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Inflammatory Bowel Disease

IBD


Presentation

Symptoms for IBD can be different from one form to the other because they are dependent on what part of the intestinal tract is involved [7]. Common symptoms are abdominal pain and diarrhea. Since these symptoms and some of the other presentations of IBD are rather nonspecific, a diagnosis for either form of the condition can be delayed for months or even years.

Affected individuals can experience abnormal bowel habits, tenesmus, and passages of mucus without pus or blood. Extraintestinal manifestations include arthralgia, rash, malaisefever, and weight loss.

Pertussis
  • Pertussis cases are at their highest levels in the post-vaccine era. There is little data regarding responses to the Tdap (tetanus, diphtheria, and acellular pertussis) vaccine in IBD patients.[ncbi.nlm.nih.gov]
  • There was suboptimal vaccination coverage : hepatitis B (55%); diphteria, pertussis, tetanus (12%); hepatitis A (7%); annual influenza (6%); varicella-zoster (3%), and pneumococcal vaccine (2%).[ncbi.nlm.nih.gov]
Weight Loss
  • Relationship between IBD and obesity remains unclear, but weight loss could be useful in the pharmacological control of IBD.[ncbi.nlm.nih.gov]
  • He was then diagnosed with IBD, after presenting with weight loss, diarrhea, and malabsorption, which required resumption of PN and infliximab treatment.[ncbi.nlm.nih.gov]
  • Both patients had ulcerative colitis and presented with fever, abdominal pain, and weight loss. Radiological workup and aspiration showed sterile splenic abscesses. The AA were unresponsive to antibiotics.[ncbi.nlm.nih.gov]
  • Perianal disease was noted in 43 patients (43.9%) and weight loss in 60 (61.2%). In UC, E4 (58.4%) was the most common disease activity site, indicating pancolonic involvement as the major type.[ncbi.nlm.nih.gov]
  • It could present extra intestinal findings, such as fever, weight loss, arthralgia, mucocutaneous lesions, hepatic, renal and ophthalmological involvement.[ncbi.nlm.nih.gov]
Malnutrition
  • Depending upon the nature of the association, skin conditions associated with IBD can be listed under 4 categories: specific, reactive, secondary to malnutrition or malabsorption, and secondary to drug therapy.[ncbi.nlm.nih.gov]
  • Inflammatory bowel disease (IBD) has been historically associated with underweight and malnutrition. The impact of both underweight and obesity on the clinical course of IBD in adults is controversial.[ncbi.nlm.nih.gov]
  • What side effects of IBD can cause malnutrition? There are several reasons why people with IBD may be at risk for malnutrition. The following list includes some side effects that contribute to malnutrition.[ucsfhealth.org]
  • Vitamin B-12 and iron deficiency frequently lead to anemia in patients with malnutrition. Colon cancer.[patients.gi.org]
  • […] ulcers) in the digestive tract Gastrointestinal bleeding and anemia Intestinal infections and pus accumulation Painful anal tears (fissures) Fistulas or abnormal tunnels connecting the intestines to nearby organs such as the vagina , bladder , and skin Malnutrition[innerbody.com]
Diarrhea
  • A 2-month-old girl with a dysmorphic face presented with recurrent respiratory tract infections, vomiting, diarrhea and hepatosplenomegaly.[ncbi.nlm.nih.gov]
  • A 6-year-old boy with a history of diarrhea and rectal bleeding was referred to our department where he underwent ultrasound (US) examination for suspected inflammatory bowel disease.[ncbi.nlm.nih.gov]
  • Fluid requirements increase during or after episodes of diarrhea and with exercise. Make sure you replenish losses of electrolytes from diarrhea.[ucsfhealth.org]
  • He was then diagnosed with IBD, after presenting with weight loss, diarrhea, and malabsorption, which required resumption of PN and infliximab treatment.[ncbi.nlm.nih.gov]
  • The most common symptoms of ulcerative colitis, which occurs in the lining of the colon (large intestine) and/or rectum only, are diarrhea, rectal bleeding—often with mucous—and abdominal pain.[oregonclinic.com]
