Symptoms and treatment of Inflammatory bowel disease (IBD)

Description

The inflammatory bowel disease, also known as IBD, is a generic term for a group of diseases that cause swelling and inflammation of the tissues in the digestive tract.

The most common types of crohn's disease include:

Ulcerative colitis. This condition involves inflammation and sores, called ulcers, along the wall of the colon and rectum.
Crohn's disease. In this type of IBD , the lining of the digestive tract becomes inflamed. The condition often involves the deeper layers of the digestive tract. Crohn's disease the most common disease that affects the small intestine. However, it can also affect the large intestine and, remarkably, in the upper gastrointestinal tract.

Symptoms of ulcerative colitis and Crohn's disease usually include abdominal pain, diarrhea, rectal bleeding, extreme tiredness and weight loss.

For some people, the IBD is only a mild illness. But for others, it is a condition that causes disability and can lead to life-threatening complications.

Symptoms

Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs. The symptoms may vary from mild to severe. A person with IBD, it is likely that periods of active disease followed by periods of remission.

The common symptoms of Crohn's disease and ulcerative colitis are:

The diarrhea.
Abdominal pain and cramping.
Blood in the stool.
Loss of appetite.
Losing weight without trying.
Feeling very tired.

When to see a doctor

Consult a health care professional if you experience a lasting change in your bowel habits or if you have any of the symptoms of inflammatory bowel disease. Although inflammatory bowel disease is not usually fatal, is a serious disease that, in some people, it can cause life-threatening complications.

Causes

The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now, the health professionals know that these factors may aggravate IBD, but are not the cause of the same. Several factors that could play a role in its development.

Immune system. A possible cause is the change in the function of the immune system. When the immune system tries to fight off an invading virus or bacterium, an immune response that is not typical causes the immune system to attack the cells in the digestive tract also.
Genes. Several genetic markers have been associated with IBD . Traits transmitted in families also appear to play a role in that IBD is more common in people who have relatives with the disease. However, most people with IBD do not have this family history.
The environmental triggers. The researchers believe that environmental factors may play a role in the obtaining of IBD , especially the factors that affect the intestinal microbioma. These may include: Being raised in a sterile environment, like a child, with limited exposure to the germs.Have a gastrointestinal infection early in life.Taking antibiotics during the first year of life.Most bottle-fed.
Raised in a sterile environment, like a child, with limited exposure to the germs.
Have a gastrointestinal infection early in life.
Taking antibiotics during the first year of life.
Most bottle-fed.
Raised in a sterile environment, like a child, with limited exposure to the germs.
Have a gastrointestinal infection early in life.
Taking antibiotics during the first year of life.
Most bottle-fed.

Risk factors

Risk factors for inflammatory bowel disease include:

Age. Most of the people who receive the IBD are diagnosed before 30 years of age. But some people do not have the disease to 50 or 60 years.
Race or ethnic origin. IBD is more common in white people, but can occur in any person. The number of people with IBD, it is also increasing in other races and ethnicities.
The history of the family. You're at higher risk if you have a blood relative — as a parent, sibling or child with the disease.
Smoking cigarettes.Cigarette smoking is the most important controllable risk factor for contracting the illness of Crohn's disease. The habit of smoking can help prevent ulcerative colitis. However, its damage to health in general outweighs any benefit, and quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.
Nonsteroidal anti-inflammatory drugs. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium and other. These medications may increase the risk of developing IBD, or make the disease worse in people who have IBD .

Smoking cigarettes. Cigarette smoking is the most important controllable risk factor for contracting the illness of Crohn's disease.

The habit of smoking can help prevent ulcerative colitis. However, its damage to health in general outweighs any benefit, and quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.

Complications

Ulcerative colitis and Crohn's disease have some complications in common and others that are specific for each condition. Complications encountered in both of these conditions can include:

The Colon cancer. Have ulcerative colitis or Crohn's disease that affects the majority of your colon may increase your risk of colon cancer. The early detection of cancer with a colonoscopy at regular intervals, it usually begins around 8 to 10 years after diagnosis. Consult with a medical professional when and how often you need to make this test.
The skin, the eyes and inflammation of the joints. Certain conditions, including arthritis, skin lesions and inflammation of the eye, called uveitis, may occur during IBD flare-ups.
Medicine side effects. Certain drugs for inflammatory bowel disease is associated with a risk of infections. Some carry a small risk of developing certain types of cancer. Corticosteroids may be associated with a risk of osteoporosis, high blood pressure and other conditions.
Primary sclerosing cholangitis. In this rare disorder that is observed in people with IBD , the inflammation causes the formation of scar tissue within the bile ducts. This healing, finally, reduces the pipes, restricting the flow of bile. Eventually, this can cause damage to the liver.
The blood clots. IBD increases the risk of blood clots in veins and arteries.
Severe dehydration. Too much diarrhea can cause dehydration.

