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Tuesday, January 26, 2010

Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis) - Causes, Symptoms, Diagnosis, and Treatment



What is Inflammatory Bowel Disease?

Inflammatory bowel disease is the name of a group of disorders that cause the intestines to become inflamed (red and swollen). Inflammatory bowel disease (IBD) is a chronic, nonspecific inflammation of the gastrointestinal tract.

If you have inflammatory bowel disease, you may have abdominal cramps and pain, diarrhea, weight loss and bleeding from your intestines. Two kinds of inflammatory bowel disease are Crohn's disease and ulcerative colitis. Crohn's disease usually causes ulcers (open sores) along the length of the small and large intestines. Crohn's disease either spares the rectum, or causes inflammation or infection with drainage around the rectum. Ulcerative colitis usually causes ulcers in the lower part of the large intestine, often starting at the rectum.

Inflammatory Bowel Disease (IBD) Causes

The exact causes are unknown (idiopathic disease). The disease may be caused by a germ or by an immune system problem. Researchers believe that a number of factors may be involved, such as the environment, diet, and possibly genetics.

An unknown factor/agent (or a combination of factors) triggers the body’s immune system to produce an inflammatory reaction in the intestinal tract that continues without control. As a result of the inflammatory reaction, the intestinal wall is damaged leading to bloody diarrhea and abdominal pain.

Genetic, infectious, immunologic, and psychological factors have all been implicated in influencing the development of IBD.

Inflammatory bowel disease may also cause a delay in puberty or growth problems for some kids and teens with the condition, because it can interfere with a person getting nutrients from the foods he or she eats.

Inflammatory Bowel Disease (IBD) Signs and Symptoms

Crohn's Disease

Inflammatory bowel disease may also have constipation. With Crohn's disease, this can happen as a result of a partial obstruction (called stricture) in the intestines. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum (also known as proctitis).

Symptoms may range from mild to severe and generally depend upon the part of the intestinal tract involved. They include the following:

* Abdominal cramps and pain

* Bloody diarrhea

* Severe urgency to have a bowel movement

* Fever

* Loss of appetite

* Weight loss

* Anemia (due to blood loss)

* Rectal bleeding

* Skin and eye irritations

Inflammatory Bowel Disease (IBD) Diagnosis

The diagnosis of IBD is based on a combination of exams: endoscopic, X-rays, and blood and tissue tests. Upon diagnosis, IBD patients may need additional tests to monitor the disease and diagnose possible complications or side effects of medications.

Laboratory Tests

1. Stool examination

  • A stool examination is done to eliminate the possibility of bacterial, viral, or parasitic causes of diarrhea.
  • A fecal occult blood test is used to examine stool for traces of blood that cannot be seen with the naked eye.
2. Complete blood count
  • An increase in the white blood cell count suggests the presence of inflammation in the body.
  • If you have severe bleeding, the red blood cell count may decrease and hemoglobin level may fall (anemia).
Endoscopy

Several types of endoscopy are used to determine if the patient has ulcerative colitis or Crohn's disease and how much bowel is affected. All use a thin, flexible tube with a lighted camera inside the tip, which allows doctors to look at the lining of the gastrointestinal (GI) tract. The image is magnified and appears on a television screen. Each procedure is named for the part of the GI tract examined:

colonoscopy and sigmoidoscopy for IBD

1. Sigmoidoscopy.

In this procedure, your health care provider uses a sigmoidoscope (a narrow, flexible tube with a lens and a light source) to visualize the last one-third of the large intestine, which includes the rectum and the sigmoid colon. The sigmoidoscope is inserted through the anus and the intestinal wall is examined for ulcers, inflammation, and bleeding. During this procedure, your health care provider may take samples (biopsies) of the lining of the intestine.

2. Colonoscopy.

A colonoscopy is an examination similar to a sigmoidoscopy, but with this procedure, the entire colon can be examined.

3. EGD (Esophagogastroduodenoscopy)

Examines the lining of the esophagus, stomach (gastro), and duodenum (first part of the small intestine).

4. ERCP (Endoscopic retrograde cholangiopancreatography)

Examines the bile ducts in the liver and the pancreatic duct.

