Information on IBS, Irritable Bowel Syndrome and IBS Treatment - Dirk Budka |
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Inflammatory Bowel Disease
IBD is not a single ailment. It refers to a number of disorders that cause inflammation and frequently ulcers in the intestinal tract.
ULCERATIVE COLITIS
Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the large intestine. The inflammation usually occurs in the rectum and lower part of the colon, but it may affect the entire colon. Ulcerative colitis rarely affects the small intestine except for the end section, called the terminal ileum. Ulcerative colitis may also be called colitis or proctitis.
THE CAUSE OF ULCERATIVE COLITIS
No theory has been proven yet. The most popular theory is that the body’s immune system reacts to a bacterium which causes ongoing inflammation of the intestinal wall.
UC sufferers have abnormalities in their immune system, but practitioners do not know whether they are a cause or a result of the disease. Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods/food groups, but these factors may trigger symptoms in some patients.
THE SYMPTOMS OF ULCERATIVE COLITIS
Abdominal pain and bloody diarrhoea are the most common symptoms. Patients also experience:
Fatigue
Rectal bleeding
Loss of nutrients/loss of body fluids
Loss of appetite
Weight loss
50% of sufferers have just mild symptoms. Others have frequent fever, bloody diarrhoea, nausea and severe abdominal cramps. Other problems like eye inflammation, arthritis, liver diseases, osteoporosis, skin rashes and anaemia can also occur.
DIAGNOSIS OF ULCERATIVE COLITIS
Physical exams and a series of tests are necessary. Blood test check for anaemia (can indicate bleeding in the colon or rectum). They also uncover high white blood cell count (signs of inflammation). Colonoscopy or sigmoidoscopy are necessary to detect any inflammation, bleeding or ulcers on the colon wall.
During the exam, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the colon to view with a microscope. A barium enema x-ray of the colon may also be required. This procedure involves filling the colon with barium, a chalky white solution.
TREATMENTS FOR ULCERATIVE COLITIS
The treatments depends on the seriousness of the disease. In many cases, a strict diet can do the job. But there is no “one-fits-all-diet”. Every patient experience UC differently. Emotional and psychological support is important.
Some patients have periods in wich the symptoms dissapear completely for a period of time.
Generally, most people are treated with medication or a combination of medication and strict exclusion diets.
Aminosalicylates drugs which contain 5-aminosalicyclic (5-ASA) help to control inflammation. The downside? Sometimes it is helpful for UC sufferers to avoid salicylate rich foods… and the side effects of Aminosalicylates: Guess… Nausea, heartburn and … diarrhoea.
Corticosteroids (prednisone or hydrocortison) also reduce the inflammation. These drugs are used, when the aminosalicylates do not work. Side effects? Weight gain, acne, facial hair, high blood pressure, mood swings and… increase in risk of inflammation.
Immunomodulators reduce the inflammation by affecting the immune system. Patients have to be monitored for low white blood cell count, pancreatitis and hepatitis.
Up to 30% of UC sufferers need surgery (removal of the colon).
5% of UC sufferers develop colon cancer.
IS THERE HOPE FOR THE FUTURE?
Practitioner have underestimate the benefits of exclusion diets for decades. This is now changing thanks to serious work and research by nutritional scientists, gastroenterologists and microbiologists.
CROHN'S DISEASE
Crohn's disease causes inflammation in the small intestine. Crohn's disease usually occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected organ. The inflammation can cause pain and can make the intestines empty frequently, resulting in diarrhoea.
THE CAUSE OF CROHN’S DISEASE
The most popular theory is that the body’s immune system reacts to viruses or bacteria by causing ongoing inflammation in the intestine. Patients with Crohn’s Disease patients tend to have problems with their immune system. The disease is not caused by emotional stress.
Already in 1967, microbiologists believed, that Crohn's disease is NOT an autoimmune disorder, but is triggered by bacteria/bacterial imbalances. After years of research, more and more experts believe that at least one bacterium is very much connected with Crohn's disease: Mycobacterium avium paratuberculosis
THE SYMPTOMS OF CROHN'S DISEASE
Crohn's disease is a chronic condition. This means that it lasts a long time, sometimes for the rest of the affected person's life. The term chronic refers to time, not to how serious a condition is. Crohn's disease is characterised by flare-ups of symptoms. These alternate with periods of no symptoms at all - this is called remission. Usually there is no obvious trigger for the symptoms coming back (a relapse). When you have symptoms, the disease is said to be active. Symptoms include:
diarrhoea - it may contain blood, pus or mucus
a painful and swollen abdomeN
loss of appetite
weight loss
fever
rectal bleeding - this may lead to anaemia (a condition when you have too few red blood cells or not enough haemoglobin in your blood)
tears, ulcers or abscesses (pus-filled areas) around your anus
Active Crohn's disease may cause other problems such as:
mouth ulcers
joint pain
eye inflammation
rashes
ulcers on your skin
fertility problems and, in women, an increased risk of miscarriage
Complications
With severe, long-term inflammation, you may develop complications. These include:
a fistula - an abnormal connection between two parts of the body, most commonly between your bowel and your skin
an abscess in your abdomen
a stricture (narrowing of the bowel) - this can be caused by scar tissue that builds up after inflammation and may block your bowel
a slightly increased risk of developing bowel cancer if you have had Crohn's colitis (Crohn's disease of the colon - your colon is part of your large bowel) for more than eight to 10 years
COLLAGENOUS COLITIS
Collagenous colitis (CC) was described concurrently in 1976 by Lindstrom and by Freeman. In 1980, Read described microscopic colitis, which is clinically indistinguishable from CC but is differentiated from it by colonic biopsy features. Later, the term lymphocytic colitis (LC) was proposed by Lazenby to replace the term microscopic colitis and to distinguish it from infectious colitis and inflammatory bowel disease (ulcerative colitis and Crohn disease). The term microscopic colitis is now used to describe both CC and LC, and these conditions should be considered in any patient with unexplained nonbloody diarrhea. Patients undergoing either sigmoidoscopy or colonoscopy for unexplained diarrhea who have normal endoscopic findings should have biopsy samples taken to diagnose or rule out either form of microscopic colitis.
LC and CC are relatively rare conditions that are diagnosed when a patient with chronic watery nonbloody diarrhea has an endoscopically or radiographically normal colon, but colonic biopsies show unique inflammatory changes. Because the mucosa is not ulcerated or otherwise disrupted, the diarrhea generally does not contain blood or pus.
Pathophysiology
The characteristic feature of LC is an infiltration of lymphocytes into the colonic epithelium. CC shares this feature but additionally shows a distinctive thickening of the subepithelial collagen table. LC and CC have been suggested to represent different phases of a single pathophysiologic process, with LC possibly being a precursor or earlier phase of CC; however, this has not been proven.
The diarrhea in CC is more likely due to the inflammatory process than to the subepithelial collagen layer, although this layer may serve as a cofactor in the role of a diffusion barrier.
Increased levels of immunoreactive prostaglandin E2 in stool water may contribute to a secretory diarrhea.
Some patients with CC and concurrent collagenous infiltration of the duodenum and/or the ileum have demonstrated altered small bowel dysfunction, demonstrated by reduced D-xylose absorption.
Some individuals have bile acid malabsorption demonstrated by the Se-75-homotaurocholate (SeHCAT) test, in which a positive test result is shown by retention of less than 11% of the administered dose of radioactivity after 7 days.
Some patients with CC may have increased mucosal secretion of vascular endothelial growth factor, a fibrosis-enhancing peptide.
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