Inflammatory Bowel Disease: Types, Causes and Effects

Inflammatory Bowel Disease Types, Causes and EffectsChapter 1 THE INFLAMMATORY bowel infirmityWHAT IS INFLAMMATORY BOWEL DISEASEInflammatory bowel infirmity (IBD) means chronic inflammation of all or part of your digestive tract. IBD bottom be classified into two, which is, ulcerative colitis and Crohns unhealthiness. IBD is precise annoying and debilitating, and rouse some generation lead to livelihood-threatening complications. The IBD is called an auto repellent disease be earn the bodys immune system attacks the digestive system. The disease is so ascetical that it whitethorn cause group AB pain, slanty diarrhea, cramps and fever.This is however different from Irritable Bowel Syndrome (IBS).DIFFERENCE BETWEEN INFLAMMATORY BOWEL DISEASE (IBD) AND INLAMMATORY BOWEL SYNDROME (IBS)The difference between the IBS and the IBD is that IBD is structural, but IBS is not. If the gut is examined by x-ray, endoscopy, biopsy or surgery, structural damage to the gut end be seen. In IBD, the damage is caused by the inflammation and may require heavy duty medication, or plain surgery. Whereas in IBS, the examination of the gut of a person having IBS would help detect nothing. It can all be detected by gut symptoms. These may include ab cramps or pain, harder or looser bowel movements than average, excess gas, diarrhea and constipation or alternating between the two.Both of these affect people of all ages but young people be mostly affected. Females have much chances of having IBS. IBD has no grammatical gender preference but is mostly found in Jews and people from Northern Europe. IBS is a worldwide disorder, while IBD is prominent in the planets clement zones.In IBD, the gut is damaged by chronic inflammation. The damage is fought by the defense mechanism of the body resulting in fever and malaise. The bowels ar disrupted, they may turn tail and anemia is common too. There is inability to eat during attacks, inflammation is caused which results in wasting of energy, ultimately resulting in free weight loss and malnutrition.IBS cannot be identified by findings of physical examination. However, the structural damage caused by IBD is as head capable of producing striking physical findings like a mass in the abdomen, or the symptoms such as that of weight loss and anemia. Other differences include the need for surgery in IBD, which is not required in IBS. IBS does not induce complications in the gut, skin, joints and eyes, but IBD does.CROHNS DISEASE This is the type of IBD that may involve any part(s) of the gastrointestinal tract, ranging from mouth to anus. Listed below ar a few characteristic features fire usually occurs in patches.The pain is usually experienced in the lower right abdomen.The colon may turn thick and might appear to be rocky.Ulcers in and along the digestive tract atomic number 18 very deep, sometimes extending into every layer of the bowel wall.During bowel movement, rectal bleeding is not common.Ulcer ative colitis is the fleck type of IBD, which is taken up in the subsequent chapters.Chapter 2 ULCERATIVE COLITISDefining Ulcerative colitisColitis means the inflammation of the colon, or more largely, inflammation of the large intestine ( that comprises of colon, caecum and rectum). Ulcerative colitis is a disease of the colon, which is the largest part of the large intestine, characterized by ulcers (open sores). These ulcers argon painful wounds, they may bleed and in like manner produce mucus and pus. The mucosa (inner lining) of the intestine becomes red and swollen. The rectal area is most severely affected. If the lining of the colon is damaged, it may cause bloody diarrhea.Where Crohns disease can affect almost any part of the digestive tract, Ulcerative colitis only affects the large intestine. Crohns disease can be treated by removing the affected parts and reconnecting the healthy ones. Whereas to treat ulcerative colitis, one may have to remove the large intestine comp letely (called colectomy). It can occur at upliftedly irregular intervals, at times, with symptoms extremely severe, and sometimes, no symptoms at all.Ulcerative Colitis- An autoimmune conditionIn autoimmunity, an organism fails to recognize its own constituent parts as self, and thus leads to an immune response against its own tissues and cells. Such diseases are termed as autoimmune diseases.In some some other words, our