Inflammatory bowel disease (IBD) is a group of inflammatory disorders affecting the small and/or large intestine (colon). The two most common forms are Crohn’s disease (CD) and ulcerative colitis (UC). While UC is limited to the large intestine, CD can involve the entire gastrointestinal tract, anywhere from the mouth to the anus.
While the precise cause of CD is unknown, the present thinking is that it develops due to an overly strong and inappropriate attack by the immune system against intestinal bacteria. Trillions of bacteria normally live in the lining of our large intestines, and actually carry out
important functions. Something happens along the way (a “trigger”) which causes the immune system to turn against normal, healthy bacteria and start killing them off. The intestinal lining cells that the bacteria live in become “collateral damage,” leading to inflammation, erosions, and ulcers.
For many years, doctors observed that CD tended to occur more within families and certain ethnicities (in particular Ashkenazi Jews), suggesting a genetic predisposition. We now know through DNA analysis that certain genetic mutations may lead to CD. Interestingly, some of these inherited genetic errors influence the way the immune system handles intestinal bacteria.
Experts believe that you can’t get CD without a certain genetic make-up and a “trigger.” These triggers probably include infections, antibiotics, and other uncertain environmental factors. Rates of CD are on the rise, likely in part due to improved recognition and diagnosis. Some feel that being “too clean” in childhood may stunt the immune system and contribute to the development of CD later in life (“the hygiene hypothesis”).
Crohn’s disease usually presents with diarrhea and abdominal pain, though patients can complain primarily of constipation, nausea, and vomiting (due to bowel obstruction). Other common symptoms include fatigue, fever, and weight loss. CD can also affect parts of the body beyond the small and large intestine (extra-intestinal manifestations). This can lead to joint pain, rash, eye pain and redness, oral ulcers, and even hepatitis (inflammation of the liver and biliary system).
There is no single test for CD. Doctors use a combination of patient history, physical exam, radiology studies (eg. Barium x-rays, CT), and endoscopy (eg. Colonoscopy) to come to a diagnosis. Other potentially useful tests include capsule or “pill endoscopy” (a pill with a camera within it which is swallowed and travels through the intestines) and a blood test comprised of various antibodies commonly elevated in CD.
There has never been a better time to have CD. With earlier diagnosis and potent medications aimed at reducing intestinal inflammation, more and more people are living happy and productive lives, without the need for frequent hospitalization or surgery. Drug therapy can range from rather mild oral medication taken once daily to powerful injectables (in the vein, skin, or muscle) administered as little as once monthly. The major goal of therapy is to heal the intestinal lining, while minimizing (preferably avoiding) the use of corticosteroids (eg. Prednisone) and preventing surgery.
Patients with CD can contribute to their well-being by staying away from cigarette smoking and non-steroidal anti-inflammatory drugs (eg. Ibuprofen). A healthy lifestyle including stress-reduction, regular exercise, and a well-balanced diet can do wonders to keep CD in remission.
By: Darren Schwartz, M.D. Gastroenterologist in Gig Harbor and Tacoma, Washington at Digestive Health Specialists.
For information on the local Crohn’s and Colitis Foundation of American chapter, visit: http://www.ccfa.org/chapters/northwest/