Encyclopedia of Health and Medicine

62 The Gastrointestinal System
The symptoms typical with IBD also are common
with many gastrointestinal disorders. Determining
the diagnosis requires a careful history of
the pattern of symptoms, thorough physical
examination, laboratory tests to look for markers
of inflammation and autoimmune activity in the
blood and in the stool, and imaging procedures to
detect ulcerations and changes in the intestinal
mucosa.
BARIUM SWALLOW with small bowel followthrough,
in which the radiologist takes additional
X-rays to follow the flow of barium as it leaves the
STOMACH and passes through the small intestine,
can visualize the ulcers and strictures (narrowed
areas) that characterize Crohn’s disease when it
involves the small intestine. Sigmoidoscopy allows
visual exploration of the lower colon, the site of
ulcerative colitis. Esophagogastroduodenoscopy
(EGD) may reveal involvement of the upper gastrointestinal
tract in Crohn’s disease.
These procedures help rule out other conditions
as much as to confirm IBD. Doctors typically
withhold these procedures during active flares of
disease, however, to avoid further irritating the
intestinal mucosa and because the inflamed
mucosa presents an increased risk for inadvertent
complications such as bowel perforation.
Crohn’s Disease
“skip” pattern of intestinal
involvement
can affect any part of
gastrointestinal tract
infiltrates multiple layers of
mucosa
right lower abdominal mass
CLINICAL FEATURES OF IBD
Ulcerative Colitis
continuous intestinal
involvement
affects only the COLON, starts
with the RECTUM
involves only the surface
layer of mucosa
Treatment Options and Outlook
Most people achieve relief from IBD symptoms
through medications that suppress the immune
response or target gastrointestinal function. Treatment
protocols draw from various classifications
of medications to address acute (active disease)
and maintenance (remission) levels of care.
Among them are ANTIDIARRHEAL MEDICATIONS, anticholinergic
medications, 5-AMINOSALICYLATE (5-ASA)
MEDICATIONS, CORTICOSTEROID MEDICATIONS, IMMUNO-
SUPPRESSIVE MEDICATIONS, ANTIBIOTIC MEDICATIONS,
and MONOCLONAL ANTIBODIES (MABS). While antibiotics
treat enteric infections and abscesses that
develop in the inflamed intestinal mucosa, they
also seem to reduce complications and result in
overall improvement of symptoms.
All of these medications have significant side
effects. Because IBD is dynamic and unpredictable
in its cycles of symptoms and remission, finding
the most effective therapeutic balance remains a
challenge. Medication regimens are highly individualized.
As research progresses, new medications
and treatment options enter the mix.
Surgery to remove the affected portion of the
bowel becomes a treatment option to consider
when damage to the intestine becomes extensive
or symptoms no longer respond to medical treatments.
For ulcerative colitis, surgery typically ends
the disease process though the amount and location
of bowel removed may have functional consequences,
including colectomy (surgery to
remove part or all of the colon). For Crohn’s disease,
surgery provides long-term relief though the
disease may resurface or progress to involve
remaining portions of the gastrointestinal tract.
Lifestyle is an important dimension of IBD not
so much for its influence on the course of the disease
but rather a result of IBD’s influence on
lifestyle. IBD is a long-term disorder for which, at
present, there is no cure. The unpredictable
nature of IBD’s cycles and potential severity of
attacks make it difficult for those who have it to
stray far from its presence. Treatments attempt to
manage symptoms for optimal QUALITY OF LIFE
across the spectrum of the disease. During periods
of remission most people who have IBD are able
to participate fully in the activities they enjoy.
During periods of active disease, many people find
it difficult to maintain regular activities.
Complications associated with IBD are numerous,
arising both from the disease and from its
treatments. Autoimmune arthritis, notably ANKY-
LOSING SPONDYLITIS, often develops. Common with
long-standing ulcerative colitis are the EYE infections
EPISCLERITIS and UVEITIS, the biliary disorder
sclerosing cholangitis, and significantly increased
risk for COLORECTAL CANCER. Doctors recommend
annual screening colonoscopy for people who have
IBD with involvement of the colon or rectum
beginning 8 to 10 years after diagnosis or earlier