What are inflammatory bowel diseases?
These are disorders where the bowel becomes red and inflamed. In ulcerative colitis the lining of the large bowel is involved. In Crohn’s disease (named after an American physician) any part of the digestive tract can be affected and the full thickness of the bowel wall can become inflamed. Crohn’s disease, when it affects the colon and ulcerative colitis are similar so it is sometimes hard to tell which one the patient has.
Why does ulcerative colitis and Crohn’s disease come on?
The reasons for the onset of these conditions are not known. People who suffer from them may have a defence mechanism against normally present gut bacteria which acts abnormally. A longstanding reaction to a specific virus or bacterium may be significant. There may be an increased susceptibility in some families but the likelihood of transferring the problem to children is low.
Ulcerative colitis symptoms
Symptoms can be troublesome variably throughout a person’s life. Typically people suffering from ulcerative colitis are well and do not have symptoms, a disease condition known as remission. Relapses occur when the disease flares up again, with the resulting relapses being unpredictable in terms of being worse than before, or better or similar to previous ones. Urgent need to pass mucus and blood with the stool, a general tiredness, abdominal pain prior to passing stool and diarrhoea in severe flare ups are the typical symptoms. If the condition affects only the rectum, the final part of the bowel, it is called proctitis and the typical symptoms are the passing of blood and mucus but in the absence of diarrhoea.
What are the symptoms of Crohn’s disease?
Crohn’s disease also tends to occur throughout life with similar inactive remissions and relapsing flare ups as ulcerative colitis. Due to the fact that Crohn’s disease can be active anywhere in the bowel the symptoms can be very variable. Most commonly there is:
Diarrhoea sometimes with bleeding
Abdominal pain. The inflammation either causes pain directly or causes narrowing of the bowel (stricture) resulting in gripey pains and bloating (distension) with wind.
Bodyweight loss due to a reduction in appetite when active disease is present along with potential poor nutrient absorption.
A severe stricture of the bowel can cause bowel obstruction with consequent distension, vomiting and pain.
In some patients a leak (fistula) develops through the inflamed bowel into another organ, such as skin, bladder or vagina, causing a discharge.
Bleeding can occur with diarrhoea.
What causes the disease to relapse?
The causes of a relapse are often not very clear. A triggering event is sometimes identifiable but is not the underlying disease cause. Examples could be:
Commonly occurring infections such as flu, gastroenteritis and colds.
Anti-arthritis drugs, antibiotics and aspirin.
Personal worries and stress.
Food intake. Milk products can engender a reaction in some patients and a milk exclusion diet may be necessary. Cereals can be a particular source of adverse reactions and should be cut out of the diet and carefully put back in later.
How is inflammatory bowel disease diagnosed?
Your doctor will do a sigmoidoscopy if ulcerative colitis or Crohn’s disease of the large bowel (Crohn’s colitis) is suspected. An instrument with a light in it is passed through the back passage (anus) to look at the lining (mucosa). A tiny snip (biopsy) of mucosa will be taken and inspected under a microscope. Tests may also include:
An x-ray during a barium enema where the liquid barium is injected into the bowel through the anus.
Blood samples.
Colonoscopy. In this investigation the patient is sedated and a flexible endoscope is inserted past the anus and up through the whole colon.
Blood samples are routinely taken.
If Crohn’s disease of the upper gut is suspected:
An endoscopy of the upper gastrointestinal tract can allow inspection and biopsies of the upper intestine and stomach, passing the endoscope through the mouth.
The intestine may be investigated by a barium x-ray examination.
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