Inflammatory bowel diseases

**Inflammatory bowel disease (IBD) is a term used to describe a disease that causes chronic inflammation of the digestive tract. Inflammatory bowel disease (IBD) is often confused with irritable bowel syndrome (IBS), but the two are different diseases. Irritable bowel syndrome (IBD) is a more serious disease that has several complications, including damage to the intestine and malnutrition.**

**Ulcerative colitis and Crohn's disease are two major forms of inflammatory bowel diseases, and other types of inflammatory bowel diseases include lymphocytic colitis and collagenous colitis. If internists are unable to distinguish between these two main types of inflammatory bowel disease, the disease is classified as indeterminate colitis.** **Although no cure has been found for inflammatory bowel diseases, symptoms can be managed with therapeutic interventions and lifestyle changes. With effective treatment, almost 50% of people with Crohn's disease will see improvement or reduction of symptoms in the next 5 years. About 45% of people who have recovered will not see a recurrence of the disease in the next year. Every year, 48% of people with ulcerative colitis recover and 30% see relief of symptoms. Mortality caused by inflammatory bowel diseases and its complications is uncommon.** **People with Crohn's disease have a slightly higher mortality rate than the general population. People with mild to moderate ulcerative colitis are not at risk. Consult a gastroenterologist if you notice any long-term changes in bowel movements or other symptoms of inflammatory bowel disease. Inflammatory bowel diseases are divided into two categories: **

** Ulcerative colitis (colon ulcer or intestinal colitis)** **Intestinal colitis causes long-term inflammation and ulcers in the inner lining of the large intestine (colon) and rectum. Ulcers of the colon (rectum) are divided into different types according to the location and intensity of the involvement:** **Rectal ulcer: It is the mildest type of ulcerative colitis and the inflammation is limited to the rectum.** **Intestinal pervasive colitis: Inflammation affects the entire large intestine.** **Inflammation of the rectum and sigmoid: Inflammation of the rectum and the lower and terminal part of the colon.** **Colitis of the terminal intestine: inflammation spreads from the rectum to the left colon.** **Acute and severe ulcerative colitis: is a rare form of colon ulcer that affects the entire large intestine and causes severe symptoms such as pain.**

**Crohn's disease** ** This type of inflammatory bowel disease causes inflammation of the lining of the digestive tract and often spreads to the depth of the tissue. Crohn's disease can affect any part of the digestive system, from the mouth to the anus, although the most common areas affected are the large intestine and the terminal part of the small intestine. This disease can occur at any age, but it is more common in people aged 15 to 35.**

**causes of disease** **Researchers do not know exactly what is the main cause of inflammatory bowel disease. It is possible that the body's immune system causes inflammatory bowel disease. Usually, the immune system protects the body against infections caused by bacteria or viruses. After the infection is gone, that part of the immune system becomes silent to be activated again if necessary. But in people with intestinal inflammation, the body's immune system may overreact to a common bacteria in the digestive tract.** **Once the immune system is activated, it will not be deactivated when it should be turned off. Over time, this causes inflammation and damages the digestive system. Although researchers do not know what causes intestinal inflammation, research has shown that the risk of developing intestinal inflammation is higher in women who use antibiotics, birth control pills, or non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen. Stress does not cause inflammatory bowel disease, but it can worsen its signs and symptoms.**

**Symptoms of inflammatory bowel diseases vary depending on the severity and location of the inflammation and vary from mild to severe. Patients with inflammatory bowel diseases experience active periods of the disease called the relapse period, as well as periods of cessation or reduction of symptoms, called the recovery period. Common signs and symptoms between Crohn's disease and ulcerative colitis include:** - **diarrhea** - **Fever and fatigue** - **Abdominal pain and abdominal muscle cramps** - **presence of blood in stool** - **Decreased appetite** - **unwanted weight loss** - **nausea** - **vomiting** - **Painful and difficult bowel movements** - **Feeling of not emptying the intestines after defecation** - **presence of pus or mucus in stool** - **night sweat** **Other symptoms of inflammatory bowel diseases that are not related to the digestive system:** - **joint pain** - **Oral wounds** - **Inflammation of the eye** - **skin diseases** - **Irregular menstrual periods in women** - **Growth disorders in children** **How does inflammatory bowel disease affect women?** **Intestinal edema disease affects women in certain ways and can cause the following cases:** - ** In women who have intestinal inflammation, there is a possibility that they will experience premenstrual symptoms such as headache and period pain. Diarrhea, abdominal pain, and other signs and symptoms of intestinal inflammation can worsen before and during periods.** - ** The risk of iron deficiency anemia is higher in women who have intestinal inflammation compared to women who do not have this disorder. If you have an intestinal disease, the body cannot absorb iron well and the risk of bleeding in the digestive system will increase.** - **When the signs and symptoms of inflammatory bowel disease flare up, you will have trouble getting pregnant.**

**Ages of disease** **Crohn occurs at any age, but it often shows itself in youth and before the age of 30.** **Risk factors and exacerbation of the disease** **Family history, white skin, smoking, use of anti-inflammatory drugs such as ibuprofen, diclofenac sodium, naproxen sodium, which lead to intestinal inflammation and exacerbation of the disease, living in industrial cities, living in more northern climates, and high-fat diets are risk factors for the disease.**

