Inflammatory Bowel Disease | The Canadian Encyclopedia


Inflammatory Bowel Disease

There are two main types of inflammatory bowel disease (IBD), ulcerative colitis and Crohn's disease. Both affect, to varying degrees, the gastrointestinal system, which is the area from the mouth to the anus.

Inflammatory Bowel Disease

There are two main types of inflammatory bowel disease (IBD), ulcerative colitis and Crohn's disease. Both affect, to varying degrees, the gastrointestinal system, which is the area from the mouth to the anus. IBD wears away the lining of the intestinal tract until it becomes raw and begins to bleed, much like a skinned knee. It causes pain, internal bleeding, diarrhea, fever, fatigue and weight loss.

Symptoms vary among patients; some have significant internal bleeding and may require one or more blood transfusions, while others are more bothered by abdominal pain or diarrhea. People with IBD may become malnourished, dehydrated and develop bone loss, and children can experience diminished growth. The symptoms of IBD worsen and then improve; the increase in symptoms is called a "flare up" of the disease and improvement is "remission."

The types of IBD vary in the locations they affect. Ulcerative colitis develops in the lining of the large intestine, or colon, and affects continuous areas. Crohn's disease develops most often in the lower part of the small intestine but can occur in any part of the gastrointestinal tract, and affects all layers of intestine, with patches of diseased tissue intersected by normal intestine. The types of IBD occur equally among patients with the disease. Irritable bowel syndrome (IBS) has certain symptoms similar to IBD, but it is not a type of inflammatory bowel disease.

The cause of IBD is unknown and there is no cure. Inflammatory bowel disease symptoms were first recognized as a specific disease in 1913, and Crohn's disease was first named in 1932. Both disease types are most common in North America and northern Europe, with the highest rates believed to occur in Canada. A 2006 study at the University of Alberta by Dr. Richard Fedoruk determined that 1 in 350 Canadians has IBD, but the rates are highest in Nova Scotia and Alberta, where 1 in 330 people have it. The reason for greater frequency in northern latitudes is not clear. Scientists know that a certain type of genetic mutation makes people vulnerable to the disease, but they believe that there may be some environmental factors at play as well, since not everyone with the mutation develops the disease.

IBD is usually diagnosed when the person is a young adult. Ulcerative colitis is found most frequently in people between the ages of 15-25 and 45-55, but it can occur at any age. Crohn's disease may be diagnosed in an adult, but it can occur in children as young as age 5. Any person can develop IBD regardless of skin colour or ethnicity, although it occurs more often in Caucasians. Even elite athletes who maintain excellent health can be affected by the disease, such as NHL player Fernando Pisani.

Inflammatory bowel disease is an autoimmune disease, which causes immune system dysfunction. The immune system in people with IBD causes the inflammation. It is not known if stress is a factor in disease development, but it can worsen the progression of the disease. People with IBD may develop other autoimmune diseases, such as rheumatoid arthritis or extra-intestinal manifestations of IBD. These can affect virtually any organ but most commonly affect the joints, skin and eyes.

Diagnosis of IBD can require multiple tests and invasive procedures. Other diseases are ruled out before IBD is diagnosed. Medication is the main treatment and includes anti-inflammatories, corticosteroids, antibiotics, immunosuppressive drugs, painkillers and biological response modifiers. Acupuncture is an alternative treatment helpful for some; some people have found probiotics to be beneficial.

A surgical procedure to remove diseased bowel, which eliminates the symptoms and may eliminate the disease, is an option for ulcerative colitis. However, patients with ulcerative colitis who have had their colons removed have gone on to develop Crohn's disease. Surgery is not a cure for Crohn's disease as it can occur in areas that remain after the diseased portion is removed.

No diet has been demonstrated to manage IBD effectively. Some foods negatively affect one person with IBD and have a positive affect on another. Specific foods may worsen symptoms, such as lactose in dairy products. After a certain food triggers symptoms it should be avoided.

Treatment with biological response modifier medication has been very successful. Access to the treatment is difficult because of expense and limited supply, and treatment attempts with several other medications are necessary before it can be recommended. The region where a patient lives affects treatment availability, with greater difficulty for rural or northern Canadians.