Inflammatory bowel disease is the name of a group of disorders that cause the intestines to become inflamed (red and swollen). The inflammation lasts a long time and usually comes back over and over again. More than 600,000 Americans have some kind of inflammatory bowel disease every year.
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 is an IBD that causes ulcers to form in the gastrointestinal (GI) tract anywhere from the mouth to the anus. Some people who have Crohn's disease have severe symptoms, while others have less severe symptoms. Some people who have the disease have long periods without symptoms, even without getting treatment. Others with more severe disease will need long-term treatment or even surgery.
Ulcerative colitis (say: “ul-sir-uh-tiv cole-eye-tiss”) is an IBD that causes your colon (a part of your large intestine) to become red and swollen. The redness and swelling can last for a few weeks or for several months. Symptoms may come and go for up to a year. These occurrences are called flare-ups.
Symptoms include stomach cramps, pain that comes and goes, diarrhea and blood in your stool. Other symptoms include losing weight, feeling sick to your stomach, having joint pain and feeling tired.
Symptoms of ulcerative colitis vary depending on how severe your case is and what section of your large intestine is affected. Symptoms often include the following:
You may have diarrhea over a period of weeks or months. The diarrhea may have blood in it. Some people have abdominal pain. The diarrhea and abdominal pain tend to come and go.
It is not yet known what causes Crohn's disease. It seems to run in families, but there is no known pattern of inheritance. About 500,000 people in the United States have Crohn's disease. Anyone can get Crohn's disease.
No one knows for sure what causes ulcerative colitis either. Some doctors think it may happen when your body overreacts to normal bacteria in your digestive system. Ulcerative colitis also seems to be hereditary. This means it runs in families.
Based on your symptoms, your doctor may suspect that you have Crohn's disease or ulcerative colitis. Your bowel movements may be tested for germs and the presence of blood. Your doctor will probably look inside your intestines with a sigmoidoscope or a colonoscope. In these procedures, the doctor uses a narrow flexible tube to look directly inside your intestines.
While no blood test can prove you have IBD, your blood might show anemia, salt imbalance, vitamin deficiency or increased signs of inflammation. Your doctor also may order special x-rays or a procedure called endoscopy. Endoscopy lets your doctor look at your GI tract to check for ulcers by inserting a small scope into your body through your mouth or anus.
The best thing you can do is to take good care of yourself. It's important to eat a healthy diet. Depending on your symptoms, your doctor may ask you to cut down on the amount of fiber or dairy products in your diet. It also may be necessary to limit or avoid caffeine, alcohol and carbonated beverages. In addition to eating well, you need to get enough rest and exercise regularly. It's also important that you learn to manage the stress in your life. When you become overly upset by things that happen at home or at work, your intestinal problems can get worse.
You will most likely be treated by a team of doctors. This team may include your family physician, a gastroenterologist (a specialist in stomach and intestinal disorders) and, possibly, a surgeon.
The goal of treatment is to get rid of the inflammation. Many types of medicine can reduce inflammation, including anti-inflammatory drugs such as sulfasalazine, corticosteroids such as prednisone, and immune system suppressors such as azathioprine and mercaptopurine. An antibiotic, such as metronidazole, may also be helpful for killing germs in the intestines, especially if you have Crohn's disease.
These medicines may be given in one of the following ways:
To help treat your symptoms, your doctor may recommend anti-diarrheals, laxatives, pain relievers or other over-the-counter (OTC) drugs. It is important to talk to your doctor before taking any OTC medicine on your own. Your body may not be able to handle the effects of medicine. If you have severe symptoms, such as diarrhea, fever or vomiting, you may need to go to the hospital to be treated with special fluids and medicines that must be given intravenously.
Steroids are generally used for people who have more severe form of Crohn’s disease. In more aggressive disease, steroids may be used with immunosuppressants or with a newer medicine called infliximab.
If ulcerative colitis becomes so severe that it can't be helped by medicines, it may be necessary to surgically remove part or all of your colon. Between 25% and 40% of people who have ulcerative colitis eventually need surgery. Crohn's disease usually isn't helped with surgery.
Because Crohn's disease and ulcerative colitis keep coming back and their symptoms cannot be predicted ahead of time, patients who have these illnesses can become depressed. If you feel depressed, talk with your family doctor. An antidepressant medicine could help you feel better.
If you have IBD, you are at an increased risk of colon cancer. Talk to your doctor about whether regular screening for colon cancer is right for you.
By asking questions, reading informational materials and discussing your treatments with your doctor, you'll be able to understand your illness and manage it better. Patient support groups are helpful, especially if you have severe disease.
Management of Crohn's Disease -- A Practical Approach by D Knutson, M.D., G Greenberg, M.D., and H Cronau, M.D. (American Family Physician September 15, 2003, http://www.aafp.org/afp/20030815/707.html)
Written by familydoctor.org editorial staff