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Inflammatory Bowel Disease (IBD) refers to the chronic inflammation of the mucosal lining of the intestine or bowel, with the major types being ulcerative colitis and Crohn’s disease.

Both ulcerative colitis and Crohn's disease are characterized by an inflammation of the mucosal lining of the intestine, and thus both conditions share certain symptoms. However, the extent and location of the inflamed bowel segments are different in each condition. Ulcerative colitis and Crohn’s disease manifest as fatigue, loss of appetite and sometimes a fever, with specific symptoms directly related to the bowel.

These symptoms include irregular bowel movements containing mucous and or/ blood, severe diarrhea, and abdominal pain. The inflammation may result in loss of blood through the bowel. This loss, which may take the form of so-called “occult” or hidden bleeding, can only be detected with a special test and may lead to anemia through the loss of iron.

In both ulcerative colitis and Crohn's disease, symptoms may occur not only in the bowel. More than 25% of patients experience pain or even inflammation (arthritis) in larger and smaller joints of the spine and pelvis. As in other types of arthritis, this joint inflammation results in swelling, pain and restricted movement. The skin in patients with IBD may also react in the form of painful purplish-red areas of thickening, most commonly occurring on arms and legs. Somewhat less frequent symptoms include inflammation of the eyes, particularly the iris and conjunctiva. Both may also be associated uncharacteristically with inflammation of the liver.

Ulcerative colitis, which affects only the colon, is typically characterized in its acute phase by diarrhea (mixed with mucous and/or blood). The severity of the diarrhea depends on the inflammatory activity and the extent of the bowel inflammation. Diarrhea may be very severe in cases in which the entire colon is affected. However, if only the final portions of the colon (the sigmoid or rectum) are affected, the stool may be more solid but traces of blood can be detected.

Crohn’s disease may affect both the small bowel and colon. In its initial phase it may cause few or no symptoms at all and, particularly in cases in which the colon is only partially affected or completely spared, there may be no diarrhea. In many cases, there may be abdominal pain which sometimes can be confused with appendicitis. Crohn’s disease is associated with nutritional deficiencies in its early stages, resulting in significant weight loss.

In some patients the disease manifests with inflammation in the region of the anus, resulting in the formation of fistulae and abscesses. A fistula is a tube-like tract lined with inflammatory cells. It may connect two hollow organs or open into the outer skin or the anal mucosal membrane. Fistulae are found in up to 30% of patients with Crohn’s disease.

Weeping, purulent fistulae in the region of the anus, particularly if they recur, should always suggest the need for more extensive examination of the bowel. Whenever a patient reports the occurrence of several of the above described symptoms, the physician should consider the possibility of IBD.

The actual cause of IBD remains elusive. It is likely, however, that these chronically recurring episodes of inflammation in the bowel are related to a complex interaction between environmental factors and a hereditary predisposition for these diseases. Genetic predispositions require other factors, such as virus or bacteria, change in nutritional behavior or the consumption of certain preservatives or other food additives, or disturbances of the body’s own immune system or intestinal barrier.

To date no definitive evidence has been found to prove a connection between these factors and the development of IBD. It‘s very probable that environmental factors play a role. On the other hand, it is very unlikely that IBD is due to an underlying infectious disease. Hence, infecting other persons with the disease is not possible.

If you suspect that you may have IBD, the following tests should be considered for confirmation:

Physical examination of your entire body, especially the abdomen and rectum.
Laboratory tests, including blood and stool samples, which may reveal signs of general inflammation.
Ultrasound examination of the abdomen to detect any changes, such as widening of the bowel and thickening of its wall.
Endoscopy to look at the inner lining of the digestive tract.
Radiological examinations, such as x-ray, MRI, and CT scan.

Treatment options for IBD include medication, nutritional management, emotional support and surgery.

The primary goal of treatment is to alleviate the patient’s symptoms (diarrhea, pain, and blood loss) and, once this is successful, to prevent recurrence.

It is important to note that patients with Crohn’s disease who quit smoking have a 60% decreased chance of recurrence over two years.

Although IBD is a chronic disease that has periods of remission and relapse, most people have a normal life span and many have a good quality of life. For those who have chronic and persistent symptoms:

Know your body and how IBD affects you.
Learn to care for yourself — have control over those things you can control.
Develop a support system that works for you: family, friends and support groups.
Be sure to follow instructions from your medical team.

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