Inflammatory bowel disease

Introduction

Inflammatory intestinal disease (IBD) is a group of chronic disorders characteristic of inflammation of the digestive system, which is leading to symptoms such as abdominal pain, diarrhea, fatigue and weight loss. This mainly affects the intestines and can cause long -term complications when untreated. The exact cause is unknown, but genetic, immune and environmental factors play an important role.

Types of Inflammatory bowel disease

Crohn’s Disease

Crohn's disease causes deep inflammation anywhere in the digestive system, often severely affects the absorption of nutrients.

Ulcerative Colitis

Ulcerative colitis causes frequent inflammation in the colon and rectum, causing bloody diarrhea and cramps.

Microscopic Colitis

Microscopic colitis leads to chronic watery diarrhea, diagnosed through microscopic examination of colon tissue samples.

Indeterminate Colitis

Indeterminate colitis shows overlapping features of Crohn’s and ulcerative colitis, requiring further evaluation for diagnosis.

Causes of Inflammatory bowel disease

Genetic factor plays an important role, as IBD often moves in families and increases sensitivity.
A highly active immune system accidentally attacks healthy intestinal cells, causing chronic inflammation.
Highly unhealthy diets in processed foods, fat and sugars can trigger intestinal inflammation.
Environmental factors such as pollution, lifestyle and industrialization contribute to high IBD risk.
The imbalance in the intestine microbyota affects digestion and weakens intestinal immunity, deteriorating inflammatory reactions.
Smoking increases the risk and severity of Crohn's disease, but may slightly reduce the risk of ulcerative colitis.
Excessive stress can affect intestinal-brain interaction, deteriorating and provoking IBD symptoms.
Some infections can irritate the intestinal lining, trigger abnormal immune responses and inflammation.
The use of nonsteroidal anti-inflammatory drugs (NSAID) can disturb the digestive system, which can increase the risk of inflammation.
Vitamin D deficiency and low sunlight risk is associated with high IBD growth rates.

Clinical features of Inflammatory bowel disease:

Abdominal Pain and Cramping

Patients experience persistent abdominal pain and cramping, usually in the lower abdomen, caused by inflammation and bowel wall irritation.

Chronic Diarrhea

Frequent loose or watery stools occur, often accompanied by urgency and mucus, due to intestinal inflammation and poor nutrient absorption.

Rectal Bleeding

Inflammation and ulcers in the intestinal lining cause bleeding, resulting in blood-streaked stools and increasing the risk of anemia.

Weight Loss and Fatigue

Ongoing inflammation, nutrient malabsorption, and appetite loss lead to significant weight reduction, persistent weakness, and chronic tiredness in patients.

Fever and Malaise

Systemic inflammation triggers low-grade fever, malaise, and a general feeling of unwellness during active flare-ups of the disease.

Symptoms associated with Inflammatory bowel disease

Constant or recurring abdominal pain and cramps due to intestinal inflammation.

Repeatedly, loose, and water stools lead to chronic diarrhea.

The presence of blood or mucus in the stool due to intestinal ulcers.

Unpartned weight loss due to absorption of poor nutrients and loss of appetite.

Constant fatigue and weakness as a result of chronic inflammation and anemia.

Low desire to eat due to stomach discomfort and digestive problems.

Low-grain fever occurring during the flare of intestinal inflammation.

Combined pain and inflammation as an expression of an additional-enemies of IBD.

Investigations in Inflammatory bowel disease

A CBC test helps detect anemia, infections, and inflammation associated with IBD. Low hemoglobin levels indicate blood loss, while elevated white blood cell counts suggest active inflammation or infection. Platelet count may also be increased due to the body’s inflammatory response in IBD.

These inflammatory markers are used to assess the level of systemic inflammation. Elevated ESR and CRP levels indicate active disease and help monitor treatment response. They are non-specific but play an important role in identifying the severity of IBD.

Stool analysis detects infections, blood, and inflammatory markers like calprotectin or lactoferrin. It helps distinguish IBD from other causes of diarrhea, such as infections or irritable bowel syndrome (IBS). High calprotectin levels usually indicate ongoing inflammation in the intestines.

Colonoscopy is the gold standard for diagnosing IBD. It allows direct visualization of intestinal inflammation, ulcers, and bleeding. Biopsy samples are collected to confirm the diagnosis and differentiate between Crohn’s disease and ulcerative colitis based on microscopic examination of tissues.

This investigation examines only the rectum and lower colon. It is less invasive than colonoscopy and useful during acute flare-ups when a full colonoscopy may be risky. Tissue samples may also be taken for histological confirmation and assessment of disease extent.

In some cases, especially with Crohn’s disease, inflammation may affect the upper gastrointestinal tract. Upper endoscopy helps visualize the esophagus, stomach, and duodenum. It aids in detecting ulcers, strictures, and other abnormalities that are not visible through colonoscopy alone.

This technique uses a small, swallowable camera capsule to capture images of the small intestine, which is difficult to access through traditional endoscopy. It helps identify inflammation, ulcers, or bleeding in areas not reachable by standard procedures, especially in suspected Crohn’s disease.

Cross-sectional imaging techniques like CT and MRI enterography are used to visualize bowel wall thickening, fistulas, abscesses, and extra-intestinal complications. MRI is often preferred due to its safety and detailed imaging capabilities, especially in evaluating small bowel involvement in Crohn’s disease.

These radiological studies involve ingesting or injecting a contrast material to outline the intestines on X-rays. They help detect strictures, fistulas, or structural abnormalities. Although less commonly used today due to advanced imaging techniques, they can still be useful in certain scenarios.

Blood tests may detect antibodies like pANCA and ASCA, which help differentiate between ulcerative colitis and Crohn’s disease. Genetic testing can identify susceptibility genes associated with IBD, although these tests are supplementary and not used alone for diagnosis.