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{{PsyPerspective}}
:''IBD redirects here.
 
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{{About|bowel inflammation|[[functional colonic disease|functional disorder]]|Irritable bowel syndrome}}
In [[medicine]], '''inflammatory bowel disease''' ('''IBD''') is a group of [[inflammation|inflammatory]] conditions of the [[colon (anatomy)|large intestine]] and, in some cases, the [[small intestine]]. It should not be confused with IBS, [[irritable bowel syndrome]], which is less severe.
 
  +
{{Infobox disease
  +
| Name = Inflammatory bowel disease
  +
| Image = Cryptitis high mag.jpg
  +
| Caption = [[Micrograph]] showing [[inflammation]] of the [[large bowel]] in a case of inflammatory bowel disease. Colonic [[biopsy]]. [[H&E stain]].
  +
| DiseasesDB = 31127
  +
| ICD10 =
  +
| ICD9 =
  +
| ICDO =
  +
| OMIM =
  +
| MedlinePlus =
  +
| eMedicineSubj = med
  +
| eMedicineTopic = 1169
  +
| eMedicine_mult = {{eMedicine2|emerg|106}} {{eMedicine2|oph|520}}
  +
| MeshID = D015212
  +
}}
  +
{{Gastropsychology}}
   
  +
In [[Gastro psychology]] and [[medicine]], '''inflammatory bowel disease''' ('''IBD''') is a group of [[inflammation|inflammatory]] conditions of the [[colon (anatomy)|colon]] and [[small intestine]]. The major types of IBD are [[Crohn's disease]] and [[ulcerative colitis]].<ref name=Baumgart2>{{cite journal | author = Baumgart DC, Carding SR | year = 2007 | title = Inflammatory bowel disease: cause and immunobiology. | journal = The Lancet | volume = 369 | issue = 9573 | pages = 1627–40 | pmid = 17499605 | doi = 10.1016/S0140-6736(07)60750-8 }}</ref><ref name=Baumgart>{{cite journal | author = Baumgart DC, Sandborn WJ | year = 2007 | title = Inflammatory bowel disease: clinical aspects and established and evolving therapies. | journal = The Lancet | volume = 369 | issue = 9573 | pages = 1641–57 | pmid = 17499606 | doi = 10.1016/S0140-6736(07)60751-X }}</ref><ref name="pmid17653185">{{cite journal |author=Xavier RJ, Podolsky DK |title= Unravelling the pathogenesis of inflammatory bowel disease. |journal=Nature |volume=448 |issue=7152 |pages=427–34 |year=2007 | pmid= 17653185 | doi=10.1038/nature06005}}</ref>
==Forms==
 
  +
  +
==Classification==
 
The main forms of IBD are [[Crohn's disease]] and [[ulcerative colitis]] (UC).
 
The main forms of IBD are [[Crohn's disease]] and [[ulcerative colitis]] (UC).
   
Accounting for far fewer cases are other forms of IBD:
+
Accounting for far fewer cases are other forms of IBD, which are not always classified as typical IBD:
 
* [[Collagenous colitis]]
 
* [[Collagenous colitis]]
 
* [[Lymphocytic colitis]]
 
* [[Lymphocytic colitis]]
 
* [[Ischaemic colitis]]
 
* [[Ischaemic colitis]]
 
* [[Diversion colitis]]
 
* [[Diversion colitis]]
* [[Behçet's syndrome]]
+
* [[Behçet's disease]]
* [[Infective colitis]]
 
 
* [[Indeterminate colitis]]
 
* [[Indeterminate colitis]]
   
The main difference between Crohn's disease and UC is the ''location'' and ''nature'' of the inflammatory changes in the gut. Crohn's can affect any part of the [[gastrointestinal tract]], from [[mouth]] to [[anus]] (''skip lesions''), although a majority of the cases start in the [[terminal ileum|terminal]] [[ileum]]. Ulcerative colitis, in contrast, is restricted to the [[colon (anatomy)|colon]] and the anus.
+
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 [[mouth]] to [[anus]] (''[[skip lesion]]s''), although a majority of the cases start in the [[terminal ileum]]. Ulcerative colitis, in contrast, is restricted to the [[colon (anatomy)|colon]] and the rectum.<ref>{{cite web | url=http://www.ccfa.org | title=Crohn's & Colitis Foundation of America}}</ref>
  +
{{Pathophysiology in CD vs. UC}}
 
[[Light microscopy|Microscopically]], ulcerative colitis is restricted to the [[mucosa]] ([[epithelium|epithelial lining]] of the gut), while Crohn's disease affects the whole bowel wall.
+
[[Light microscopy|Microscopically]], ulcerative colitis is restricted to the [[mucosa]] ([[epithelium|epithelial lining]] of the gut), while Crohn's disease affects the whole bowel wall ("transmural lesions").
   
