Inflammatory bowel disease
Ahmed Shalabi, MD, is a colorectal surgeon on staff at Banner Del E. Webb Medical Center in Sun City West. His office can be reached at (623) 974-7858.
Question: My husband has episodes of abdominal pain and diarrhea that keep getting worse and lately include blood in his stool. He had a colonoscopy and gave tissue samples. The doctor says it might be inflammatory bowel disease. What is that?
Answer: While I can’t be sure of the reason for your husband’s symptoms without seeing his biopsy results, what you describe does sound like Inflammatory Bowel Disease (IBD), a group of disorders that cause chronic inflammation of the digestive tract.
The inflammation (redness and swelling) of the intestinal lining leads to severe abdominal pain and bloody or black diarrhea. Inflammation lasts a long time and usually comes back over and over again.
Nearly two million people in the United States are affected by IBD, with the two most common types being ulcerative colitis and Crohn’s disease. Ulcerative colitis is limited to the colon and affects only the innermost layer of tissue lining the colon in a continuous pattern, almost like a carpet. Inflammation begins in the rectum and then spreads to other segments of the colon. Crohn’s disease can affect any part of the digestive tract, from the mouth to the anus, though it most commonly affects the small intestine and/or the colon. Crohn’s disease affects the entire thickness of the bowel walls, which explains frequent complications with abscesses and fistulas, which are abnormal connections between two organs that don’t normally connect. Both ulcerative colitis and Crohn’s disease include active periods (when inflammation is present) and periods of remission (when inflammation is absent or minor).
While the cause of IBD is unknown, research suggests that it is related to a genetic defect in how the intestinal immune system uses inflammation to respond to an offensive agent like a bacterium, virus or certain food protein that is tolerated by most people. Inflammation continues without control, causing damage to the intestinal wall that leads to bloody diarrhea, abdominal pain, fever and weight loss.
Studies show that IBD ordinarily occurs in northern countries with cooler temperatures, and it appears to be most prevalent among individuals who led hyper-clean lifestyles with limited exposure to dirt and germs in early childhood. Genetics also play an important role. Individuals who have a first degree relative (e.g. mother, father or sibling) with IBD are 10 times more likely to develop the disease.
IBD, which has no cure, is usually managed by a care team that includes a family doctor, gastroenterologist and colorectal surgeon. Medication is used to control the disease by reducing the frequency of flare-ups and killing germs that may be present. When medication alone cannot control symptoms, surgery may be necessary. Surgical options vary based on the type, stage and severity of the disease. Longstanding inflammation has been shown to cause joint problems and even certain types of cancer.