Complications of Crohn's disease may include:

Intestinal obstruction. Crohn's disease affects the full thickness of the bowel wall. Over time, parts of the intestine can thicken and narrow, which can block the flow of digestive contents. Surgery may be necessary to remove the diseased part of the intestine. Rarely, bowel or colon obstruction can be seen in ulcerative colitis and could be a sign of colon cancer.
Malnutrition. Diarrhea, abdominal pain and cramps, can make it difficult for you to eat or to your intestine to absorb enough nutrients to keep you hydrated. It is also common to develop anemia due to low iron or vitamin B-12 caused by the disease.
Fistulas. Sometimes, the inflammation may extend completely through the intestinal wall and create a fistula between the connection of the different parts of the body that is not typical. Fistulas near or around the anal area are the most common type. But the fistulas can also occur internally or to the wall of the abdominal area. In some cases, a fistula may become infected and form a pocket of pus is called an abscess.
The Anal fissure. This is a small tear in the tissue that lines the anus, or in the skin around the anus, where infections can occur. It is often associated with the painful passage of stool and can lead to a fistula around the anus.

Complications of ulcerative colitis may include:

Toxic megacolon. Ulcerative colitis can cause the colon to rapidly expand and swell, a serious illness known as toxic megacolon.
A hole in the colon, called a perforated colon. A perforation of the colon is more commonly caused by toxic megacolon, but it can also occur spontaneously.

Diagnosis

To help confirm a diagnosis of IBD , a health care professional recommends a combination of tests and procedures:

Laboratory tests

Blood tests.The blood test can determine if there are signs of infection or anemia, a condition in which not enough red blood cells to carry oxygen to the tissues. These tests can also be used to check the levels of the inflammation, the function of the liver or the presence of infections that are not active, such as tuberculosis. The blood can also be tested to detect the presence of immunity against infections.
Stool studies. A stool sample may be used for the testing of blood or of organisms, such as bacteria that cause the infection or, rarely, parasites in the stool. These can be the causes of diarrhea and the symptoms. Sometimes looking for the feces of the markers of inflammation, such as calprotectin, it can be useful.

Blood tests. The blood test can determine if there are signs of infection or anemia, a condition in which not enough red blood cells to carry oxygen to the tissues.

These tests can also be used to check the levels of the inflammation, the function of the liver or the presence of infections that are not active, such as tuberculosis. The blood can also be tested to detect the presence of immunity against infections.

Endoscopic procedures

Colonoscopy. This test allows a view of the entire colon and parts of the small intestine using a thin, flexible, lighted tube with a camera at the end. During the procedure, a small tissue sample called a biopsy may be taken for the analysis. A biopsy is the way to make the diagnosis of IBD, in comparison with other forms of inflammation.
Flexible sigmoidoscopy. This test uses a thin, flexible, lighted tube to examine the rectum and the sigmoid colon, the last portion of the colon. If the colon is very swollen, this test may be used in place of a full colonoscopy.
The upper gastrointestinal endoscopy. In this procedure, a thin, flexible, lighted tube used to examine the esophagus, stomach, and first part of the small intestine, called the duodenum. While it is unlikely that these areas to be involved with the Crohn's disease, this test may be recommended if you have nausea and vomiting, difficulty eating, or upper abdominal pain.
The capsule endoscopy. This test is sometimes used to help diagnose Crohn's disease involving the small intestine. You swallow a capsule that has a camera on him. The images are transmitted to a recorder you wear on your belt, after the capsule comes out of his body without pain in the stool. You may need an upper endoscopy with biopsy to confirm the diagnosis of Crohn's disease. Capsule endoscopy should not be done if a bowel obstruction is suspected.
The balloon enteroscopy-assisted. For this test, a scope is used in conjunction with a device called an overtube. This allows the technician to look further into the small intestine where standard endoscopes cannot reach. This technique is useful when the results of a capsule endoscopy is not as expected, but the diagnosis is still in question.