 
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.
 
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 idiosyncrasies in the presentation. In this case, a diagnosis of indeterminate colitis may be made. Although a recognised definition, not all centres refer to this.
In rare cases, patients have been diagnosed with both Crohn's disease and ulcerative colitis, though whether it is a combination or simply unidentifiable as one or another is uncertain.
 
   
  +
==Signs and symptoms==
==Diagnosis==
 
  +
{{Symptoms in CD vs. UC}}
Although very different diseases, both may present with any of the following symptoms: abdominal pain, [[vomiting]], [[diarrhea]], [[hematochezia]], [[weight loss]] and various associated complaints or diseases ([[arthritis]], [[pyoderma gangrenosum]], [[primary sclerosing cholangitis]]). Diagnosis is generally by [[colonoscopy]] with [[biopsy]] of pathological lesions.
+
Although very different diseases, both may present with any of the following symptoms: abdominal pain, [[vomiting]], [[diarrhea]], [[rectal bleeding]], severe internal cramps/muscle spasms in the region of the pelvis, [[weight loss]] and various associated complaints or diseases like [[arthritis]], [[pyoderma gangrenosum]], and [[primary sclerosing cholangitis]]. Diagnosis is generally by assessment of inflammatory markers in stool followed by [[colonoscopy]] with [[biopsy]] of pathological lesions.
  +
{{Findings in CD vs. UC}}
   
 
==Treatment==
 
==Treatment==
  +
{{Treatment in CD vs. UC}}
Depending on the level of severity, IBD may require [[immunosuppression]] to control the symptoms. such as [[azathioprine]], [[methotrexate]], or [[6-mercaptopurine]]. More commonly, treatment of IBD requires a form of [[mesalamine]]. Often, [[steroid]]s are used to control disease flares and were once acceptable as a maintenance drug. In use for several years in Crohns disease patients and recently in patients with Ulcerative Colitis, [[Biological therapy for inflammatory bowel disease|biologicals]] has been used such as the intravenously administered Remicade. Severe cases may require [[surgery]], such as [[bowel resection]], [[strictureplasty]] or a temporary or permanent [[colostomy]] or [[ileostomy]]. [[Alternative medicine]] treatments 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].
 
  +
Optimal treatment of inflammatory bowel disease depends on what form it consists of. For example, [[mesalazine]] is more useful in [[ulcerative colitis]] than in [[Crohn's disease]].<ref name=agabegi2nd>Pages 152-156 (Section: Inflammatory bowel disease(IBD)) in:{{cite book |author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages= |isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}}</ref> Generally, depending on the level of severity, IBD may require [[immunosuppression]] to control the symptom, such as [[prednisone]], [[TNF inhibitor|TNF inhibition]], [[azathioprine]] (Imuran), [[methotrexate]], or [[6-mercaptopurine]]. More commonly, treatment of IBD requires a form of [[mesalazine]].
   
 
Often, [[Glucocorticoid|anti-inflammatory steroid]]s 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, [[Biological therapy for inflammatory bowel disease|biologicals have been used]] such as TNF inhibitors. Severe cases may require [[surgery]], such as [[bowel resection]], [[strictureplasty]] or a temporary or permanent [[colostomy]] or [[ileostomy]]. [[Alternative medicine]] treatments 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.<ref>[http://www.gaiagarden.com/articles/therapeuticapplications/ta_treating_bowel_disease.php A Phytotherapeutic Approach to Lower Bowel Disease] Gaia Garden</ref>
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 immunosurpression drugs with a [[mesalamine]] (which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.
 