bodys defense mechanism goes wrong and attacks its own healthy tissue. There are harmless bacteria present inside the colon, which are nonsensical to be harmful by the defense mechanism, and are attacked, leading to inflammation.Classifying Ulcerative ColitisUlcerative ProctitisThis is Ulcerative colitis in its around the bendest form. There is inflammation only within the rectal area. The various signs and symptoms are as followsRectal painRectal bleedingThere is an urge to move the bowels but inability to do so.ProctosigmoiditisThis involves the lower end o f the colon, that is, the sigmoid colon and the rectum. The signs and symptoms are as followsAbdominal painBloody diarrheaAbdominal crampsConstant urge to go to the thunder mugLeft sided colitisThere in inflammation in the rectum, up on the left side along the sigmoid colon and the descending colon. The signs and symptoms areAbdominal cramping on the left sideBloody diarrheaWeight lossPancolitis (Universal colitis)This involves and affects the whole colon. The signs and symptoms areBloody diarrhea (there may be severe bouts)Abdominal painAbdominal crampsWeight lossFatigueFulminant ColitisThis is the most rare form of colitis and it can be life threatening. It affects the whole colon. Patients execrable from fulminant colitis are at a constant risk of toxic megacolon (the colon becomes swollen, or bloated, or distended) and colon rupture. The signs and symptoms are as followsSevere diarrhea, that can lead to shock and dehydrationSevere painSYMPTOMS OF ULCERATIVE COLITISThe Gastroin testinal symptoms includeDiarrhea with blood and mucus. This implies the inactive onset of the disease which may persist for an extended period, maybe weeks. If rectal examination is conducted, blood may be found. The diligents also suffer from drastic weight loss. Due to the inflammation and extreme loss of blood from the gastrointestinal tract, anaemia may occur. There may be mild abdominal muscle pain, or painful bowel movements accompanied with painful abdominal cramping. adept may even experience fatigue and loss of appetite.One may experience very mild or almost no symptoms, called remission, which may be followed by symptoms that are troublesome, called flare-ups or relapses. These may be triggered by stress. Flare-ups may be very troublesome, in which patients may have to forsake their bowels about six times or more each day. Heartbeat may be fast or irregular, accompanied by shortness of breath and high fever.Severity of the diseaseMild diseaseThis means less than four stools each day. Blood may be present or absent. Patient may experience mild cramping and abdominal pain. The patient may feel constipated, with a continuous feeling of needing to empty the bowel, with cramping or pain and little or almost no fecal output.Moderate diseaseThis means more than four stools each day. Patient also displays signs of anemia, fever around 100 to 102 degrees Fahrenheit.Severe DiseaseThis means around six stools with blood each day, implying observable bowel movement, toxicity demonstrated in the form of fever, anaemia and tachycardia.Fulminant DiseaseThis means more than or equal to ten bowel movements each day, accompanied by continuous bleeding, abdominal tenderness, toxicity, colonic dilation and blood transfusion is often required. Patients may have toxic megacolon as the inflammation extends beyond the mucosal layer. At times, the serous tissue layer also gets involved causing colonic perforation. If not treated, fulminant disease may lead to death.Ext raintestinal SymptomsAs ulcerative colitis is an autoimmune disease, patients may go up symptoms as well as complications outside the colon. These includeUlcers in the mouth.Opthalmic Irritated and red eyes, or inflammation o iris called iritis.Musculoskeletal swollen-headed joints (arthritis). These may be large joints, or small joints of hands or feet. Or joints of the spine.Cutaneous Inflammation of the subcutaneous tissue.Painful and ulcerating lesion of the skin.A deformity of the ends of the fingers (Clubbing).Inflammation of the bile ducts (Primary Sclerosing Cholangitis).Chapter 3 Causes of Ulcerative ColitisThe causes of Ulcerative Colitis are still not known. Yet, the possible causes are listed belowGENETICSThe disease can be inherited if one has a close relative suffering from the disease. therefrom it can be found in the family. The regions of the genome