{"id":2971,"date":"2018-12-23T15:33:17","date_gmt":"2018-12-23T15:33:17","guid":{"rendered":"https:\/\/www.mybiosource.com\/learn\/?p=2971"},"modified":"2023-03-11T14:04:57","modified_gmt":"2023-03-11T14:04:57","slug":"inflammatory-bowel-disease-an-intestinal-manifestation","status":"publish","type":"post","link":"https:\/\/www.mybiosource.com\/learn\/inflammatory-bowel-disease-an-intestinal-manifestation\/","title":{"rendered":"Inflammatory Bowel Disease \u2013 An intestinal manifestation"},"content":{"rendered":"\n\n\n
\n

Table of Contents<\/u><\/strong><\/h3>\n

1. Introduction<\/strong><\/a>
\n\u2022 Explanation of IBD, its subtypes – Crohn\u2019s disease (CD) and ulcerative colitis (UC)
\n2. Pediatric Inflammatory Bowel Disease<\/strong><\/a>
\n\u2022 CD is predominant in the pediatric population
\n3. Symptoms of IBD: <\/strong><\/a>
\n4. Differences Between Crohn\u2019s Disease and Ulcerative Colitis<\/strong><\/a>
\n5. Types of Crohn\u2019s Disease<\/strong><\/a>
\n6. Other Types of Colitis<\/strong><\/a>
\n7. IBD Treatment<\/strong><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Crohn\u2019s disease (CD) and ulcerative colitis<\/span> (UC) represent two broadest subtypes of Inflammatory bowel disease (IBD), which encompasses a spectrum of diseases. CD is inflammation of any part of the gastrointestinal<\/span> tract which causes patchy areas of inflammation in different sections. While UC typically involves some or all of the large intestine and causes continuous inflammation in one area. 1.<\/strong> They are a type of chronic and relapsing intestinal inflammation with some extraintestinal complications. Recently, rising incidence of IBD has been observed internationally 2<\/strong>. CD generally affects young adults in the third decade of life.<\/p>\n

However, pediatric<\/span> inflammatory bowel disease is often more extensive and severe than adult cases and a quarter all IBD cases are diagnosed in children <18 years 4.<\/strong> \u00a0Also, it is reported that patients with childhood-onset CD exhibit a more active disease and require more immunosuppressive therapy<\/span>. Overall, CD is the predominant IBD subtype comprising 59\u201373% of pediatric<\/span> IBD, while UC comprises 24\u201332% of pediatric<\/span> IBD 5,6<\/strong>. Colorectal<\/span> cancer (CRC) is the most frequent malignant complication in patients with IBD.<\/p>\n

The common symptom reported by the patients are abdominal pain and diarrhea. In UC cases mostly rectal bleeding<\/span> has also been observed (83\u201395%) compared to CD (40%). In patients with CD often weight loss and perianal disease have been observed. For the diagnosis of IBD physical examination is very fundamental. General assessment may show some evidence of growth failure or pubertal delay as well as pallor suggestive of anemia<\/span>. Additionally, a careful perianal examination is also performed to examine for the perianal<\/span> disease. Further investigation is done for occult or gross blood in the stool. IBD patients might also experience extraintestinal manifestations like joint disease and mucocutaneous disease. Thus, clinicians also search for tender swollen joints, apthous stomatitis, and erythema nodosum<\/span> (tender red nodules typically on the extensor surface of lower extremities).<\/p>\n

The inflammation caused by Crohn\u2019s disease goes deeper into the intestinal wall. In Crohn\u2019s disease patients, approximately 60% have some\u00a0colon inflammation along with inflammation elsewhere in the digestive tract, while for the other half the disease is limited to the colon. In spite of differences between Crohn\u2019s disease and ulcerative colitis, at times it can be difficult to differentiate between the two. Also often the\u00a0treatment options\u00a0are different depending on the diagnosis. Few other complications from Crohn\u2019s colitis are – abscesses (pockets of pus that forms in the colon) or fistulas (abnormal connections formed between the colon and other organs) and the narrowing of the colon. Patients with Crohn\u2019s disease of the colon are also at a higher risk of developing colorectal cancer. Chron\u2019s disease is characterized into five types based on which parts of the digestive tract are affected. The location of inflammation affects what symptoms you have and what type of treatment is needed. (Table 1)<\/p>\n

\u00a0\"\"<\/sup><\/p>\n

Of the above five form of Chron\u2019s disease, Ileocolitis<\/span> is the most common form. It affects about 40% of people with Crohn\u2019s disease. It is estimated that about 50 to 200 people are living with Crohn\u2019s disease per 100,000 people.\u00a0UC\u00a0also has a few types depending on the affected area. Rectum inflammation is called ulcerative proctitis and entire large intestine inflammation is pancolitis. \u00a0According to an estimate, there are 120 to 200 people living with UC\/100,000 people whereas about 8 to 14 UC cases are diagnosed per 100,000 people each year.<\/p>\n

