausea and vomiting. Chronic inflammation may cause an abnormal opening between the intestine and other organs. It may manifest as drainage of infected material or stool near the opening of skin near anus. Inflammation may lead to pus formation in the intestinal walls causing fever and pain.
The chronic inflammation may also cause symptoms outside the digestive system and include:
- Arthritis
- Disorders of skin
- Eye inflammation
- Inflammation of bile ducts
- Inflammation of liver
- Delayed growth in children
- Delayed sexual growth in children
Causes
It is observed that inflammatory bowel disease occurs due to hereditary factors (runs in family), low immunity to fight infections, and auto immune response. Usually, when bacteria invade the digestive tract, the immune system of the body fights against them. However, in susceptible individuals, the body’s immune system abnormally reacts to the foreign body or natural microbes that are present in the intestine, causing inflammation. Crohn’s disease is seen to occur more in the age group between 15 years to 35 years of age. Smoking and people of Jewish ancestry have more risk of getting Crohn’s disease.
Diagnosis
The doctor will advise blood tests to check for antibodies, anemia or any infection that may be present. The stools are tested to check if there are any white blood cells which are an indication of ulcerative colitis. The doctor performs a colonoscopy procedure in which a tube with a camera at its end is passed into the colon to check for any abnormalities and also to collect sample of the tissue for analysis in the lab (biopsy). A barium enema may be done, if colonoscopy cannot be performed. In this procedure, a barium dye is passed into the colon through enema (liquids are introduced into colon through anus). The lining of the intestine is coated by barium and the doctor can then study these areas to detect abnormalities. A CT scan of pelvis or abdomen is done if doctor suspects any abnormality. An X ray of abdomen may be taken to rule out severe abnormalities like perforations in the colon. In Crohn’s disease, capsule endoscopy is done in which you have to swallow a capsule with a camera in it which takes pictures inside your digestive tract, and then transmits it to the computer in your belt. It is a safe procedure and the capsule comes out in the stools.
Treatment
To treat inflammatory bowel disease, a combination of healthy diet, managing stress, and medication are needed. The doctor will advise you to reduce the intake of dairy products and fiber in your diet. You need to avoid stressful situations at home and work as stress increases the intestinal problem. The medications used are anti-inflammatory drugs like sulfasalazine (azulfidine), mesalamaine (Rowasa ,Asacol), balsalazide(colazal), olsalazine (dipentum); corticosteroids like prednisolone; immune system suppressors like cyclosporine(Gengraf, sandimmune, neural),Azathioprine (Azasan, Imuran), mercaptopurine (Purinethol), infliximab(Remicade) and also metronidazole which acts well on anaerobic bacteria present in intestine. If the symptoms like diarrhea, vomiting and fever are not being controlled by medication, then you must rush to the hospital without delay, where you will be given fluids and medication intravenously. Surgery is advised when the symptoms do not come under control with medication where the severely affected part of colon is surgically removed.
