Part One – Inflammatory Bowel Disease
Inflammatory Bowel Disease " Part One
by Jonathan Blood Smyth
The bowel inflammatory diseases
These are disorders where the bowel becomes red and inflamed. In
ulcerative colitis the lining of the large bowel is involved. In
Crohn's disease (named after an American physician) any part of the
digestive tract can be affected and the full thickness of the bowel
wall can become inflamed. Crohn's disease, when it affects the colon
and ulcerative colitis are similar so it is sometimes hard to tell
which one the patient has.
Why does ulcerative colitis and Crohn's disease come on?
The cause or causes are not known. It is possible that affected people
have an abnormal defence mechanism against the bacteria which are
normally present in the gut. A long-term reaction to a particular
bacterium or virus may be important. People in some families are more
susceptible than in others, but the chance of passing this tendency on
to children is small.
Symptoms of ulcerative colitis
Symptoms can be troublesome variably throughout a person's life.
Typically people suffering from ulcerative colitis are well and do not
have symptoms, a disease condition known as remission. Relapses occur
when the disease flares up again, with the resulting relapses being
unpredictable in terms of being worse than before, or better or similar
to previous ones. Urgent need to pass mucus and blood with the stool, a
general tiredness, abdominal pain prior to passing stool and diarrhoea
in severe flare ups are the typical symptoms. If the condition affects
only the rectum, the final part of the bowel, it is called proctitis
and the typical symptoms are the passing of blood and mucus but in the
absence of diarrhoea.
Crohn's disease symptoms
Crohn's disease also tends to occur throughout life with similar
inactive remissions and relapsing flare ups as ulcerative colitis. Due
to the fact that Crohn's disease can be active anywhere in the bowel
the symptoms can be very variable. Most commonly there is:
Diarrhoea sometimes with bleeding
Abdominal pain. The inflammation either causes pain directly or causes
narrowing of the bowel (stricture) resulting in gripey pains and
bloating (distension) with wind.
Bodyweight loss due to a reduction in appetite when active disease is
present along with potential poor nutrient absorption.
A fistula (leak between two organs) can occur in the inflamed bowel and
burst through into an organ such as the bladder, vagina or skin, with a
In some patients a leak (fistula) develops through the inflamed bowel
into another organ, such as skin, bladder or vagina, causing a
Local inflammation can cause abdominal pain or cause a narrowing of the
bowel (a stricture) with symptoms of abdominal bloating, wind and pain
of a gripey nature.
Reasons why the disease relapses
It is not always possible to identify the causes of relapse and even
when the trigger occurrence is identified this is not the cause of the
condition. Possible reasons are:
Dietary intake. Milk products can make people react and then they
should try a diet free from milk. Particular foods, for example
cereals, can produce an unwelcome reaction. Excluding the trigger foods
from the diet and then re-introducing them later is useful.
Widespread infections such as gastroenteritis, flu and colds.
Personal worries and stress.
Diet. Some patients may react to milk products, in which case they will
need a milk-free diet. Some sufferers find that certain foods, such as
cereals, can cause problems. These foods can be cut out of the diet and
tried again later.
The diagnosis of inflammatory bowel disease
Crohn's disease of the bowel (known as Crohn's colitis) or ulcerative
colitis can be diagnosed by sigmoidoscopy. This involves the insertion
of a narrow endoscope with a light up the rectum and into the bowel so
the lining of the organ can be checked. A sample of the bowel lining
may be biopsied for microscopic examination. Other tests include:
An x-ray during a barium enema where the liquid barium is injected into
the bowel through the anus.
Exclusion of infection by taking stool specimens.
Barium enema x-ray (barium liquid is run into the bowel through the
Blood samples are routinely taken.
If Crohn's disease of the upper gut is suspected:
An endoscopy of the upper gastrointestinal tract can allow inspection
and biopsies of the upper intestine and stomach, passing the endoscope
through the mouth.
The intestine may be investigated by a barium x-ray examination.
Jonathan Blood Smyth is the Superintendent of Physiotherapy
at an NHS hospital in the South-West of the UK. He writes articles
about back pain, neck pain, and injury management. If you are looking
in Coventry visit his website.
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