Sometimes, when it is difficult to differentiate between Crohn\u2019s disease and ulcerative colitis \u00a0\u201cindeterminate colitis\u201d term is used.\u00a0When the inflammation is in the large intestine and can be seen only under a microscope Microscopic colitis<\/span>\u00a0term is used.\u00a0There are 2 forms of microscopic colitis collagenous colitis<\/span> and lymphocytic colitis<\/span>. <\/p>\n

Microscopic colitis is most common in older adults. and often overlaps with other autoimmune<\/span> diseases. An inflammation in the part of the large intestine that is left after surgery to redirect waste (feces) out of the body is called as Diversion colitis<\/span>. Normally, waste travels through the large intestine to the rectum. and eliminated through the anus. However, if there are problems with the intestine, waste can be eliminated through an ostomy, or surgical opening in the skin. It develops in the part of the intestine that is no longer in use. It may develop because of the bacteria in that part living on the undigested starches and fiber in normal waste. Most people who have fecal diversion surgery develop diversion colitis, but less than half of people have symptoms. Further inflammation of the blood vessels can also occur and it is termed as Beh\u00e7et\u2019s disease, a rare autoimmune<\/span> disease. The most common symptoms of Beh\u00e7et\u2019s disease<\/span> are mouth ulcers<\/span>, genital ulcers<\/span>, and eye inflammation.\u00a0When the digestive tract is affected, ulcers typically appear at the end of the small intestine (ileum) and start of the large intestine (cecum). For this reason, Beh\u00e7et\u2019s disease may be confused with Crohn\u2019s disease.<\/p>\n

There is a range of drugs prescribed for the IBD treatment. These include steroids, 5ASAs, thiopurines, 6-mercaptopurine (6-MP), immunosuppressants such as azathioprine, methotrexate and ciclosporin, and biological drugs like infliximab and adalimumab.\u00a0Other drugs used for IBD include antibiotics such as metronidazole and ciprofloxacin, and symptomatic drugs such as antidiarrheals and bulking agents. Initially, the aim of drug treatment is to reduce inflammation in the gut.\u00a0 Once the condition is under control maintenance treatment is given where drugs are prescribed to maintain remission and prevent relapse 8. In some cases, if medical treatment is not effective, then surgery may be required.<\/p>\n

IBD disease management is a complex process which includes both treatment and non-treatment decisions (such as self-management behaviors) to improve symptoms and reduce disease flares. These non-treatment methods, such as diet modification, stress management, and alternative therapies, are decisions meant to decrease symptoms and improve health-related quality of life.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Carvalho RS, Abadom V, Dilworth HP, et al. Indeterminate colitis: a significant subgroup of pediatric<\/span> IBD. Inflamm Bowel Dis. 2006;12:258\u2013262.<\/li>\n
  2. Kapoor A, Bhatia V, Sibal A. Pediatric<\/span> inflammatory bowel disease. Indian Pediatr. 2016;53:993\u20131002.<\/li>\n
  3. Pigneur B, Seksik P, Viola S, et al. Natural history of Crohn\u2019s disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis. 2010;16: 953\u2013961.<\/li>\n
  4. Abraham BP, Mehta S, El-Serag HB. Natural history of pediatric<\/span>-onset inflammatory bowel disease: a systematic review. J Clin Gastroenterol. 2012;46: 581\u2013589. \\<\/li>\n
  5. Winter DA, Karolewska-Bochenek K, Lazowska-Przeorek I, et al. Pediatric<\/span> IBDunclassified is less common than previously reported: results of an 8-year audit of the EUROKIDS Registry. Inflamm Bowel Dis. 2015;21:2145\u20132153.<\/li>\n
  6. Bequet E, Sarter H, Fumery M, et al. Incidence and phenotype at diagnosis of very-early-onset compared with later-onset paediatric inflammatory bowel disease: a population-based study [1988\u20132011]. J Crohns Colitis. 2016;11: 519\u2013526.<\/li>\n
  7. Mills, S., & Stamos, M.J. (2007). Colonic Crohn’s disease. Clin Colon Rectal Surg, 20, 309\u2013313.<\/li>\n
  8. Mottet C, Schoepfer AM, Juillerat P, et al. Experts Opinion on the Practical Use of Azathioprine and 6-Mercaptopurine in Inflammatory Bowel Disease. Inflamm Bowel Dis 2016;22(11):2733-2747<\/li>\n<\/ol>\n

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    Table of Contents 1. Introduction \u2022 Explanation of IBD, its subtypes – Crohn\u2019s disease (CD) and ulcerative colitis (UC) 2. Pediatric Inflammatory Bowel Disease \u2022 CD is predominant in the pediatric population 3. Symptoms of IBD: 4. Differences Between Crohn\u2019s Disease and Ulcerative Colitis 5. Types of Crohn\u2019s Disease 6. Other Types of Colitis 7. […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[31],"tags":[82],"class_list":["post-2971","post","type-post","status-publish","format-standard","hentry","category-news","tag-inflammatory-bowel-disease"],"_links":{"self":[{"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/posts\/2971","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/comments?post=2971"}],"version-history":[{"count":0,"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/posts\/2971\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/media?parent=2971"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/categories?post=2971"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.mybiosource.com\/learn\/wp-json\/wp\/v2\/tags?post=2971"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}