  +
 
Usually the treatment is started by administering drugs with high anti-inflammatory effects, 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 [[mesalazine]]. If unsuccessful, a combination of the aforementioned immunosuppression drugs with a [[mesalazine]] (which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.
  +
  +
[[Histoplasma]] produces toxins that cause intestinal disease called [[histoplasmosis]] that is a “serious consideration” in an immunocompromised patient with signs and symptoms of IBD. Antifungal drugs such as [[nystatin]] (a broad spectrum gut antifungal) and either [[itraconazole]] (Sporanox) or [[fluconazole]] (Diflucan) have been suggested as a treatment for IBD disorders such as [[Crohn’s disease]] and [[ulcerative colitis]] that all share the same symptoms such as diarrhea, weight loss, fever, and abdominal pain.<ref>Holland D. The Fungal Etiology of Inflammatory Bowel Disease
  +
.</ref>
   
 
==Prognosis==
 
==Prognosis==
  +
{{Complications of CD vs. UC}}
While IBD can limit quality of life due to pain, vomiting, diarrhea, and other socially unacceptable symptoms, it is rarely fatal on its own. Fatalities due to complications such as [[toxic megacolon]], [[bowel perforation]] and surgical complications are also rare.
+
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 perforation]] and surgical complications are also rare.
   
While patients of IBD do have an increased risk of [[colorectal cancer]] this 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.
+
While patients of IBD do have an increased risk of [[colorectal cancer]], this 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.
   
  +
New evidence suggests that patients with IBD may have an elevated risk of [[endothelial dysfunction]] and [[coronary artery disease]].<ref>
After treatment, the patient is usually switched to a lighter drug with fewer 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.
 
  +
{{cite journal
  +
| author = Roifman I, Sun YC, Fedwick JP, Panaccione R, Buret AG, Liu H, Rostom A, Anderson TJ, Beck PL
  +
| title = Evidence of endothelial dysfunction in patients with inflammatory bowel disease
  +
| journal = Clin. Gastroenterol. Hepatol.
  +
| volume = 7
  +
| issue = 2
  +
| pages = 175–82
  +
| year = 2009
  +
| month = February
  +
| url = linkinghub.elsevier.com/retrieve/pii/S1542-3565(08)01109-9
  +
| accessdate = 2009-11-04
  +
| doi = 10.1016/j.cgh.2008.10.021
  +
| pmid = 19121648
  +
}}</ref>
   
 
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.
==Recent findings==
 
A recent hypothesis posits that some IBD cases are caused by an overactive [[immune system]] attacking various tissues of the digestive tract because of the lack of traditional targets such as [[parasite]]s and worms. The number of people being diagnosed with IBD has increased as the number of infections by parasites, such as [[roundworm]], [[hookworm]] and [[human whipworm]]s, has fallen, and the condition is still rare in countries where parasitic infections are common. This is similar to the [[hygiene hypothesis]] applied to [[allergy|allergies]].
 
   
  +
==Research==
Initial reports (Summers ''et al'' 2003) 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.
 
  +
The following treatment strategies are not used routinely, but appear promising in most forms of inflammatory bowel disease.
   
 
Initial reports<ref>{{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}}
Prebiotics and probiotics are showing increasing promise as treatments for IBD (Furrie, 2005) and in some studies have proven to be as effective as prescription drugs (Kruis, 2004).
 
 
</ref> suggest that "[[helminthic therapy]]" may not only prevent but even 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<ref>{{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=}}</ref> and in some studies have proven to be as effective as prescription drugs.<ref>{{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=}}</ref>
More recently, research (Hue et al 2006) 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<sup>+</sup> 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 the [[University of Bath]] 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.<ref>{{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=10.1053/j.gastro.2005.05.026 |url=}}</ref>
==References==
 
* Furrie, E. Biotic Therapy Cuts Inflammation in Ulcerative Colitis. Gut 2005;54:242-249.
 
* Kruis, W., P Fric, J Pokrotnieks, M Lukás, B Fixa, M Kascák, M A Kamm, J Weismueller, C Beglinger, M Stolte, C Wolff, and J Schulze. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 2004; 53: 1617-1623.
 
* Summers RW, Elliott DE, Qadir K, Urban JF Jr, Thompson R, Weinstock JV. ''Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease.'' Am J Gastroenterol 2003;98:2034-41. PMID 14499784.
 
