Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD)

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IBD can be accompanied by other conditions like gallstones, arthritis, and osteoporosis.

Inflammatory bowel diseases (IBD) are chronic inflammatory diseases of all or part of the digestive tract. IBD's primarily include Crohn's disease and ulcerative colitis, though indeterminate colitis and microscopic colitis are often also included in this category. By contrast, irritable bowel syndrome (IBS) is not in the same category, since it is not associated with inflammation of the intestine. IBD are diseases affecting, in most cases, young people in the prime of their social, professional, and emotional life.

These diseases can be painful and debilitating, and sometimes lead to life-threatening complications. Their diagnosis is sometimes difficult and might require special expertise and techniques. In addition to the gastrointestinal tract, IBD might affect several organs and body parts such as the joints, liver, the skin and eyes, causing complications which might require special care.

For these reasons, IBD are best managed by gastroenterologists and other specialists with specific experience and expertise in the field. At Carilion Clinic, a team of accomplished gastroenterologists, surgeons, pathologists, radiologists, and other specialists provides the best multidisciplinary care for diagnosis and therapy of these conditions. The specialists in our IBD Center also have a strong academic track record and actively pursue clinical and basic research in IBD, thus allowing patients access to a variety of novel treatment options.

CAUSES AND DEVELOPMENT OF DISEASE

Although known for a long time (the first account being documented in 300 A.D.), the precise cause of Crohn's disease and ulcerative colitis is still unknown (this often referred to as "idiopathic"). As in most idiopathic diseases, genetic and environmental factors seem to be involved.

Even though we do know IBD tend to be much more frequent in the same family, specific genetic abnormalities have been identified so far only in a minority of patients. Testing for these genetic abnormalities is not currently recommended because it is not guaranteed to predict IBD.

Video: Dario Sorrentino, M.D. talks about treatment options for IBD.

As for the environmental factors, cigarette smoking seems very important—being very harmful in Crohn's disease, while appearing surprisingly protective in ulcerative colitis. The protracted use of non-steroidal anti-inflammatory drugs and the intestinal bacteria also seem important in triggering the disease, though their precise role is still unclear. It should be noted that IBD, especially ulcerative colitis, are often diagnosed shortly after major psychological traumas (death of a family member, abandonment, etc.), however, the role played by these events in causing the disease is not yet known.

These and probably many other factors might act upon a congenitally aggressive immune system and cause inflammation. Such inflammation does not appear to revert back to normal over time as it does in persons who do not develop IBD.

It appears that the activation of the immune system (like an army) fights the enemy (the environmental factor) as usual. By contrast with healthy individuals, however, in IBD the mobilization of the army does not stop even when the enemy has been eliminated thus continuing to cause needless destruction (chronic inflammation).

FEATURES OF IBD

IBD are accompanied in about 20% of cases by extra intestinal (or systemic) manifestations. Some might result from a change in metabolic processes (e.g. gallstones and kidney stones), others may be caused by the same immune defect(s) that are at the basis of these diseases (e.g. arthritis). Some also might be caused by medications used to treat IBD over a long period of time, such as steroids (e.g. osteoporosis). Still the causes of others are unknown (e g. sclerosing cholangitis—a serious illness of the biliary system that develops strictures).

From a clinical point of view the most frequent manifestations are those involving the joints and bones, in particular arthritis in large joints (such as knees, elbows, or wrists), ankylosing spondylitis (which causes morning stiffness in the lower back due to a progressive fusion of the vertebrae of the column) and osteoporosis. Also relatively common is the erythema nodosum (a reddish patch a few inches in diameter with an itchy lump in the middle especially affecting the skin of the lower limbs), as well as various eye diseases. These diseases could precede the onset of IBD by many years or appear after the diagnosis of IBD is made.

The management of these conditions varies. In some cases, they are controlled by the same medical therapy used to treat IBD, in other cases they might disappear after surgery for IBD, and still in other cases, being unrelated to the underlying disease, they might evolve independently.

INDETERMINATE COLITIS

Indeterminate colitis is a term used to indicate IBD limited to the colon (i.e. which does not affect the small intestine) which falls outside the diagnostic tissue criteria of Crohn’s disease or ulcerative colitis (10% of all cases of IBD seem to belong in this category). Many physicians and researchers propose that this diagnosis can only be made after having excluded with certainty Crohn’s disease and ulcerative colitis. In about half of these cases the diagnosis of Crohn’s disease or ulcerative colitis will become apparent in time. Some blood tests and specific antibodies (called ANCA and ASCA) are helpful in distinguishing Crohn’s disease from ulcerative colitis. Therefore, the term “indeterminate colitis” should be used to indicate a temporary diagnosis. In approximately half of the cases of indeterminate colitis, however, a diagnosis of Crohn’s disease or ulcerative colitis cannot currently be made. Therefore, many think that these patients have a specific disease, different from Crohn’s disease and ulcerative colitis.

These patients tend to have a more severe course and a greater risk of colectomy and developing cancer compared with patients with Crohn’s disease and ulcerative colitis. Extraintestinal manifestations have the same frequency in these patients and treatment tends to be similar to that used in ulcerative colitis of similar severity.

Patient Resources

Carilion Clinic is committed to providing support and resources for patients with IBD. Visit our Patient Resources section for a list of organizations for more information.