- Inflammatory bowel disease
Name = PAGENAME
DiseasesDB = 31127
eMedicineSubj = med
eMedicineTopic = 1169
eMedicine_mult = eMedicine2|emerg|106 eMedicine2|oph|520
MeshID = D015212
The main forms of IBD are
Crohn's diseaseand ulcerative colitis(UC).
Accounting for far fewer cases are other forms of IBD:
The main difference between Crohn's disease and UC is the "location" and "nature" of the inflammatory changes. Crohn's can affect any part of the
gastrointestinal tract, from mouthto anus("skip lesions"), although a majority of the cases start in the terminal ileum. Ulcerative colitis, in contrast, is restricted to the colon and the rectum. [http://www.ccfa.org]
Microscopically, ulcerative colitis is restricted to the
mucosa(epithelial lining of the gut), while Crohn's disease affects the whole bowel wall.
Finally, Crohn's disease and ulcerative colitis present with extra-intestinal manifestations (such as liver problems, arthritis, skin manifestations and eye problems) in different proportions.
Rarely, a definitive diagnosis of neither Crohn's disease nor ulcerative colitis can be made because of idiosyncrases in the presentation. In this case, a diagnosis of
indeterminate colitismay be made. Although a recognised definition, not all centres refer to this.
ymptoms and diagnosis
Although very different diseases, both may present with any of the following symptoms: abdominal pain,
vomiting, diarrhea, hematochezia(bright red blood in stools), weight lossand various associated complaints or diseases like arthritis, pyoderma gangrenosum, and primary sclerosing cholangitis. Diagnosis is generally by colonoscopywith biopsyof pathological lesions.
Depending on the level of severity, IBD may require
immunosuppressionto control the symptom, such as prednisone, infliximab(Remicade), azathioprine(Imuran), methotrexate, or 6-mercaptopurine. More commonly, treatment of IBD requires a form of mesalamine. Often, steroids are used to control disease flares and were once acceptable as a maintenance drug. In use for several years in Crohn's disease patients and recently in patients with Ulcerative Colitis, biologicals have been used such as the intravenously administered Remicade. Severe cases may require surgery, such as bowel resection, strictureplastyor a temporary or permanent colostomyor ileostomy. Alternative medicinetreatments for bowel disease exist in various forms, however such methods concentrate on controlling underlying pathology in order to avoid prolonged steroidal exposure or surgical excisement [http://www.gaiagarden.com/articles/therapeuticapplications/ta_treating_bowel_disease.php] .
Usually the treatment is started by administering drugs with high anti-inflammatory affects, such as prednisone. Once the inflammation is successfully controlled, the patient is usually switched to a lighter drug to keep the disease in remission, such as
Asacol, a mesalamine. If unsuccessful, a combination of the aforementioned immunosuppression drugs with a mesalamine(which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.
While IBD can limit quality of life because of pain, vomiting, diarrhea, and other socially unacceptable symptoms, it is rarely fatal on its own. Fatalities due to complications such as
toxic megacolon, bowel perforationand surgical complications are also rare.
While patients of IBD do have an increased risk of
colorectal cancerthis is usually caught much earlier than the general population in routine surveillance of the colon by colonoscopy, and therefore patients are much more likely to survive.
The goal of treatment is toward achieving remission, after which the patient is usually switched to a lighter drug with fewer potential side effects. Every so often an acute resurgence of the original symptoms may appear: this is known as a "flare-up". Depending on the circumstances, it may go away on its own or require medication. The time between flare-ups may be anywhere from weeks to years, and varies wildly between patients - a few have never experienced a flare-up.
A recent hypothesis posits that some IBD cases are caused by an overactive
immune systemattacking various tissues of the digestive tract because of the lack of traditional targets such as parasites and worms. The number of people being diagnosed with IBD has increased as the number of infections by parasites, such as roundworm, hookwormand human whipworms, has fallen, and the condition is still rare in countries where parasitic infections are common. This is similar to the hygiene hypothesisapplied to allergies. Fact|date=July 2007
Initial reports [cite journal |author=Summers RW, Elliott DE, Qadir K, Urban JF, Thompson R, Weinstock JV |title=Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease |journal=Am. J. Gastroenterol. |volume=98 |issue=9 |pages=2034–41 |year=2003 |pmid=14499784 |doi= 10.1111/j.1572-0241.2003.07660.x|url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0002-9270&date=2003&volume=98&issue=9&spage=2034] suggest that "
helminthic therapy" may not only prevent but even cure (or control) IBD: a drink with roughly 2,500 ova of the " Trichuris suis" helminth taken twice monthly decreased symptoms markedly in many patients. It is even speculated that an effective "immunization" procedure could be developed—by ingesting the cocktail at an early age.
