INTRODUCTION-
It is a blanket term used for different types of chronic inflammatory disorders of GIT (Gastro intestinal tract) which can be debilitating and can leads to life threatening complications. Researchers in current scenario believed that loss of tolerance against the indigenous enteric flora is the central point of IBD pathogenesis as a whole.
Various types of IBD are as follows-
1)ULCERATIVE COLITIS– In this condition it involves ulcers all along the superficial lining of large intestine (colon) and rectum( rarely involves small intestine).
2)CROHN’S DISEASE- In this condition it is characterized by inflammation of digestive tract (any part from mouth to anus ) which can even involve deeper lining of the tract. It affects whole part of the small intestine and upper part of the large intestine in general.
3)MICROSCOPIC COLITIS– causes intestinal inflammation that’s only detectable with a microscope.
We must differentiate IBD from Irritable bowel syndrome(functional gastrointestinal disease) as it is a group of symptoms while former is a disease as causes and treatments vary from each other. IBS is also termed as ‘spastic colon or nervous stomach’ where it affects the bowel rhythm of contraction (more than often or sometimes less than normal), it is not detectable by lab findings or scans as it does not cause any inflammatory changes in the colon and it also do not need of hospitalization in patients. But we must keep in mind that any individual can suffer from IBD and IBS at the same time, also IBD causes symptoms of IBS too in patients while there is no relationship of IBS leading to IBD which need a very careful clinical observation to distinguish them from each other for proper management.
ETIOLOGY-
Causation is idiopathic in nature but still it is believed to be an immune-mediated which causes persistent inflammation of the colon in long run. Many factors play their role in IBD and their aggravation is as follows-
1)GENETICS – Heredity also plays an important role in chances to have IBD in lifetime, as it is more common to those with family history of IBD than those who are not having any such history, but it is also seen in those persons who are not having any such family history as it is also dependent on several other factors.
2) IMMUNE RESPONSE – It is believed by researchers that immune mediated faulty response is responsible for symptoms of IBD as antibodies attacks the GIT cells as in case of any auto-immune response system where antibodies attack their own cells instead of foreign body.
3)ENVIRONMENTAL TRIGGERS- It refers to individual habits and surrounding factors, which acts as triggering factor for IBD symptoms. People with familial history are more prone to develop symptoms under these triggers. It broadly comprises of stress, strain, smoking and drinking habits, long term medication, mental and emotional issues like depression, etc.
RISK FACTORS-
1)AGE/RACE– Before the age of 30 most of the cases are diagnosed, sometimes symptoms appear around age of 50’s or 60’s too in some individuals. So, it is rather common among young adults than old age adults. It can happen to any race although it is more common among white race.
2)FAMILY HISTORY- IBD can happen to anyone but an individual is at higher risk if they have a family history of IBD than others.
3)HABITS- Smoking is most important controllable habit which helps in prevention of IBD especially Crohn’s disease. Quitting smoking is also beneficial for overall gut health.
4)MEDICATIONS- NSAID (pain killers like ibuprofen, etc.) long term or unadvised use can lead to IBD and also worsen the case if already suffering from it.
SYMPTOMS-
It varies according to degree of inflammation (mild to severe) as well as location of colon. Symptom have tendency of remission followed by active spell of illness known as IBD flares.
Sign and symptoms which are present in both the type of IBD are as follows-
1)Most of the cases presents complain of diarrhoea, also bowel urgency is present (need to defecate urgently). Also, diarrhoea alternates with constipation is observed in many cases. Bloating and gas issues are present. Mainly characterized by upset stomach all the time.
2) Weight loss is present which is unintended without any effort weight remains unstable. Unidentified reason for loss of appetite.
3) Constant fatigue and loss of energy even after slight work is found in some cases.
4) Pain and cramps in abdomen is present during IBD flare.
5) Hematochezia (bloody stool) and mucus is also present.
6) Few rare symptoms which are found in IBD patients are- fever, eye issues (itching or pain), painful joints, skin rashes or ulcers, etc. Some suffers from nausea and vomiting too along with upset stomach.
DIAGNOSIS-
Symptoms are almost same in both types of IBD, so on clinical examination or by any single test is unable to diagnose the type of IBD. So a complete case taking of present complaints along with past and family history is taken by the physician which then followed by following tests, they are as follows-
1)CBC (Complete blood count)
2)Stool examination.
These two tests are done to diagnose the signs of intestinal inflammation.
Other examination which are used as definitive diagnostic tool in medical practice are as follows-
1)EUS (endoscopic ultrasound)- to examine the GIT swelling and ulcers in the whole tract.