Imaging tests

X-ray. If you have severe symptoms, your doctor may use a standard X-ray of the abdominal area to rule out serious complications, such as toxic megacolon, or perforation of the colon.
The computed tomography scan, also called a CT scanner. You may have a ct scan — a special X-ray technique that provides more detail than a standard X-ray. This test looks at the entire bowel as well as the tissues outside the gut. CT enterography is a special type of ct scan that provides better images of the small intestine. This test has been replaced by a barium X-rays in most medical centers.
Magnetic resonance imaging, also called magnetic resonance imaging. A magnetic resonance imaging scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. An mri is particularly useful for the evaluation of a fistula around the anal area or the small intestine, a test called the mr enterography. Unlike the TC , there is no radiation exposure with magnetic resonance imaging .

Treatment

The goal of inflammatory bowel disease treatment is to reduce the inflammation that causes the symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission and reduce the risk of complications. IBD treatment usually consists of medications or surgery.

Anti-inflammatory drugs

Anti-inflammatory medications are often the first step in the treatment of ulcerative colitis, typically of mild-to-moderate disease. Anti-inflammatory include aminosalicylates, such as mesalamine (Delzicol, Rowasa, others), balsalazide (Colazal) and olsalazine (Dipentum).

Time-limited courses of corticosteroids are also used to induce remission. In addition to being anti-inflammatory, steroids are immunosuppressing. The type of medication recommended depends on the area of the colon is affected.

Immunomodulators

These medications work in a variety of ways to suppress the immune response that releases the inflammation-inducing chemicals in the body. When released, these chemicals can damage the lining of the digestive tract.

Some examples of immunosuppressive drugs include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan) and methotrexate (Trexall).

Small molecules

More recently, drugs administered by the oral route, which is known as small molecules have become available for the treatment of IBD. Inhibitors of the Janus kinase, also called inhibitors of JAK, is a type of small-molecule medicine that helps to reduce inflammation by targeting the parts of the immune system that causes inflammation in the intestines. Some inhibitors of JAK for IBD include tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

Ozanimod (Zeposia) is another type of small-molecule medicine is available for IBD . Ozanimod is a medication known as a sphingosine-1-phosphate receptor modulator, also called a modulator of S1P receptors.

The Food and Drug Administration, also called the FDA recently issued a warning about tofacitinib, stating that preliminary studies show an increased risk for heart-related conditions and cancer of taking this medication. If you are taking tofacitinib for ulcerative colitis, do not stop taking the medication without first consulting with a health care professional.

Biological products

The biological treatments are a new category of therapy, in which treatment is directed toward the neutralization of the proteins in the body that cause inflammation. Some of these drugs are given intravenously, also called IV, infusions, and others are injections yourself. Examples include the use of infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), certolizumab (Cimzia), vedolizumab (Entyvio), ustekinumab (Stelara) and risankizumab (Skyrizi).

Antibiotics

Antibiotics can be used with other medicines or when the infection is a concern — in the case of perianal Crohn's disease, for example. Often prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Other medications and supplements

In addition to the management of inflammation, some medications may help to relieve the symptoms. But always consult a healthcare professional before taking any otc medications. Depending on the severity of IBD is, one or more of the following may be recommended:

Antidiarrheals.A fiber supplement — such as psyllium (Metamucil) or methylcellulose (Citrucel) — can help relieve mild to moderate diarrhea by adding bulk to the stool. For more severe diarrhea, loperamide (Imodium a-D) can be effective. These medications and supplements can be harmful or not effective in some people with stenosis, or certain infections. Check with your health care team before starting these treatments.
Pain relievers. For mild pain, acetaminophen (Tylenol, others) may be recommended. However, the drugs called nonsteroidal anti-inflammatory drugs, which include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), and diclofenac sodium, is probably going to make the symptoms worse and can make the illness worse.
Vitamins and supplements. If you are not the absorption of nutrients, vitamins, and nutritional supplements may be recommended.

Antidiarrheals. A fiber supplement — such as psyllium (Metamucil) or methylcellulose (Citrucel) — can help relieve mild to moderate diarrhea by adding bulk to the stool. For more severe diarrhea, loperamide (Imodium a-D) can be effective.

