Inflammatory
bowel disease is one of the five major gastrointestinal diseases in
the United States, affecting approximately 700,000 to 2,000,000
Americans. But considering its high prevalence, it is still without a
universally-recognized cure. The disease is a a combination of
chronic GI tract inflammation and other associated symptoms such as
diarrhea, constipation, rectal bleeding, and cramps. In general,
there are two separate sets of conditions and symptoms for the
disease, separating into two primary forms of IBD: Crohn's disease
and ulcerative colitis.
Crohn's
disease is easily recognizable from the range of inflammation.
Lesions and ulcerations can form anywhere from the mouth to the anus,
most often in small intestine through the large intestine. Typically
there will be periods of remission where the tissues are healed,
followed by worsening lesions and ulcerations. At first they start
off as small cold-sore-like lesions and eventually become true
ulcers. In the intermediate stages, the lining of the GI tract
becomes inflamed and swells, limiting the opening of the GI tract.
This can lead to constipation, nausea, vomiting, and cramping. When
the bowels become ruptured with ulcers, the bacteria that line the
gut to help break down foods can escape the GI tract and search for
food elsewhere in the body, resulting in damage to surrounding
organs.
Ulcerative
colitis only affects the colon (large intestine) and the rectum.
Unlike Crohn's disease, the distribution of lesions in ulcerative
colitis is continuous, only affecting the outer layers of the gut.
Bleeding into the colon or rectum due to lesions is quite common and
results in blood in the stool. The purpose of the colon is to
reabsorb the water from what is left of the food being processed.
When the colon is inflamed it cannot function properly, resulting in
looser stool, diarrhea, abdominal bloating, and a sensation of
incomplete bowel movements. Surgery is a common solution to
ulcerative colitis when medication is not sufficient.
For
either case of IBD, the diagnosis is made through a colonoscopy,
stool sample, and blood work. Not only will a stool sample rule out
evidence of infection or parasites, recent studies have shown that
the protein calprotectin is marker of intestinal inflammation. The
blood tests will show increased white blood cells, evidence of
inflammation. If both results come back as predicted, a colonoscopy
is performed to further deduce whether the IBD is Crohn's disease or
ulcerative colitis.
Although
there is no known cure, there is plenty of medication to remedy the
symptoms of either form of IBD. The most common medications are
aminosalicylates, steroids, antibiotics, and anti-inflammatories. In
general, their purpose is to induce remissions and stabilize
symptoms, while reducing the risk of cancer. Surgery is an option for
Crohn's disease, but since it can affect the entire GI tract, it is
not a cure. About 75% of Crohn's patients will get a surgery to
remove lesions and inflamed tissue. The disease recurs often and
surgery is only a temporary solution. Ulcerative colitis, on the
other hand, only affects the end of the tract. Removal of the colon
and rectum, a colonectomy, is quite standard if symptoms are not
improved by medication. Post-surgery, colonectomy patients are
considered permanently cured from ulcerative colitis. This is
currently the only cure for any inflammatory bowel disease.
Resources:
American
College of Gastroenterology. “Fecal Microbiota Transplants
Effective Treatment for C. Difficile, Inflammatory Bowel Disease,
Research Finds.” ScienceDaily,
2 Dec. 2011. Web. 12 Oct. 2012.
Cabrera, Chanchal.
“A Phytotherapeutic Approach to Lower Bowel Disease.” Gaia Garden
Herbals, 2008.
http://www.gaiagarden.com/articles/therapeuticapplications/ta_treating_bowel_disease.php
Cleveland Clinic Department of Gastroenterology, The. “Digestive Diseases: Causes of Inflammatory Bowel Disease.” WebMD, 31 January 2005. http://www.medicinenet.com/script/main/art.asp?articlekey=41964
“Inflammatory Bowel Disease.” Center for Disease Control and Prevention, 15 July 2011. http://www.cdc.gov/ibd/
“What are Crohn's
and Colitis?” Crohn's and Colitis Foundation of America.
http://www.ccfa.org/what-are-crohns-and-colitis/
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I'd like to point out that the treatments are available, but the therapeutic effects don't sufficiently outweigh the adverse effects. It's also super super super expensive ($9/mg). A 100 mg dose that must be given a once or twice a month for the course of a year dose is really slimming the checkbooks ha ha. The major adverse effects include psoriasis and immunosuppression, recurrence of viral, bacterial, and parasitic infections, demyelination of CNS, and blood disorders, which is not exactly something that is preferred by patients (sort of a Faustian bargain per se). It's either wait it out and endure the flare-ups or take the meds and face other problems. However, there is some progress with TNF-alpha inhibitors in clinical research, possibly offsetting the balance. Infliximab, one such TNF-alpha inhibitor, had 39-45% of patients in remission in comparison to placebo (21%) in the ACCENT 1 Trial. TNF-alpha inhibition is even considered for ulcerative colitis, showing 60-70% response in patients with ulcerative colitis.
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