Inflammatory Bowel Disease (IBD) is an immune-mediated chronic inflammation of your gastrointestinal tract. Normally, the cells and proteins that make up the immune system protect you from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations—called autoimmune response.
There are two types of IBD, Crohn’s disease and ulcerative colitis; both manifest as chronic immune-mediated inflammation of your gastrointestinal system. While they both cause similar symptoms, they are managed differently. Crohn’s disease may affect any part of your gastrointestinal system, from your mouth to the anus. Ulcerative colitis, however, is limited to the colon, otherwise known as the large intestine.
It is estimated that 1.4 million Americans have IBD, which tends to run in families and affect males and females equally.
Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon.
It is often difficult to diagnose which form of IBD is present because both Crohn’s disease and ulcerative colitis cause similar symptoms. Both illnesses are marked by an abnormal response by the body’s immune system, leading to chronic inflammation of the gastrointestinal tract.
Symptoms related to inflammation of the GI tract include:
Individuals with ulcerative colitis may also experience swelling and pain in the hip and knee joints and pain in the eyes or skin. The symptoms of ulcerative colitis tend to come and go, with fairly long periods in between flare-ups, during which patients may experience no distress at all. These periods of remission can span months or even years. The unpredictable course of ulcerative colitis can make medical management quite challenging.
Doctors usually perform a sigmoidoscopy, or a similar test called a colonoscopy, to diagnose ulcerative colitis. For these tests, the doctor puts a thin tube into your rectum (the lower part of the large intestine) and threads it up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon. The tube also has tools attached, so the doctor can take samples of tissue to look at under the microscope.
People with ulcerative colitis often need lifelong treatment, which may consist of medicine, surgery, and lifestyle changes; however, with effective treatment, many people are able to live fairly normal lives with ulcerative colitis.
There are many different medicines that help reduce the symptoms of ulcerative colitis. Almost all of these medicines work by reducing inflammation and the body’s immune response. The newest drugs available to treat IBD are biologic therapies, which help to reduce inflammation by blocking specific proteins that play a role in inflammation.
Surgery may be helpful if medicines are unable to control your symptoms, or if the medicines cause side effects that you can’t tolerate. There are two main types of surgery used to treat ulcerative colitis:
There are many things you can do that may improve your symptoms, including:
Ulcerative colitis can lead to colon cancer. People with ulcerative colitis get screened early and often for colon cancer. Screening guidelines recommend a colonoscopy performed a few years after diagnosis, and repeated every 1 to 2 years thereafter.
Although considerable progress has been made in IBD research, investigators do not yet know what causes this disease. Studies indicate that the inflammation in IBD involves a complex interaction of factors: the genes the person has inherited, the immune system, and environmental factors.
Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body’s defenses to produce an inflammation that continues without control. The body’s immune system usually eliminates foreign invaders (substances), such as bacteria, viruses, and fungi. Normally, harmless bacteria (many of which aid in digestion) are protected in the GI tract; however, for people with IBD, the immune system reacts to these bacteria with inflammation. Environmental triggers initiate these immune responses, which can lead to chronic inflammation, ulceration, and thickening of the intestinal wall. Researchers believe that once the IBD patient’s immune system is “turned on,” it does not know how to properly “turn off”. As a result, inflammation damages the intestine and causes the symptoms of IBD. That is why the main goal of medical therapy is to help patients regulate their immune system better.
The environmental factors that trigger IBD are not known, but several potential risk factors have been studied, including:
While ulcerative colitis tends to run in families, researchers have been unable to establish a clear pattern of inheritance. Studies show that up to 20 percent of people with ulcerative colitis will also have a close relative with the disease. The disease is more common among white people of European origin and among people of Jewish heritage. While genetics is clearly a factor, the association is not simple. It is likely that more than one gene is at work, and just having the genes associated with IBD doesn’t absolutely predict that the disease will occur. These genes are known as susceptibility genes as they increase the chances for getting the disease. It is clear that other factors, including environmental factors, must also come into play.