These medications and supplements can be harmful or not effective in some people with stenosis, or certain infections. Check with your health care team before starting these treatments.

Nutritional support

If the weight loss is significant, a health professional may recommend a special diet given via a feeding tube, called enteral nutrition, or nutrient that is injected into a vein, it is called parenteral nutrition. Nutritional support can improve your overall nutrition and allow the bowel to rest. The rest of the small intestine can reduce inflammation in the short term.

If you have stenosis, or narrowing of the intestine, your health care team may recommend a low residue diet. This diet can help to minimize the possibility of undigested food from getting stuck in the narrow part of the intestine and cause a blockage.

Surgery

If diet and lifestyle changes, drug therapy, or other treatments do not relieve the symptoms of IBD, surgery may be recommended.

Surgery for ulcerative colitis.The surgery involves the removal of the entire colon and the rectum. An internal pouch is made and attached to the anus. This allows the passage of stool without having a bag of feces on the outside of the body. In some people, the creation of an internal pouch is not possible. Instead, surgeons create a permanent opening in the abdomen, called a stoma ileal, through which the stool to the collection in an attached bag.
Surgery for Crohn's disease.Up to two-thirds of people with Crohn's disease require at least one surgery in their lives. However, the surgery does not cure Crohn's disease. During the surgery, the surgeon removes a damaged part of the digestive tract, and then reconnects the healthy sections. The surgery can also be used to close fistulas and drainage of abscesses. The benefits of surgery for Crohn's disease are usually temporary. The disease recurs in many people, often close to the reconnected tissue. The best approach is to follow the surgery with a medication to decrease the risk of recurrence.

Surgery for ulcerative colitis. The surgery involves the removal of the entire colon and the rectum. An internal pouch is made and attached to the anus. This allows the passage of stool without having a bag of feces on the outside of the body.

In some people, the creation of an internal pouch is not possible. Instead, surgeons create a permanent opening in the abdomen, called a stoma ileal, through which the stool to the collection in an attached bag.

Surgery for Crohn's disease. Up to two-thirds of people with Crohn's disease require at least one surgery in their lives. However, the surgery does not cure Crohn's disease.

During the surgery, the surgeon removes a damaged part of the digestive tract, and then reconnects the healthy sections. The surgery can also be used to close fistulas and drainage of abscesses.

The benefits of surgery for Crohn's disease are usually temporary. The disease recurs in many people, often close to the reconnected tissue. The best approach is to follow the surgery with a medication to decrease the risk of recurrence.

Lifestyle and home remedies

Sometimes you may feel helpless when facing the inflammatory bowel disease. But changes in your diet and lifestyle can help manage the symptoms and lengthen the time between flare-ups.

Diet

There is No firm evidence that what you eat causes of inflammatory bowel disease. But some foods and drinks may make your symptoms worse, especially during a crisis.

You may find it helpful to keep a food journal to track what you are eating, as well as how you feel. If you find that certain foods are causing your symptoms to flare up, you can try to delete those foods.

Here are some dietary suggestions that can help you manage your condition:

Limit dairy products. Many people with inflammatory bowel disease, problems such as diarrhea, abdominal pain and gas improved by the limitation of the non-use of dairy products. You may be lactose intolerant, that is to say, your body can't digest the milk sugar, called lactose in dairy products. The use of an enzyme product, such as Lactaid can help.
Eat small meals. You may find that you feel better eating five or six small meals a day instead of two or three larger ones.
Drink plenty of fluids. Try to drink plenty of fluids a day. The water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
Consider the possibility of multi-vitamins. Because Crohn's disease can affect your ability to absorb nutrients and due to that your diet may be limited, and multivitamin and mineral supplements are often helpful. Check with your health care team before taking any vitamins or supplements.
Talk with a dietitian. If you begin to lose weight or your diet has become very limited, talk with a registered dietitian.

Smoking

Smoking increases your risk of having Crohn's disease, and once you have it, smoking can make it worse. People with Crohn's disease who smoke are more likely to have relapses and the need for medication and repeat surgeries.

Stress

The association of stress with Crohn's disease is controversial, but many people who have the disease of reports of symptoms flares during high-stress periods. If you have trouble managing stress, try one of these strategies:

Exercise. Even moderate exercise can help to reduce stress, relieve depression and the setting of bowel function . Talk with your doctor or other health care provider about an exercise plan that is right for you.
Biofeedback. This stress-reduction technique can be trained to reduce muscle tension and decrease the heart rate with the help of a biofeedback machine. The goal is to help you enter a relaxed state so that you can deal more easily with stress.
Relaxation and breathing exercises. A way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to help you feel calm.