**Effective factors in inflammatory bowel diseases** ** So far, the cause of IBD has not been determined correctly, previously doctors considered diet and stress to be the cause, but now they believe that these factors aggravate IBD and are not its cause. Several factors may play a role in the development of inflammatory bowel diseases, which we will explain:** **Immune system: One of the possible causes of inflammatory bowel diseases is the malfunction of the immune system. When the body's immune system fights against invading agents such as certain foods, viruses and bacteria, the abnormal immune response causes the body's immune system to attack the cells of the digestive system as well.** **Genetics: Heredity seems to play an important role in the development of inflammatory bowel diseases as a specific link has been discovered between IBD and gene mutations. 20% of people with ulcerative colitis have a close relative with IBD, but so far no specific pattern has been found on how IBD is inherited.** **Bacteria and virus: According to research, Escherichia coli bacteria and enterovirus are associated with Crohn's disease.** **Environment: Factors such as smoking, birth control pills, diet, breastfeeding, vaccinations, antibiotics and other factors are known as factors affecting inflammatory bowel diseases.**

**Complications of the disease** **Inflammation: can be limited to the intestinal wall or spread throughout the entire intestine** **Intestinal obstruction: Crohn's affects the thickness of the intestinal wall. Over time, parts of the intestinal wall can become thick or narrow and lead to blocking the flow of substances inside the digestive tract. A person may even need surgery to remove the damaged part of the intestine.** **wounds: these wounds can be from the mouth to the anus and even in the genital area** **Fistula: Sometimes wounds can lead to the creation of a small hole in the intestinal wall and create a fistula. A fistula is an abnormal communication tunnel between different areas of the body. Fistula can be established between the intestine, skin or between the intestine and another organ and lead to continuous exit of intestinal contents to the skin. In some cases, the fistula becomes infected and becomes an abscess, and if not treated, it will threaten human life** **Anal fissures: Small cracks in the skin around the anus that often cause pain during defecation and can lead to fistulas** **Nutrition malabsorption: Diarrhea, abdominal pain, and heartburn can make it difficult for you to eat or absorb enough food in your intestines. And it can also lead to anemia caused by iron or vitamin deficiency ** **Colon Cancer: Crohn's increases the chance of colon cancer. A general rule of thumb for healthy people without Crohn's is a colonoscopy every 10 years after age 50** **Other complications: Anemia, osteoporosis, liver and bile duct problems are other problems and complications of Crohn's**

**disease treatment** **The treatment of ulcerative colitis is combined with drug therapy and sometimes surgery is also used. Currently, there is no definitive treatment for ulcerative colitis, and the treatment of ulcerative colitis patients is different. In the treatment process, doctors use different methods and protocols for treatment. In the treatment, doctors start with mild therapeutic drugs and gradually reach stronger drugs.** **The goal of ulcerative colitis treatment is to reduce inflammation in the intestine, which reduces the symptoms of the disease. Also, another goal of treatment is to improve the prognosis of the disease by limiting the complications of the disease. In the best case of treatment, the disease becomes symptomless, but the treatment must continue.** **A very important point in the treatment of the disease is to avoid stopping the drug without the doctor's permission, which may cause the treatment of the disease to reverse and aggravate its complications.** ** Your doctor may prescribe a special diet through an internal feeding tube or intravenous injection to treat your ulcerative colitis. This treatment will help improve your nutritional status and allow your gut a short break. Intestinal rest reduces inflammation in the short term. Your doctor may use short-term nutritional therapy along with drug therapy.** ** In most cases, surgery can cure ulcerative colitis. This usually means a complete removal of the colon (proctocolectomy). In most cases, this procedure is called ileoanal anastomosis. Your surgeon allows the patient to pass stool by making a pouch from the end of the intestine that is directly connected to the anus.** **Usually, in some cases, it is not possible to use the above method. Instead, surgeons make a permanent opening in the abdomen (ileal stoma) to direct the stool into an external pouch.** ** 8 years after the onset of the disease, further screening is needed every three years to check the possibility of colon cancer. Because the risk of colon cancer may increase with the duration of the disease, especially in those with a longer length of the intestine. The intervals between colonoscopies depend on the location of the bowel involvement, the duration of the disease and your physical condition.** **If, in addition to ulcerative colitis, a person has primary sclerosing cholangitis as a result of liver complications, he needs to undergo a colonoscopy every one to two years after ulcerative colitis is diagnosed.**

**Do we need surgery to treat ulcerative colitis?** **Perhaps, one out of three people with ulcerative colitis will need surgery to treat this problem in some cases. In this surgery, the doctor removes the colon and rectum to treat ulcerative colitis. After the rectum and colon are removed, the body can no longer dispose of waste materials by itself, and in this situation, the doctor performs two types of surgical procedures to remove waste materials from the body:** - ** In one method, the doctor removes the large intestine such as the rectum. After this procedure, the body cannot dispose of solid waste by itself. In this method, the doctor creates a small hole on the abdominal wall, then removes the end of the small intestine from that hole so that the waste materials can leave the body. A bag is placed on the open part of the abdomen to collect the waste material. You may need to empty it several times during the day.** - **The doctor connects the end of the small intestine to the anus and creates an internal bag so that the waste materials are collected in the bag and exit the anus as usual.** **The method the doctor uses to do this depends on your symptoms and their severity, your age, and how the disease affects your quality of life, such as the type of activities you do.**

**\*Gastroenterology specialist in Mashhad\***