that can be united to this disease are the chromosome number 1, 3, 5, 6, 12, 14, 16, 19. Since none of these have been faulty continuously, it has led to a conclusion that the disease occurs collectible to a combination of various genes. One of the regions, for example, has been linked to ulcerative colitis is chromosome band 1p36.ENVIRONMENTAL FACTORSInflammation may be encouraged by diet. For example, if there is a large intake of vitamin b6 and unsaturated fat affect the developing of ulcerative colitis. There are many other discovered dietary factors which may lead to the relapse or education of the disease, like meat protein and alcoholic beverages. Vitamin D deficiency is also a leading cause of the disease. Breastfeeding may also lead to the development of the disease.The role of atomic number 16 in Ulcerative ColitisSulphur is found in many foods and messages like milk, eggs, cheese, mayonnaise. It is also used as a food preservative because it stabilizes protein structures. It also prevents microbial growth during fermentation of wine and beer.Bacteria that are present in the bowe l convert the sulphur present in the food to hydrogen sulphide, which is called fermentation. This substance is harmful as it can cause abdominal pain and urgent and frequent bowel movements. Because of the already existing inflammation of the bowel lining, patients suffering from ulcerative colitis find it difficult to break down the gas as they produce more hydrogen sulphide than normal. This toxic substance, in high amounts, reduces the protective unction of the cells that are lining the bowel. It can also cause cell death and induce ulceration in the superficial mucosa of the intestine. Hence the cells lining the colon are harmed.IMMUNE SYSTEMTheories suggest that a virus or a bacterium also may trigger ulcerative colitis as the digestive tract may become inflamed when the immune system tries to get rid of the invading microorganism (pathogen). This inflammation is caused due to the release of white blood cells to destroy the present pathogen. This may lead to an autoimmune rea ction/condition in which the body produces an immune response even during the absence of the pathogen. This happens because the body tries to eliminate pathogens which are either gut friendly, or non-existent.RISK FACTORSThe factors that raise the risk of developing Ulcerative colitis are as followsAge Though it may affect people at any and every age, it is more commonly found in people aged 15 to 30.Genetics If someone has a close relative with the Crohns disease or ulcerative colitis, they are at a high risk of development of the disease.Isotretinoin The give-and-take of cystic acne is often through with(p) with the help of this medicine. It can cure other kinds of acne too, but it increases the risk of this disease. The medicine is also called Accutane. Amnesteem, Sotret and Claravis (These are the various other brand names).Appendectomy The removal of the appendix may lead to the reduction of the risk of developing ulcerative colitis but an increased risk of Crohns disease.Cha pter 4 DIAGNOSISUlcerative colitis is diagnosed only when the possible signs and symptoms of infection, Crohns disease, irritable bowel syndrome (IBS) and colon cancer have been ruled out. The following tests are carried outBLOOD TESTSThey help to check anaemia, and also help to diagnose the name of the bowel disease the patient has.STOOL SAMPLEIf there are white blood cells present in the stool, it implies that the patient is suffering from an inflammatory disease, possibly ulcerative colitis. It also helps rule out other diseases, like those caused by bacteria, viruses and parasites. Clostridium difficile usually causes diarrhea but also common amongst people suffering from ulcerative colitis. Bowel infection can also be check this way.COLONOSCOPYThe entire colon can be viewed using a flexible, thin and lighted tube which has a camera attached to it. Small tissue samples are also taken (called biopsy) so that a laboratory analysis can be conducted and ulcerative colitis may be di agnosed.SIGMOIDOSCOPYThis test is done if the colon is inflamed severely. A thin, lighted and flexible tube is used to examine the last portion of the colon, the sigmoid. But the drawback of this procedure is that the problems occurring higher up the colon may be missed and a full picture of the affected colon is not achieved.BARIUM ENEMAThe