2)Colonoscopy-to view both large and small intestine as a whole.
3)CT or MRI (Scanning) are done routinely to check and also over rule the chances of other disease conditions and also to check the overall health of gut, to look for signs of inflammation or abscess if present.
4)Flexible sigmoidoscopy (rectum and anus) is done to determine the chances of ulcerative colitis in IBD patient.
5)For more detailed picture of the intestine and to know exact location of inflammation, it is achieved by capsule endoscopy (camera captures the internal images of gut lining throughout the GIT)
MANAGEMENT-
Line of treatment is divided into surgical and non-surgical both, it depends on stage and type of IBD-
1)NON-SURGICAL (CONSERVATIVE MODE)-
Main aim is to limit the inflammation to prevent IBD flare, it includes combination of anti-inflammatory medications with antibiotics (if superadded infections are also present). Administration of biologics to supress immune mediated reaction to prevent flares, also immunomodulators are prescribed for the same function.
For acute symptoms, patients take medications for pain, bowel issues and supplements (vitamins, probiotics, etc. ) as per condition under physician supervision.
2)SURGICAL –
In IBD it depends on the stage and condition of the patient,
In Crohn’s disease and ulcerative colitis, in both they need surgical intervention when conservative line of treatment provides no relief during symptom flare.
Symptoms may return after few years of surgery, in case of Crohn’s disease it relapses after a time period of 10 years on an average. Surgical procedure proctocolectomy ( removal of colon and rectum) is curative in case of ulcerative colitis but problem may arise with ileal pouch which needs further management.
COMPLICATIONS-
Common complications to both types of IBD are-
1)Increased risk of colon cancer. So, screening is must after 5 years of diagnosis under physician guidance.
2)In the IBD Flare period some patients also suffer from other system inflammation at the same time, mainly eyes, joint, as well as skin conditions.
3)Long term medication side effects are also present, it includes-
a) Risk of certain cancers in some medicines are present.
b) Osteoporosis, blood pressure issues (High B.P.), etc.
c)Liver issues like primary sclerosing cholangitis, ultimately leading to liver damage.
4) Vascular issues, clots in arteries and veins which leads to other complications in long run.
OTHER THAN THESE COMMON COMPLICATIONS, COMPLICATIONS WHICH ARE PARTICULAR TO UC AND CHRON’S DISEASE IS AS FOLLOWS-
1)ULCERATIVE COLITIS-
a) Toxic megacolon, also it can lead to perforated colon, sometimes it can occur separately too.
b) Diarrhoea can lead to dehydration (mild to severe), so it is very important to remain hydrated by taking water in regular short intervals during the flare phase of UC.
2)CROHN’S DISEASE-
a) Most grave complication is bowel obstruction, which needs surgical intervention.
b) Defective nutrition which leads to anaemia due to low iron or vitamin B12 due to faulty absorption function of intestine in long run. Individual become weak and show the symptoms of anaemia along with IBD.
c) Formation of fissures and fistulas (near or around anal area/perianal region).
PREVENTIVE MEASURES-
In case of IBD we cannot prevent its occurrence but we can prevent its flare up stages by adopting several measures in terms of life style changes, they are as follows-
1)Diet modifications- Most important is to identify foods those acts as trigger for symptoms, it varies from patient to patient (ex- lactose intolerance, peanut allergy in some). When identified those food items should be restricted from diet. Also, meals should be regulated in small portions and at interval of 2-4 hours as per physician. During flare diet should be modified into soft and bland food which are less irritant to gut. Daily consumption of coffee, tea, soft carbonated drinks should be in limit as well as alcohol consumption is to be controlled along with smoking. Increase intake of water to avoid dehydration.
2)Stress and anxiety management- It can be done individually or by taking help of counsellor, it includes mainly taking care of mental as well as emotional well-being. Few ways are to engage in meditation, yoga, learning new things, taking out time for hobbies in day to day life, etc.
3)Maintain a proper sleep- wake cycle in daily life.
4)Remain physically active (include outdoor activity in daily routine)..
IT IS WELL OBSERVED IN ANY CASE OF IBD THAT IT CAN NOT BE PREVENTED FROM ITS OCCURRENCE BUT ITS FLARE OF SYMPTOMS CAN BE MANAGED WELL THROUGHOUT LIFE BY FOLLOWING PROPER MEASURES UNDER PHYSICIAN GUIDANCE TO PREVENT ITS COMPLICATIONS.
HAPPY LEARNING
Contributor- Dr. Apurva Varangi