5. Endoscopic ultrasound.

Uses an ultrasound probe attached to an endoscope to obtain deep images of the gut. In IBD, this is most often used to look at fistulas in the rectal area.

6. Capsule endoscopy.

Patients swallow computerized cameras in vitamin-sized capsules to produce images of sections of the small intestine that are beyond the reach of an EGD. Read more on capsule endoscopy.

7. Upper endoscopy.

If you have upper GI symptoms (nausea, vomiting), an endoscope (narrow, flexible tube with a light source) is used to examine the esophagus, stomach, and the duodenum. The endoscope is inserted through the mouth, and the stomach and duodenum are examined for ulceration. Ulceration occurs in the stomach and duodenum in 5-10% of persons with Crohn disease.

Radiology Tests

Radiologic tests provide information that endoscopy cannot. EGD and colonoscopy can visualize only the stomach, the very upper small intestine (EGD) and the colon and very lower small intestine (colonoscopy). Most of the small intestine cannot be imaged by endoscopy, although Mayo is currently evaluating capsule endoscopy for this purpose. Radiographic tests can image the small intestine.

1. Barium x-ray
  • Upper gastrointestinal (GI) tract: This exam uses x-rays to find abnormalities in the upper GI tract (esophagus, stomach, duodenum, sometimes the small intestine). For this test, you are required to swallow barium (a chalky white substance). When barium is swallowed, it coats the inside of the intestinal tract, which can be documented on x-rays. If you have Crohn disease, abnormalities will be seen on barium x-rays.
  • Lower gastrointestinal (GI) tract: In this exam, barium is given in an enema that is retained in the colon while x-rays are taken. Abnormalities will be noted in the rectum and colon in persons with Crohn disease and ulcerative colitis.
2. Plain X-rays

Plain X-rays without contrast detect blockage in the small or large intestine.

3. X-rays with Contrast

Contrast X-rays are used with endoscopy in monitoring and treating IBD. These X-rays track special liquid contrast, usually barium, as it passes through the intestine, highlighting specific conditions.

4. CT Scan

A CT scanner takes simultaneous X-rays from different angles to reconstruct images of the internal organs.

5. MRI

Magnetic Resonance Imaging (MRI) is used to evaluate perianal fistulas and abscesses in patients with IBD. Other potential uses are being investigated.

6. White Blood Cell Scan

Inflammation of the GI tract is characteristic of ulcerative colitis and Crohn's disease. Leukocyte scintigraphy (tagged white blood cell scan) detects white blood cell accumulation in inflamed tissue.

7. Ultrasound

In general, ultrasound technology is not useful for examining the bowel, although sometimes it is used in combination with other radiological tests.

Inflammatory Bowel Disease (IBD) Treatment

Aminosalicylates:
These types of medications are among the most commonly used to treat IBD and include agents such as sulfasalazine (Azulfidine®) and mesalamine (Asacol®, Pentasa®, Colazal®).

Steroids:
Steroids such as prednisone and methylprednisolone are commonly used to treat patients with both ulcerative colitis and Crohn's disease. These particular types of steroids are called glucocorticoids and work as anti-inflammatory agents. They are different from anabolic steroids, which are known for their use by body builders and athletes.

6-Mercaptopurine and Azathioprine:
6-mercaptopurine (Purinethol®) and azathioprine (Imuran®) work to decrease the activity of the immune system, which then leads to reduced inflammation in the intestines. They are used both in ulcerative colitis and Crohn's disease to bring active disease under control and to maintain disease in remission. They are given orally as pills.

Methotrexate:
Methotrexate is another medication that works to decrease the activity of the immune system. It is used in Crohn's disease both to bring disease into remission and to maintain remission.

Infliximab:
Infliximab (Remicade®) may be used in moderate to severe Crohn's disease. It is a medication that is given intravenously and works on reducing intestinal inflammation by blocking a part of the immune system know as TNF (tumor necrosis factor).


Source:
http://www.emedicinehealth.com/inflammatory_bowel_disease
http://www.mayoclinic.org

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