entire large intestine can be examined using an X-Ray. A contrast solution of barium accompanied with some air is placed into the bowel with the help of an enema. Once the barium coats the entire lining of the colon, rectum and a part of the large intestine, it creates a silhouette. This is a dangerous test and hence rarely used because the pressure that is applied to inflate the colon and coat it may lead to its rupture.X-RAYAn X-ray of the abdominal area can be done to rule out the possibility of toxic megacolon and perforation as these conditions may appear because of the severe symptoms.CT SCANThis scan is carried out to check the extent of inflammation of the colon. The abdomen and pelvis are scanned if complications due to ulcerative colitis are observed or an inflamed small intestine that may be because of Crohns disease.VIDEO CAPSULE ENDOSCOPY (VCE)In this test, a patient swallows a capsule containing a camera which takes pictures of the intestine as it travels through it and sends them to a recorder wirelessly. The pictures can then be reviewed.Chapter 5 TREATMENTThe treatment of ulcerative colitis is done on the basis of the severity of the disease. It mainly consists of changes in the diet and medication. If symptoms are found to be severe and long lasting, more medicines may be required or even surgery. But medicines cannot completely the disease. They can only minimize the risk of cancer, induce remissions and maintain them and improve the lineament of life.AMINOSALICYLATESThese are anti- inflammatory drugs that are used to induce and maintain remission. 5-aminosalicylic acid (5- ASA) produces the anti-inflam matory action. Examples of aminosalicylates are-MESALAZINE Also called Pentasa, Octasa and AsacolSULFASALAZINE This belongs to a class of antibiotics and it decomposed in the intestine to release 5-ASA.Since this substance is not entirely absorbed by the intestine, it gives a topical relief.CORTICOSTEROIDSThese are often used with 5-ASA drugs to induce remission of ulcerative colitis. These work by the block the parts where leukocyte adhesion cascade occurs to induce inflammation. These have many side effects like the puffiness on the face, called moon face, and manic behavior. It may also cause bipolar disorder, inducing periods of elevated mood and depression.Examples include Cortisone, Hydrocortisone, Prednisone.IMMUNOSUPPRESSIVE DRUGSThese inhibit the immune system. They stop cell division of white blood cells that occur as an immune response. Examples are Mercaptopurine, Methotrexate, Azathioprine.DIET MODIFICATIONFresh fruit, carbonated drink and caffeine should be avoided by patients suffering from diarrhea and abdominal cramping.Some patients show lactose intolerance (they are not able to digest lactose) hence they cant consume lactose. To supplement the bone loss, calcium is given to them.The gastrointestinal and auto-immune symptoms can be helped by using the Specific Carbohydrate Diet that allows only the use of monosaccharides and not the other carbohydrates.At times due to metabolic defects, Hydrogen Peroxide may build up underneath the membrane that usually protects the walls of the intestine from the bacteria that are present. To protect ourselves from these oxidants, a need to take antioxidants arises. These include vitamins A, E, C, Selenium and manganese.HERBAL MEDICINEWhile Kampo is a medicine that is used in Japan, Boswellia is and Ayurvedic medicine that can be used as an alternative to other drugs.Medicinal cannabis can also be used as it helps reducing abdominal discomfort and abdominal irritability caused by ulcerative colitis.HELMINTH IC THERAPYSometimes, parasites may help in the reduction of the immune response of the intestine. Whipworm may be used for this purpose. Reduction of immune response may help in the complete elimination of ulcerative colitis.SURGERYColectomy is required to remove all or a part of the colon when it gets infected and begins to spread the infection to other parts.It can be classified as followsTOTAL COLECTOMY The entire colon is removedPARTIAL COLECTOMY The entire colon is not removed, but only a part of it is.HEMICOLECTOMY Removal of the left or right part of the colonPROCTOCOLECTOMY Removal of the colon as well as the rectum.Once colectomy is performed, the remaining portions of the gastrointestinal tract are reattached in order to allow the waste to be eliminated from the body.