Inflammatory Bowel Disease

About Inflammatory Bowel Disease

Inflammatory bowel disease (which is not the same thing as irritable bowel syndrome, or IBS) refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis and Crohn's disease. Although the diseases have some features in common, there are some important differences.

Ulcerative colitis is an inflammatory disease of the large intestine, or colon. In ulcerative colitis, the inner lining (mucosa) of the intestine becomes inflamed (red and swollen) and develops ulcers (open, painful wounds). Ulcerative colitis is often the most severe in the rectal area, which can cause frequent diarrhea. Mucus and blood often appear in the stool (feces or poop) if the lining of the colon is damaged

Crohn's disease differs from ulcerative colitis in the areas of the bowel it involves — it most commonly affects the last part of the small intestine (called the terminal ileum) and parts of the large intestine. However, it isn't limited to these areas and can attack any part of the digestive tract. Crohn's disease causes inflammation that extends much deeper into the layers of the intestinal wall and generally tends to involve the entire bowel wall, whereas ulcerative colitis affects only the lining of the bowel.

Causes of IBD

Research isn't conclusive on the causes inflammatory bowel disease, but experts believe that many factors might be involved, including the environment, diet, and genetics.

Current evidence suggests that in people with IBD, a genetic defect affects how the immune system works and how inflammation is triggered in response to an offending agent, like bacteria, a virus, or a protein in food. The evidence also indicates that smoking can enhance the likelihood of developing Crohn's disease.

Signs and Symptoms

The most common symptoms of both ulcerative colitis and Crohn's disease are diarrhea and abdominal pain. Diarrhea can range from mild to severe (as many as 20 or more trips to the bathroom a day). If the diarrhea is extreme, it can lead to dehydration, rapid heartbeat, and a drop in blood pressure. And continued loss of small amounts of blood in the stool can lead to anemia.

At times, those with IBD may also be constipated. With Crohn's disease, this can happen as a result of a partial obstruction (called stricture) in the intestines. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum (known as proctitis).

The loss of fluid and nutrients from diarrhea and chronic inflammation of the bowel can also cause fever, fatigue, weight loss, and malnutrition. Pain is usually from the abdominal cramping, which is caused by irritation of the nerves and muscles that control intestinal contractions.

And IBD can cause other health problems that occur outside the digestive system. Although experts don't understand why, some people with IBD can show signs of inflammation elsewhere in the body, including the joints, eyes, skin, and liver. Skin tags that look like hemorrhoids or abscesses may also develop around the anus.

Inflammatory bowel disease also might delay puberty or cause growth problems for some kids and teens because it can interfere with them getting nutrients from food.

Diagnosing IBD

Inflammatory bowel disease can be hard to diagnose because there may be no symptoms, even if the bowel has been damaged over many years. And IBD symptoms often resemble those of other conditions, which may make it difficult for doctors to diagnose.

If your child begins to lose weight quickly, has repeated bouts of diarrhea, or complains of abdominal cramping, IBD may be the cause. Call your doctor if you notice any of these symptoms to ensure that your child gets proper evaluation and treatment.

If IBD is suspected, the doctor might order blood tests to look for signs of the inflammation that often accompanies IBD, and to check for anemia and for other causes of symptoms, like infection. A stool test might also be done to check for the presence of blood.

The doctor might do a colonoscopy, using an endoscope (or colonoscope), a long, thin tube inserted through the anus and attached to a TV monitor, which will let the doctor see inflammation, bleeding, or ulcers on the wall of the colon.

The doctor also might order an upper endoscopy to check the esophagus, stomach, and upper small intestine for inflammation, bleeding, or ulcers. During either of these exams, the doctor might do a biopsy, taking a small sample of tissue from the intestinal tract lining to be viewed under a microscope or sent to a laboratory for testing.

The doctor also might order a barium study of the intestines. Your child will drink a thick white solution (barium), which shows up white on an X-ray film. This lets the doctor see parts of the intestines not reachable by an endoscope. Another way to view the intestines is via an MRI (magnetic resonance imaging), a special radiology test that involves no radiation.

Treating IBD

Drug treatment is the main method for relieving the symptoms of both ulcerative colitis and Crohn's disease. Great progress is being made in the development of medications for treating inflammatory bowel disease. The doctor may prescribe:

• anti-inflammatory drugs to decrease the inflammation
• immunosuppressive agents to prevent the immune system from attacking the body's own tissues and causing further inflammation

If symptoms don't respond to either of these medicines, the doctor might suggest surgery. But surgical procedures for ulcerative colitis and Crohn's disease are quite different.

With Crohn's disease, doctors make every attempt to avoid surgery because of the recurring nature of the disease. There's also a concern that an aggressive surgical approach will cause further complications, such as short bowel syndrome (which involves growth failure and a reduced ability to absorb nutrients).

In cases of ulcerative colitis, removal of the colon (large intestine) may be necessary, along with an ileoanal anastomosis (or ileoanal pull-through), a procedure in which the surgeon forms a pouch from the small bowel to collect stool in the pelvis. This allows the stool to pass through the anus.

To treat mild Crohn's disease, doctors might use an elemental formula (a formula with very simple and small proteins) for nutrition along with restriction of other foods. This can help prevent a child's exposure to food proteins that could potentially irritate and inflame the intestinal lining.

Caring for a Child With IBD

How can you help your child cope with inflammatory bowel disease? Because of the unpredictable nature of the disease, it's easy to feel helpless. Your child will likely be fatigued, irritable, and worried, so the best course is to seek treatment as soon as symptoms appear to help relieve as much discomfort as possible.

Although it can be difficult to get any child to eat properly, a balanced diet with adequate calories becomes even more important for kids with IBD. Diarrhea, loss of nutrients, and the side effects of drug treatment all can lead to malnutrition.

Encourage your child to eat small meals throughout the day to help manage symptoms. Pack nutritious snacks and lunches so your child won't be tempted to indulge in salty, high-fat junk food that can intensify IBD symptoms.

Talk with your doctor or a dietitian about other foods that might be a problem. Eventually, your child should learn to determine which foods provoke symptoms and work to avoid them.

Inflammatory bowel disease is a serious condition, but with proper treatment and medical care, your child can enjoy a productive, normal life.

Reviewed by: J. Fernando del Rosario, MD
Date reviewed: May 2010