Abdominal Pain
  • We report two cases of CSVV associated with ulcerative colitis, review the literature, and discuss the diagnostic evaluation of children who present with CSVV and abdominal pain.[ncbi.nlm.nih.gov]
  • He presented with abdominal pain and diarrhoea. Colonoscopic biopsy showed crypt destructive colitis, severe decrease and focal absence of plasma cells. Three months later he suffered from abdominal pain, vomiting and bloody diarrhoea.[ncbi.nlm.nih.gov]
  • She had not developed any preceding change in her bowels and did not have abdominal pain; the IBD was diagnosed on endoscopic findings. This case is also unusual for the distribution of the PG lesions that typically occur in the lower limbs.[ncbi.nlm.nih.gov]
  • Both patients had ulcerative colitis and presented with fever, abdominal pain, and weight loss. Radiological workup and aspiration showed sterile splenic abscesses. The AA were unresponsive to antibiotics.[ncbi.nlm.nih.gov]
  • Crohn’s disease : a lifelong condition in which parts of the digestive tract are prone to sores and ulcers Ulcerative colitis : a form of chronic inflammation in the digestive tract causing abdominal pain and diarrhea Symptoms of Inflammatory Bowel Disease[houstonmethodist.org]
Abdominal Cramps
  • IBD Overview Inflammatory bowel disease can cause symptoms such as abdominal cramps, bloody diarrhea, and fever. Other symptoms of IBD can include weight loss.[webmd.com]
  • Both chronic and serious, these conditions are triggered by an abnormal immune reaction that can lead to diarrhea, abdominal cramps, rectal bleeding, fever, joint pain, loss of appetite, and fatigue, not to mention fistulas and serious complications that[health.com]
  • Common symptoms include: Rectal pain or bleeding Frequent, small bowel movements Feeling an urgent need to have a bowel movement Diarrhea Blood in the stool Abdominal cramping and pain A strong feeling that you need to have a bowel movement, but not being[familydoctor.org]
  • Signs and symptoms of IBD include abdominal cramps and pain, bloody diarrhea , severe urgent need to have a bowel movement, fever , loss of appetite, weight loss , and anemia (due to blood loss).[emedicinehealth.com]
Chronic Diarrhea
  • Both are immune disorders of the intestine that can cause: Chronic diarrhea Abdominal pain Bleeding Anemia Weight loss An accurate diagnosis is essential for optimal management and is one of the strengths of the group of specialists in the IBD center[virginiamason.org]
  • Magnesium — Increased risk with extensive inflammation and/or removal of large portions of the jejunum and ileum, fistula losses and chronic diarrhea.[ucsfhealth.org]
  • Diagnostic Accuracy of Fecal Calprotectin Assay in Distinguishing Organic Causes of Chronic Diarrhea from Irritable Bowel Syndrome: A Prospective Study in Adults and Children. Clinical Chemistry 49:6 861–867. Available online at . Accessed Sep 2012.[labtestsonline.org]
Intestinal Disease
  • Clinicians who treat IBD must manage EIMs affecting multiple organs that variably correlate with intestinal disease activity. Vedolizumab is a monoclonal antibody for the treatment of IBD with a gut-selective mechanism of action.[ncbi.nlm.nih.gov]
  • […] miR-22 is known to be involved in the pathogenesis of several autoimmune diseases, but it remains unclear whether miR-22 is associated with inflammatory intestinal disease (IBD).[ncbi.nlm.nih.gov]
  • Conditions that Mimic IBD The bowel has only a few ways in which it can respond to diseases that affect it, so it is not surprising that the symptoms of IBD can overlap with other intestinal diseases.[onhealth.com]
Dysarthria
  • He then developed quadriparesis, bilateral ptosis, dysphagia and dysarthria. Patient 2: A 41year-old woman (diagnosed with ulcerative colitis and primary sclerosing cholangitis at age 35) developed speech impairment and ptosis.[ncbi.nlm.nih.gov]

