Inflammatory bowel disease
IBD
Inflammatory bowel disease, which is mainly divided into Crohn’s disease and ulcerative colitis, is an autoimmune disease in which the immune system attacks its own digestive system tissues.
The main difference between Crohn’s disease and ulcerative colitis is the location of the inflammation and the inflammation itself. Crohn’s disease can affect any part of the digestive system, often in the terminal ileum. The onset of ulcerative colitis is limited to the colon and rectum. The onset of ulcerative colitis is limited to the mucous membranes, whereas Crohn’s disease affects the entire lining of the intestine.
In addition, Crohn’s disease and ulcerative colitis also have different proportions of manifestations outside the intestine, such as inflammation of the liver, arthritis, abnormal manifestations of the skin and inflammation of the eye. Crohn’s disease affects 400,000 to 600,000 people in North America. Estimates of prevalence in Northern Europe range from 27 to 48 per 100,000 population. Crohn’s disease tends to initially appear in the teens and 20s, peaking again in the 50s to 70s.
There is no cure for Crohn’s disease, and treatment is limited to controlling and relieving symptoms and preventing recurrence. Below we focus on Crohn’s disease.
Signs and symptoms of Crohn's disease
Gastrointestinal symptoms
Abdominal pain is usually spasticity and relieved by expiration. It is often accompanied by diarrhea, the nature of which depends on the part of the small intestine or colon involved. Ileitis usually results in a large amount of watery stools. Colitis may result in a smaller volume and higher frequency of stools. Bloating may increase intestinal discomfort.
Symptoms caused by bowel stenosis are also common. Abdominal pain is usually most severe in areas of bowel stenosis. In severe strictures, vomiting and nausea may indicate the onset of small bowel obstruction.
Itching or pain around the anus, non-healing sores may develop in the mouth.
Constitutional symptoms
In children, growth disorders are common. Older people may present with weight loss.
Parenteral symptoms
These include erythema nodosum, uveitis of the eye, and episcleritis, all of which can lead to vision loss if left untreated.
Crohn’s disease is associated with rheumatic diseases of the spondyloarthropathy. This group of diseases is characterized by inflammation of one or more joints (arthritis) or muscle attachment sites. Arthritis can affect the knees or shoulders, or may affect only the small joints of the hands and feet. Crohn’s disease may also involve the skin, blood, and endocrine system, increasing the risk of blood clots. Autoimmune hemolytic anemia is also more common in Crohn’s disease and can cause fatigue, pallor, and other symptoms common in anemia. Crohn’s disease can lead to osteoporosis or thinning of bones. People with osteoporosis are at increased risk of fractures. Neurological complications can occur in up to 15% of patients, most commonly seizures, stroke, myopathy, peripheral neuropathy, headache, and depression.
Complications
Include obstruction, fistula, and abscess. The risk of cancer also increases in the area of inflammation. Risk of malnutrition, increased risk after small bowel removal.
Diagnosis of Crohn's disease
Crohn’s disease can mimic ulcerative colitis on endoscopy. Sometimes challenging, colonoscopy is about 70% effective in diagnosing disease.
Endoscopy: Colonoscopy is the best test to diagnose Crohn’s disease.
Radiological tests: When the disease involves only the small intestine, barium follow-up X-rays may be used to look for inflammation and narrowing of the small intestine, or to detect colonic fistulas. CT and MRI scans are useful for assessing the small intestine by enteric-coated protocols. Imaging (MRI) is another option for imaging the small intestine and looking for complications.
Blood test
A complete blood count is helpful in the assessment of anemia, and erythrocyte sedimentation rate or ESR and C-reactive protein measurements can also be used to measure the degree of inflammation.
Differential diagnosis
The most common disease is ulcerative colitis, and distinguishing these diseases helps in the choice of treatment.
Comparison of various factors in Crohn's disease and ulcerative colitis
Crohn’s disease | Ulcerative colitis | |
Terminal ileum involvement | common | seldom |
Colon involvement | common | always |
Rectal involvement | seldom | common |
Perianal involvement | common | seldom |
Bile duct involvement | The incidence of primary sclerosing cholangitis does not increase | Higher ratio |
Distribution of the disease | Patchy areas of inflammation (skipping lesions) | Areas of persistent inflammation |
Endoscopic | Deep geographicality and waveform (snake-like) ulcers | Persistent ulcers |
Depth of inflammation | Permeable to the wall and deep into the tissue | Shallow |
fistula | common | seldom |
narrow | common | seldom |
Autoimmune diseases | It is widely considered to be an autoimmune disease | No consensus |
Cytokine response | Associated with Th1 | Vaguely related to Th2 |
Biopsy granulomas | There may be granulomas | Uncommon |
Surgical cure | It usually returns after removing the affected area | It is usually cured by removing the colon |
smoking | The risk is higher | Low risk |
Treatment
Recurrence and symptoms can be prevented and symptoms controlled with medication, lifestyle changes, and in some cases surgery.
Drugs
Antibiotics are used to control acute infections, and aminosalicylic acid anti-inflammatory drugs and corticosteroids are used to reduce inflammation. Many patients require immunosuppressive drugs.
Medications used to treat symptoms of Crohn’s disease include 5-aminosalicylic acid (5-ASA) preparations, prednisone, marijuana, immunomodulators such as azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab, natalizumab.
Lifestyle changes
Symptoms can be reduced via lifestyle changes, including dietary modification, appropriate hydration, and smoking cessation.
Surgery
Surgery may also be needed for complications such as obstruction, fistulas, and/or abscesses, or if the disease does not respond to drugs within a reasonable period of time.