Alternative medicine

Many people with digestive disorders have used some form of complementary and alternative medicine. However, there are few well-designed studies of the safety and efficacy of these treatments.

The researchers suspect that the addition of more of the beneficial bacteria that are normally found in the digestive tract may help fight the DISEASE . These bacteria are called probiotics. Although research is limited, there is some evidence that the addition of probiotics along with the taking of medications may be helpful.

Coping and support

IBD doesn't just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life can turn around a constant need to run to the bathroom. Even if your symptoms are mild, you may find that it is hard to be in a public place. All of these factors can alter your life, and can lead to depression. Here are some things you can do:

Be informed. One of the best ways to better manage your disease is to find out as much as possible about the inflammatory bowel disease. Seek information from reliable sources, such as the Crohn's and Colitis Foundation.
Join a support group. Although support groups aren't for everyone, they can provide valuable information about your condition, as well as emotional support. Group members often know about the latest medical treatments, or integrative therapies. You can also find it reassuring to be, among others, with the IBD .
Talk with a therapist. Some people find it helpful to consult a mental health professional who is familiar with the inflammatory bowel disease and the emotional difficulties it can cause.

Although you may feel discouraged by life with IBD , the investigation is ongoing, and the outlook is improving.

Preparing for your appointment

The symptoms of inflammatory bowel disease may first symbol of a visit with your primary health care team. However, you may be referred to a professional who specializes in the treatment of digestive disorders, called a gastroenterologist.

Because appointments can be brief, and there is often a lot of information to discuss, it is a good idea to be well prepared. Here's some information to help you prepare and what to expect on your visit.

What you can do

Find out how to prepare for your appointment. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason why you made the appointment.
Write down key personal information, including any major stresses or recent life changes.
Make a list of all medications, including over the counter medications and any vitamins or supplements you are taking.
Have a family member or friend. Sometimes it can be difficult to remember everything during an appointment. Someone who goes with you may remember something that you missed or forgot.
Write questions during your appointment.

Prepare a list of questions in advance can help you to get the most out of your visit. A list of questions from most important to least important in case time runs out. For inflammatory bowel disease, some basic questions to ask include:

What is the cause of these symptoms?
There are other possible causes of the symptoms?
What kinds of tests do I need? Do these tests require any special preparation?
Is this condition temporary or long-term?
What treatments are available, and which do you recommend?
There are medications should I avoid?
What types of side effects can I expect from treatment?
What type of follow-up care will I need? With what frequency do I need a colonoscopy?
Are there any alternatives to the primary approach you're suggesting?
I have other health conditions. How can I best manage them together?
Do I have to change my diet?
Is there a generic alternative to the medicine you're prescribing?
Are there brochures or other printed material that I can take with me? What sites do you recommend?
There is a risk to me or my child if I am pregnant?
There is a risk of complications in my partner's pregnancy if I have IBD and start the pregnancy?
What is the risk that my child is having IBD if I have it?
There are support groups for people with IBD and their families?

What to expect from your doctor

Your health care team is likely to ask a series of questions. Be ready to answer them may reserve time to go over points you want to spend more time. You may ask:

When did you first begin experiencing symptoms?
Have symptoms all the time or come and go?
How bad are the symptoms?
Do you have pain in your belly?
Has had diarrhea? What's the frequency?
Do you awaken from sleep during the night because of the diarrhea?
Is anyone else in your home sick with diarrhea?
You have lost weight without trying?
Have you ever had liver problems, hepatitis or jaundice?
Has had problems with the joints, eyes, or skin — including rashes and sores — or had sores in the mouth?
Do you have a family history of inflammatory bowel disease?
Do your symptoms affect your ability to work or do other activities?
Nothing seems to improve the symptoms?
Is there anything that you've noticed that it makes your symptoms worse?
Do you smoke?
Do not take nonsteroidal anti-inflammatory drugs, for example, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or diclofenac sodium? These drugs are also called Nsaids.
You've taken antibiotics recently?
Have you traveled recently? If so, where?

Symptoms and treatment of Inflammatory bowel disease (IBD)