Workup

In order to diagnose IBD, other conditions like various infections, ischemic colitis, colon cancer, and diverticulitis must be first ruled out [8]. Once these other conditions are excluded, a workup for IBD can include:

  • Blood tests including complete blood count and inflammatory markers 
  • Stool analysis for enteric pathogens 
  • Imaging of the upper gastrointestinal tract including barium enema, ultrasonography and magnetic resonance enterography 
  • Colonoscopy
  • Flexible sigmoidoscopy
  • Capsule endoscopy

Treatment

Usually, IBD can be treated with medication, surgery, or a combination of both when necessary [9]. Any specific treatment is based on whether the patient is suffering from ulcerative colitis or Crohn disease.

The major goals of any of the treatment methods are achieve remission and to prevent flares. These therapies can include symptomatic care that will help alleviate the cramps and other systemic symptoms related to the condition, as well as mucosal healing. These treatment methods are usually followed by individualized escalated steps in order to get a positive response.

Prognosis

In terms of mortality, the rate related to IBD falls between 1.4 to 5 times within the general international population according to research [6]. Between the two forms of IBD, Crohn disease is more commonly linked to mortality as people with ulcerative colitis vary only slightly from the general population.

Etiology

There are a number of factors that lead to IBD including a genetic predisposition to the condition. Other factors include altered responses to microorganisms found in the gut and a dysregulation of the immune system [2]. As of yet, there is no determinable primary cause for IBD, but researchers continue to propose theories as studies continue. According to research, the cause for the altered immune response that leads to IBD is considered to be unidentifiable [3]. Several risk factors including diet, smoking, physical activity, other disorders and medications have been proposed to contribute to the development of an inflammatory bowel disease.

Epidemiology

The instances of IBD seem to be dependent on location as the highest rates of IBD seem to be found in developed countries while developing regions show the lowest rates of recorded cases of the disorder. Similarly, the rates of IBD also seem to correlate to the climate of an area with warmer climates reporting a lower rate of IBD when compared with colder climates. Urban areas report a higher rate of IBD when paralleled with rural areas, too.

Statistically speaking, the incidence of ulcerative colitis falls between 0.5 and 24.5 cases out of 100,000 per year internationally. Crohn disease occurs between 0.1 to 16 in 100,000 cases. Annually, there are around 396 cases of general IBD reported on average.

Sex distribution
Age distribution

Pathophysiology

Crohn disease can involve any part of the gastrointestinal tract from the mouth to the perianal area. Affected segments usually are separated by normal bowel, leading to the occurrence of skip lesions. The inflammation is transmural, often extending through to the serosa, resulting in fibrosis and strictures, sinus tracts and fistula formation.

Ulcerative colitis is considered to be the inflammation of the mucosal layer of the colon with continuous involvement. The rectum is affected in the majority of cases. The inflammation leads to edema, fluid and electrolyte loss, bleeding, formation of crypt abscesses and ulceration [5].

Prevention

There are dietary changes that a patient may implement in order to reduce symptoms and stave off inflammation and recurring flare ups of IBD, however ways to prevent the disorder from ever occurring in the first place are unknown [10]. 

Summary

Inflammatory bowel disease, abbreviated IBD, is a group of inflammatory conditions with two major types, ulcerative colitis and Crohn disease [1]. After a proper workup it is usually possible to determine which form of IBD is present in a patient, if not, the condition is referred to as indeterminate colitis. Other types of colitis include microscopic colitis, lymphocytic colitis, and collagenous colitis but they are usually not considered to fall under the umbrella of IBD.

Both Crohn disease and ulcerative colitis affect the gastrointestinal tract. Ulcerative colitis affects the colon while Crohn disease is a condition that may develop in the whole digestive system, characterized by skip lesions.

Patient Information

Inflammatory bowel disease (IBD) is a chronic inflammation disorder that affects different parts of the digestive tract. Under the general diagnosis of IBD are two disorders, ulcerative colitis and Crohn disease. The former condition affects the large intestine and rectum while the latter affects the entire digestive system.

Both disorders can create pain and discomfort along with abnormal bowel habits. They can also lead to other health complications that, if left untreated, can be life threatening. 

The symptoms associated with IBD can be medically treated but there are times where surgery might be necessary to address larger problems in more severe cases. In most cases, lifestyle changes related to a person’s daily diet will be recommended to prevent flare ups of IBD. There are no known ways to prevent IBD from occurring in the first place.

References

Article

  1. Agrawal D, Rukkannagari S, Kethu S. Pathogenesis and clinical approach to extraintestinal manifestations of inflammatory bowel disease. Minerva Gastroenterol Dietol. Sep 2007;53(3):233-48.
  2. World Gastroenterology Organisation (WGO). World Gastroenterology Organisation Global Guideline. Inflammatory bowel disease: a global perspective. Munich, Germany: World Gastroenterology Organisation (WGO); 2009.
  3. American Gastroenterological Association medical position statement: perianal Crohn's disease. Gastroenterology. Nov 2003;125(5):1503-7. 
  4. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. Mar 2010;105(3):501-23; quiz 524. 
  5. Kiran RP, Nisar PJ, Church JM, Fazio VW. The role of primary surgical procedure in maintaining intestinal continuity for patients with Crohn's colitis. Ann Surg. Jun 2011;253(6):1130-5. 
  6. Farmer RG, Hawk WA, Turnbull RB Jr. Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology 1975; 68:627.
  7. Pimentel M, Chang M, Chow EJ, et al. Identification of a prodromal period in Crohn's disease but not ulcerative colitis. Am J Gastroenterol 2000; 95:3458.
  8. Burgmann T, Clara I, Graff L, et al. The Manitoba Inflammatory Bowel Disease Cohort Study: prolonged symptoms before diagnosis--how much is irritable bowel syndrome? Clin Gastroenterol Hepatol 2006; 4:614.
  9. Mekhjian HS, Switz DM, Melnyk CS, et al. Clinical features and natural history of Crohn's disease. Gastroenterology 1979; 77:898.
  10. Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 2002; 122:875.

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Last updated: 2018-06-21 21:04