Inflammatory Bowel Disease (IBD) is a condition where the bowel becomes red and inflamed. There a re two main types of IBD: Crohn's disease and ulcerative colitis . Although they have many similarities they are distinctly different diseases and both can have flare-ups (relapses) and periods of well-being (remissions). Both usually affect people aged 20-40 years but can sometimes occur in children and the elderly.
Ulcerative Colitis is inflammation of the outer lining of the colon (large bowel) only, hence the term colitis.
Crohn's disease, named after the gastroenterologist Burrill Bernard Crohn, can affect any part of the gut from the mouth to the anus, but most commonly affects the colon or ileum (small bowel) and can involve the full thickness of the bowel wall.
Both types of inflammatory bowel disease may have similar symptoms depending on the site and severity of the inflammation.
During periods of remission people with ulcerative colitis feel well most of the time. However, during a flare-up the following symptoms can occur:
More rarely there may be:
This disease also has periods of remission and flare-ups but the pattern of the disease can be more varied as Chron's disease can affect any part of the bowel. During a relapse the main symptoms are:
In addition to those listed above, both types of IBD can be associated with symptoms that manifest outside of the gut. These are far less common and can affect the following:
The principles of both types of IBD are similar but there are important differences.
Drugs for Ulcerative Colitis
Biologics i.e infliximab are antibodies grown in the laboratory that inhibits certain proteins in the body from causing Inflammation. Biologics therapies offer a distinct advantage in the IBD treatment because their mechanisms of action are more precisely targeted to the factors responsible for IBD. Biologics known as anti tumor necrosis factor ( anti TNF) agents bind and block a small protein called necrosis factor (TNF alpha) that promotes inflammation in the intestine as well as other organs and tissues.
Drugs for Chron's Disease
Steroids are used as for ulcerative colitis
5-ASA drugs can be used as for ulcerative colitis
Antibiotics, such as metronidazole, may be used for acute attacks, particularly if the disease involves the anus and rectum.
Azathiprine is being increasingly used to try to avoid the use of steroids and to prevent disease flare-ups. These drugs have particular side effects such as allergic reaction and a predisposition to infection and require careful supervision by your doctor.
Biologics i.e infliximab/ humira can be used as for ulcerative colitis
It is very important to take the medications as prescribed, even if you are feeling well, if this is what your doctor suggests as this will help keep the diseases in remission and prevent flare-ups.
Although some patients may never need an operation surgical treatment may be used for the following reasons:
Surgery for Ulcerative Colitis
This usually involves the removal of the colon and sometimes also the rectum. This necessitates the formation of an ileostomy which may be permanent or temporary. In some cases a special pouch can be formed from the remaining small bowel to function as an artificial rectum. The normal sphincter mechanism is left intact to ensure normal continence. Please see your local Stoma Care and/or colorectal nurse specialist for further information on this type of surgery.
It should be remembered that even though surgery is only performed if absolutely necessary, removal of the colon is a cure for ulcerative colitis and people often experience a greatly improved quality of life after surgery.
Surgery for Crohn's Disease
People with Crohn's disease are more likely to require surgery to:
A key component in the treatment of IBD is a healthy diet. A balanced diet from all food groups is recommended to ensure and adequate supply of carbohydrates, proteins and fats. This includes grains, dairy, fruit and vegetables, meat and alternatives. A balanced diet gives the body the nutrients needed for growth, to repair damage and fight illness.
Most people with IBD know which foods they can tolerate and in general it is spicy, fatty and raw foods more difficult to digest. Some people often feel ‘full' so eating smaller, more frequent meals can improve low energy levels and supply needed nutrients. If the disease is severe it may be necessary to take nutritional supplements to help prevent weight loss, to restore the balance of nutrients, to allow the bowel to rest and to possibly relieve pain.
Further advice is available from your colorectal nurse specialist or dietician.