Inflammatory Bowel Disease Dr. Minocha's health Blog

INFLAMMATORY BOWEL DISEASE

Ulcerative Colitis and Crohn's Disease

About the author:

Dr. Minocha is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies".

Read Daily Inflammatory Bowl Disease (IBD) and Digestive Health News/Tips Here

Inflammatory Bowel Disease means inflammation of the bowel or gastrointestinal tract. It may occur due to a variety of causes including infections, drugs, ischemia (lack of blood supply) etc. However, unless specified, it generally implies chronic idiopathic inflammatory bowel disease (IBD), the cause of which is unknown.

Inflammatory Bowel Disease (IBD) can be classified into two types : Ulcerative Colitis (UC) and Crohn's disease (CD). This classification may not be possible in some cases (10-15%), and these are called indeterminate.

Ulcerative Colitis as the name suggests involves only the colon/rectum although some "backwash ileitis" may be seen. In addition, it involves the mucosa or the innermost lining of the colon wall. In contrast, Crohn's Disease is a transmural disease (involving all layers of bowel) and may involve any part of the gut, from mouth to anus.

A variety of factors have been implicated in the causation of Inflammatory Bowel Disease (IBD) including genetics, race, diets etc. It is generally believed to be an autoimmune disorder, i.e. the person's immune system is the source of the problem. Stress does not cause the disease although it may exacerbate the flare up.

Inflammatory Bowel Disease may present with a variety of symptoms depending in part on the location of the disease. Symptoms include, abdominal pain, diarrhea, bleeding and malnutrition. Ulcerative Colitis generally manifests with rectal bleeding while Crohn's may sometimes present with vague, non-specific symptoms. Growth retardation may be seen in kids.

Clinical history and physical exam along with the laboratory abnormalities provide clues to the diagnosis. Endoscopy with biopsy usually clinches the diagnosis. Diagnosis of Crohn's Disease, although not absolute, may sometimes be made by the typical changes the small bowel seen on barium x rays.

Medical treatment of Inflammatory Bowel Disease includes aminosalicylates (ASA) and corticosteroids. Sulfasalazine is the prototype aminosalicylate and newer 5-ASA preparations like Asacol, Pentasa, Dipentum are available. In addition, ASA may be administered as rectal suppositories and enemas. Corticosteroids may be given as intravenously, by mouth or as rectal enemas. Corticosteroids have substantial long-term toxicity.

Immunomodulators are being increasingly used for IBD. Commonest is azathioprine and 6-MP but the onset of action is slow. Monitoring of 6-TG levels is done to optimize the therapy. Methotrexate is effective in Crohn's disease. Cyclosporine may be used for short term in times of emergencies. Infliximab (Remicade) infusion is an effective treatment for inflammatory as well as fistulous disease.

Many patients are turning to alternative and complementary therapy. Role of probiotics appears promising based on the results of various studies and are being increasingly recommended by physicians. Of note, just like antibiotics, all probiotics are not the same and effective for everything. It appears that combinations of several probiotic bacteria may be superior to using them alone. ..Contd on next page

IBD, UC, CD Continued on next page>>

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	Minocha et al. Acute Sulfasalazine Overdose. Journal of Toxicology Clinical Toxicolgy 1991.
	Minocha et al. Small Bowel Endometriosis Masquerading as Regional Enteritis. Digestive Diseases and Sciences 1994.
	Minocha et al. Lack Of Crucial Role of Mast Cells in Pathogenesis of Experimental Colitis in Mice. Digestive Diseases and Sciences 1995.
	Minocha A et al.: Crohn's Disease Complicating Male Genitourinary Tract Without Overlying Cutaneous Involvement. Am J Gastroenterol 1996.
	Minocha A et al.: Role of Appendectomy and Tonsillectomy in Pathogenesis of Ulcerative Colitis. Digestive Diseases And Sciences 1997.