* Hue S, Ahern P, Buonocore S, Kullberg MC, Cua DJ, McKenzie BS, Powrie F, Maloy KJ. Interleukin-23 drives innate and T cell-mediated intestinal inflammation. ''J. Exp. Med.'' 2006; '''203''':2473-2483. [http://www.jem.org/cgi/content/abstract/203/11/2473]
 
   
  +
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.<ref>{{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=10.1053/j.gastro.2005.05.026 |url=}}</ref>
==External links==
 
   
  +
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 mopping up excess cells.<ref>{{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=10.1053/j.gastro.2005.05.026 |url=}}</ref>
*An Overview of [http://www.healthcarebase.com/crohns-disease.php Crohn's Disease] and [http://www.healthcarebase.com/ulcerativecolitis.php Ulcerative Colitis]
 
*[http://www.ibdforum.com IBD Forum] A website designed for use by Doctors and other healthcare professionals specialising in the management of Inflammatory Bowel Disease
 
   
 
==References==
===Support organizations===
 
  +
{{reflist|2}}
   
 
==External links==
* [http://www.ccfa.org Crohn's and Colitis Foundation of America]
 
  +
* {{DMOZ|/Health/Conditions_and_Diseases/Digestive_Disorders/Intestinal/Inflammatory_Bowel_Disease/}}
* [http://www.efcca.org/ European Federation of Crohns and Colitis Associations] has [http://www.efcca.org/membership.htm member associations] in most European countries.
 
* [http://www.crohnszone.org CrohnsZone.org]
 
* [http://www.ibdcure.org IBDCure International]
 
   
  +
{{Gastroenterology}}
  +
{{Crohn's disease and ulcerative colitis}}
   
[[Category:Psychosomatic medicine]]
 
 
[[Category:Autoimmune diseases]]
 
[[Category:Autoimmune diseases]]
  +
[[Category:Gastrointestinal disorders]]
   
 
<!--
 
<!--
  +
[[ar:داء الأمعاء الالتهابي]]
  +
[[ca:Malaltia inflamatòria intestinal]]
 
[[de:Chronisch-entzündliche Darmerkrankungen]]
 
[[de:Chronisch-entzündliche Darmerkrankungen]]
  +
[[es:Enfermedad inflamatoria intestinal]]
  +
[[eu:Hesteetako hanturazko gaixotasun]]
  +
[[fa:بیماری‌ التهابی روده]]
  +
[[fr:Maladies inflammatoires chroniques intestinales]]
  +
[[hi:प्रदाहक आन्त्र रोग]]
 
[[hr:Upalna bolest crijeva]]
 
[[hr:Upalna bolest crijeva]]
 
[[he:מחלת המעי הדלקתי]]
 
[[he:מחלת המעי הדלקתי]]
[[ja:炎症性腸疾患]]
 
 
[[ms:Sindrom Rengsa Usus]]
 
[[ms:Sindrom Rengsa Usus]]
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[[nl:Inflammatory bowel disease]]
[[pl:IBD]]
 
 
[[ja:炎症性腸疾患]]
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[[pl:Nieswoiste zapalenia jelit]]
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[[pt:Doença inflamatória intestinal]]
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[[sl:Kronična vnetna črevesna bolezen]]
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[[sv:Inflammatorisk tarmsjukdom]]
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[[vi:Viêm ruột]]
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[[zh:炎症性肠病]]
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-->
 
-->
 
{{enWP|Inflammatory bowel disease}}
 
{{enWP|Inflammatory bowel disease}}

Latest revision as of 23:05, 3 July 2012

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Inflammatory bowel disease
Classification and external resources
Template:Px
Micrograph showing inflammation of the large bowel in a case of inflammatory bowel disease. Colonic biopsy. H&E stain.
DiseasesDB 31127
eMedicine med/1169 emerg/106 oph/520
MeSH D015212
Gastro psychology
Brain animated color nevit.gif

Specialities
Functional gastrointestinal disorder
Other disorders
Related topics

In Gastro psychology and medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.[1][2][3]

Classification[]

The main forms of IBD are Crohn's disease and ulcerative colitis (UC).

Accounting for far fewer cases are other forms of IBD, which are not always classified as typical IBD:

  • Collagenous colitis
  • Lymphocytic colitis
  • Ischaemic colitis
  • Diversion colitis
  • Behçet's disease
  • Indeterminate colitis

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 mouth to 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.[4] Template:Pathophysiology in CD vs. UC Microscopically, ulcerative colitis is restricted to the mucosa (epithelial lining of the gut), while Crohn's disease affects the whole bowel wall ("transmural lesions").

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 idiosyncrasies in the presentation. In this case, a diagnosis of indeterminate colitis may be made. Although a recognised definition, not all centres refer to this.