Prebiotics and probiotics are showing increasing promise as treatments for IBD [cite journal |author=Furrie E, Macfarlane S, Kennedy A, "et al" |title=Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial |journal=Gut |volume=54 |issue=2 |pages=242–9 |year=2005 |pmid=15647189 |pmc=1774839 |doi=10.1136/gut.2004.044834 |url=] and in some studies have proven to be as effective as prescription drugs. [cite journal |author=Kruis W, Fric P, Pokrotnieks J, "et al" |title=Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine |journal=Gut |volume=53 |issue=11 |pages=1617–23 |year=2004 |pmid=15479682 |pmc=1774300 |doi=10.1136/gut.2003.037747 |url=]
More recently, research [cite journal |author=Hue S, Ahern P, Buonocore S, "et al" |title=Interleukin-23 drives innate and T cell-mediated intestinal inflammation |journal=J. Exp. Med. |volume=203 |issue=11 |pages=2473–83 |year=2006 |pmid=17030949 |pmc=2118132 |doi=10.1084/jem.20061099 |url=http://www.jem.org/cgi/content/abstract/203/11/247 ] has shown that IL-23 is overexpressed in tissues taken from Mouse models of IBD. The group showed that knocking out IL-23 (heterodimer of IL-12p40 and IL-23p19) severely reduced inflammation of the bowel, both in terms of cells and proinflammatory cytokine production. Also, they found that a novel group of CD4+ T lymphocytes, Th17 T cells, are highly upregulated in bowels of diseased mice. Taken together, the group shows that IL-23 but not IL-12 (IL-12p40 and IL-12p35; share a subunit) drives innate and T cell mediated intestinal inflammation.
In 2005 New Scientist published a joint study by Bristol University and Bath University on the apparent healing power of cannabis on IBD. Reports that cannabis eased IBD symptoms indicated the possible existence of cannabinoid receptors in the intestinal lining, which respond to molecules in the plant-derived chemicals. CB1 cannabinoid receptors – which are known to be present in the brain – exist in the endothelial cells which line the gut, it is thought that they are involved in repairing the lining of the gut when damaged. The team deliberately damaged the cells to cause inflammation of the gut lining and then added synthetically produced cannabinoids; the result was that gut started to heal: the broken cells were repaired and brought back closer together to mend the tears. It is believed that in a healthy gut, natural endogenous cannabinoids are released from endothelial cells when they are injured, which then bind to the CB1 receptors. The process appears to set off a wound-healing reaction, and when people use cannabis, the cannabinoids bind to these receptors in the same way. Previous studies have shown that CB1 receptors located on the nerve cells in the gut respond to cannabinoids by slowing gut motility, therefore reducing the painful muscle contractions associated with diarrhoea. The team also discovered another cannabinoid receptor, CB2, in the guts of IBD sufferers, which was not present in healthy guts. These receptors, which also respond to chemicals in cannabis, appear to be associated with apoptosis – programmed cell death – and may have a role in suppressing the overactive immune system and reducing inflammation by moping up excess cells. [cite journal |author=Wright K, Rooney N, Feeney M, "et al" |title=Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing |journal=Gastroenterology |volume=129 |issue=2 |pages=437–53 |year=2005 |pmid=16083701 |doi=10.1016/j.gastro.2005.05.026 |url=]
Genetics play a crucial role in Crohn's disease but environmental factors are also involved; smoking appears to increase the risk.
* [http://www.ccfa.org/info/?LMI=4 Information about IBD] from the Crohn's and Colitis Foundation of America
* [http://www.efcca.org/ European Federation of Crohns and Colitis Associations]
* [http://www.ibdcure.org/IBD/ IBDCure International]
* [http://ibdkids.unc.edu/index.php/TopMenu/FAQ Frequently Asked Questions about IBD in Children] from the North Carolina Children's Hospital
Wikimedia Foundation. 2010.
Look at other dictionaries:
inflammatory bowel disease — n either of two inflammatory diseases of the bowel: a) CROHN S DISEASE b) ULCERATIVE COLITIS * * * (IBD) a general term for those inflammatory diseases of the intestines that have an unknown etiology, including Crohn disease and ulcerative… … Medical dictionary
inflammatory bowel disease — A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn disease … English dictionary of cancer terms
inflammatory bowel disease — noun inflammation of the colon • Syn: ↑colitis • Hypernyms: ↑inflammation, ↑redness, ↑rubor • Hyponyms: ↑regional enteritis, ↑regional ileitis … Useful english dictionary
inflammatory bowel disease — any intestinal inflammatory disease, esp. Crohn s disease and ulcerative colitis, of unknown cause. Abbr.: IBD * * * ▪ pathology chronic inflammation of the intestines (intestine) that results in impaired absorption of nutrients (nutrient). IBD… … Universalium
inflammatory bowel disease — noun Date: 1977 either of two inflammatory diseases of the bowel: a. Crohn s disease b. ulcerative colitis … New Collegiate Dictionary
inflammatory bowel disease — (IBD) any of a group of inflammatory conditions of the intestine that include (among others) ulcerative colitis and Crohn s disease … Medical dictionary
inflammatory bowel disease — IBD any of a group of inflammatory conditions of the intestine that include (among others) ulcerative colitis and Crohn s disease … The new mediacal dictionary
Biological therapy for inflammatory bowel disease — Biological therapy refers to the use of medication that is tailored to specifically target an immune or genetic mediator of disease. cite journal | author = Staren E, Essner R, Economou J | title = Overview of biological response modifiers. |… … Wikipedia
IBD (inflammatory bowel disease) — A group of chronic intestinal diseases characterized by inflammation of the bowel the large or small intestine. The most common types of inflammatory bowel disease are ulcerative colitis and Crohn disease. Crohn disease favors the ileum (the… … Medical dictionary
Bowel disease, inflammatory — A group of chronic intestinal diseases characterized by inflammation of the bowel the large or small intestine. The most common types of inflammatory bowel disease (IBD) are ulcerative colitis and Crohn disease. Crohn disease favors the ileum… … Medical dictionary