Inflammatory bowel disease

Overview of inflammatory bowel disease – The disorders that involve chronic inflammation of the digestive tract are Crohn’s disease and ulcerative colitis. Both are types of inflammatory bowel disease.

Crohn’s disease is an inflammation of the lining of the intestines which often spreads into affected tissues.

Ulcerative colitis causes sores in the innermost lining of the large intestine (colon) and rectum.

 

Symptoms of inflammatory bowel disease –

Diarrhea, which may be associated with blood. Other associated symptoms may include pain in the abdomen, urgency and/or fecal incontinence (inability to control your bowel movements), constipation, reduced appetite and unintended weight loss, fever.

 

Risk factors –

Family history – the risk of getting inflammatory bowel disease is higher if you have a close relative(parents, siblings) with the disease.

Race – Inflammatory bowel disease can occur in any race, but whites have the highest risk of getting the disease.

Cigarette smoking

Long term use of non-steroidal anti-inflammatory medications such as ibuprofen, naproxen, diclofenac.

 

Complications –

Ulcerative colitis

  • Severe bleeding,
  • Fulminant colitis (worsening of ulcerative colitis with more than 10 stools per day,abdominal pain, fever)
  • Arthritis
  • Uveitis and episcleritis (Inflammation of eye)
  • Primary sclerosing cholangitis (a chronic liver disease with inflammation)
  • Skin lesions
  • Thromboembolism (blood vessel is obstructed by a blood clot that has become dislodged from another site in the circulation.
  • Hemolytic anemia (anemia that occurs due to the breakdown of red blood cells)
  • Malabsorption (small intestine can’t absorb enough of certain nutrients and fluids)

Crohn’s disease –

  • Fistulas (tracts or communications that connect two organs or vessels that do not usually connect)
  • abscess (pus-filled swelling) in the intestine
  • Malabsorption (small intestine can’t absorb enough of certain nutrients and fluids)
  • Ulcers or pain in the mouth and gums
  • Gallstones
  • Arthritis
  • Uveitis and episcleritis (Inflammation of eye)
  • Skin lesions
  • Primary sclerosing cholangitis (a chronic liver disease with inflammation)
  • Bone loss, osteoporosis
  • Renal stones
  • Thromboembolism (blood vessel is obstructed by a blood clot that has become dislodged from another site in the circulation.

 

Diagnosis of inflammatory bowel disease –  Endoscopic findings or imaging studies in a patient with a compatible clinical history.

 

Management of inflammatory bowel disease –

Lifestyle management – After advice from your doctor, the initial treatment of functional symptoms (eg, diarrhea, abdominal pain, bloating) in patients with IBD in remission is a diet low in slowly absorbed and indigestible short-chain carbohydrates.

This diet is followed for two to six weeks as directed by your doctor and then, following symptom resolution, gradual reintroduction of foods high in fermentable carbohydrates to determine individual tolerance to specific fermentable carbohydrates.

For individuals with predominant constipation diet rich in fiber is recommended.

Restriction of fat, alcohol, and caffeine is often advised in individuals with inflammatory bowel disease.

Physical activity – After advice from your doctor, start an exercise regimen of mild to moderate intensity. Exercise improves well-being in individuals with inflammatory bowel disease.

 

Pharmacologic management –

Anti- inflammatory drugs – Mesalamine, balsalazide, olsalazine

Immunosuppressant medications – Azathioprine, mercaptopurine, cyclosporine, methotrexate, infliximab, adalimumab, golimumab, natalizumab, vedolizumab, ustekinumab

Antibiotics, in addition to other medications when there is infection – ciprofloxacin, metronidazole.

Other medications and supplements – calcium and vitamin D, pain relievers, iron, antidiarrheal medications.

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