Signs and symptoms[]

Template:Symptoms in CD vs. UC Although very different diseases, both may present with any of the following symptoms: abdominal pain, vomiting, diarrhea, rectal bleeding, severe internal cramps/muscle spasms in the region of the pelvis, weight loss and various associated complaints or diseases like arthritis, pyoderma gangrenosum, and primary sclerosing cholangitis. Diagnosis is generally by assessment of inflammatory markers in stool followed by colonoscopy with biopsy of pathological lesions. Template:Findings in CD vs. UC

Treatment[]

Template:Treatment in CD vs. UC Optimal treatment of inflammatory bowel disease depends on what form it consists of. For example, mesalazine is more useful in ulcerative colitis than in Crohn's disease.[5] Generally, depending on the level of severity, IBD may require immunosuppression to control the symptom, such as prednisone, TNF inhibition, azathioprine (Imuran), methotrexate, or 6-mercaptopurine. More commonly, treatment of IBD requires a form of mesalazine.

Often, anti-inflammatory 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 TNF inhibitors. Severe cases may require surgery, such as bowel resection, strictureplasty or a temporary or permanent colostomy or ileostomy. Alternative medicine treatments 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.[6]

Usually the treatment is started by administering drugs with high anti-inflammatory effects, 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 mesalazine. If unsuccessful, a combination of the aforementioned immunosuppression drugs with a mesalazine (which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.

Histoplasma produces toxins that cause intestinal disease called histoplasmosis that is a “serious consideration” in an immunocompromised patient with signs and symptoms of IBD. Antifungal drugs such as nystatin (a broad spectrum gut antifungal) and either itraconazole (Sporanox) or fluconazole (Diflucan) have been suggested as a treatment for IBD disorders such as Crohn’s disease and ulcerative colitis that all share the same symptoms such as diarrhea, weight loss, fever, and abdominal pain.[7]

Prognosis[]

Template:Complications of CD vs. UC 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 perforation and surgical complications are also rare.

While patients of IBD do have an increased risk of colorectal cancer, this 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.

New evidence suggests that patients with IBD may have an elevated risk of endothelial dysfunction and coronary artery disease.[8]

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.

Research[]

The following treatment strategies are not used routinely, but appear promising in most forms of inflammatory bowel disease.

Initial reports[9] suggest that "helminthic therapy" may not only prevent but even 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[10] and in some studies have proven to be as effective as prescription drugs.[11]

In 2005 New Scientist published a joint study by Bristol University and the University of Bath 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.[12]

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.[13]

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 mopping up excess cells.[14]

References[]

  1. Baumgart DC, Carding SR (2007). Inflammatory bowel disease: cause and immunobiology.. The Lancet 369 (9573): 1627–40.
  2. Baumgart DC, Sandborn WJ (2007). Inflammatory bowel disease: clinical aspects and established and evolving therapies.. The Lancet 369 (9573): 1641–57.
  3. Xavier RJ, Podolsky DK (2007). Unravelling the pathogenesis of inflammatory bowel disease.. Nature 448 (7152): 427–34.
  4. Crohn's & Colitis Foundation of America.
  5. Pages 152-156 (Section: Inflammatory bowel disease(IBD)) in:Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series), Hagerstwon, MD: Lippincott Williams & Wilkins.
  6. A Phytotherapeutic Approach to Lower Bowel Disease Gaia Garden
  7. Holland D. The Fungal Etiology of Inflammatory Bowel Disease .
  8. Roifman I, Sun YC, Fedwick JP, Panaccione R, Buret AG, Liu H, Rostom A, Anderson TJ, Beck PL (February 2009). [linkinghub.elsevier.com/retrieve/pii/S1542-3565(08)01109-9 Evidence of endothelial dysfunction in patients with inflammatory bowel disease]. Clin. Gastroenterol. Hepatol. 7 (2): 175–82.
  9. Summers RW, Elliott DE, Qadir K, Urban JF, Thompson R, Weinstock JV (2003). Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease. Am. J. Gastroenterol. 98 (9): 2034–41.
  10. Furrie E, Macfarlane S, Kennedy A, et al. (2005). Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial. Gut 54 (2): 242–9.
  11. Kruis W, Fric P, Pokrotnieks J, et al. (2004). Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 53 (11): 1617–23.
  12. Wright K, Rooney N, Feeney M, et al. (2005). Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing. Gastroenterology 129 (2): 437–53.
  13. Wright K, Rooney N, Feeney M, et al. (2005). Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing. Gastroenterology 129 (2): 437–53.
  14. Wright K, Rooney N, Feeney M, et al. (2005). Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing. Gastroenterology 129 (2): 437–53.

External links[]


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