Inflammatory Bowel Disease (IBD)

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The general name for diseases that cause inflammation of the bowels, including ulcerative colitis and Crohn’s disease. Although these two diseases are similar, there are also some important distinctions.

Ulcerative colitis is an inflammatory disease of the inner lining of the large intestine, which becomes inflamed and ulcerates. Ulcerative colitis is often most severe in the rectal area and can cause frequent bloody diarrhea. Crohn’s disease, on the other hand, affects the last part of the small intestine, although it can also affect any part of the digestive tract. Moreover, Crohn’s disease tends to involve the entire bowel wall, whereas ulcerative colitis affects only the lining.

Inflammatory bowel disease (IBD) occurs most often among people aged 15 to 30, but it can affect younger children. There are significantly more reported cases in western Europe and North America than in other parts of the world.

Cause
Scientists do not yet know what causes inflammatory bowel disease, although they suspect that a number of factors may be involved, including the environment, diet, and heredity. Smoking appears to increase the likelihood of developing Crohn’s disease. A new theory suggests that Crohn’s disease may be caused by infection (similar to CAT SCRATCH DISEASE).

Symptoms
The most common symptoms of both ulcerative colitis and Crohn’s disease are mild to severe diarrhea and abdominal pain. Pain is usually caused by abdominal cramps caused by irritation of the nerves and muscles controlling intestinal contractions. Severe diarrhea can lead to dehydration, rapid heartbeat, and low blood pressure, and continued loss of small amounts of blood in the stool can lead to anemia. Sometimes children with Crohn’s disease may experience constipation if the intestines become partially obstructed. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum.

Fever, fatigue, and weight loss may also occur in IBD as may malnutrition because of the loss of fluid and nutrients due to diarrhea and chronic inflammation of the bowel.

Children with IBD may experience a slowdown in growth and a delay in the onset of puberty.

Diagnosis
IBD can be difficult to diagnose because there may be no symptoms despite years of increasing bowel damage, or symptoms may mimic other conditions. Blood tests can reveal inflammation or abnormalities in the digestive tract. Increased white blood cell counts and sedimentation rates along with lower levels of albumin, zinc, and magnesium in the blood suggest IBD.

However, an accurate diagnosis of ulcerative colitis may require an examination of the colon by inserting a colonoscope, which allows doctors to see the degree of damage. A biopsy of the colon may help confirm the diagnosis. To diagnose Crohn’s disease, barium X rays can reveal characteristic signs of inflammation in the lining of the intestine. An upper gastrointestinal endoscopy and colonoscopy may be performed to check for evidence of bowel damage caused by inflammation.

Treatment
Medication is the primary method for treating symptoms of IBD. Steroids, cyclosporin, azathioprine, and anti-TNF antibodies restrain the immune system from attacking the body’s own tissues and causing further inflammation. Antiinflammatory drugs are also used.

If a child with IBD does not respond to these medicines, surgery may be considered, although the recurrent nature of Crohn’s disease makes surgery a last-ditch effort. An aggressive surgical approach to Crohn’s disease also can cause other complications, such as short bowel syndrome (which reduces the ability to absorb nutrients and also may cause growth failure).

Children with ulcerative colitis may need to have the large intestine removed, along with a surgical procedure in which doctors form a pouch from the small bowel to collect stool in the pelvis. After another surgery to reconnect the bowel, feces can pass through the anus.
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