The digestive system is a set of organs (including the stomach, large and small intestines, rectum, and others) that convert the foods we eat into nutrients and absorb these nutrients into the bloodstream to fuel our bodies. We seldom notice its workings unless something goes wrong, as in the case of inflammatory bowel disease (IBD). It's estimated that up to 1 million Americans have inflammatory bowel disease. It occurs most frequently in people ages 15 to 30, but it can also affect younger children and older people. And there are significantly more reported cases in western Europe and North America than in other parts of the world.
What Is Inflammatory Bowel Disease?
Inflammatory bowel disease (which is not the same thing as irritable bowel syndrome, or IBS) refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis and Crohn's disease. Although the diseases have some features in common, there are some important differences.
Ulcerative colitis is an inflammatory disease of the large intestine, also called the colon. In ulcerative colitis, the inner lining - or mucosa - of the intestine becomes inflamed (meaning the lining of the intestinal wall reddens and swells) and develops ulcers (an ulcer is a sore, which means it's an open, painful wound). Ulcerative colitis is often the most severe in the rectal area, which can cause frequent diarrhea. Mucus and blood often appear in the stool (feces or poop) if the lining of the colon is damaged.
Crohn's disease differs from ulcerative colitis in the areas of the bowel it involves - it most commonly affects the last part of the small intestine (called the terminal ileum) and parts of the large intestine. However, Crohn's disease isn't limited to these areas and can attack any part of the digestive tract. Crohn's disease causes inflammation that extends much deeper into the layers of the intestinal wall than ulcerative colitis does. Crohn's disease generally tends to involve the entire bowel wall, whereas ulcerative colitis affects only the lining of the bowel.
What Causes It?
Medical research hasn't determined yet what causes inflammatory bowel disease. But researchers believe that a number of factors may be involved, such as the environment, diet, and possibly genetics.
Current evidence suggests that there's likely a genetic defect that affects how our immune system works and how the inflammation is turned on and off in those people with inflammatory bowel disease, in response to an offending agent, like bacteria, a virus, or a protein in food.
The problem in people with the disease is that the inflammation gets turned on, but it doesn't get turned off. Medical evidence also indicates that smoking may enhance the likelihood of developing Crohn's disease.
What Are the Signs and Symptoms?
The most common symptoms of both ulcerative colitis and Crohn's disease are diarrhea and abdominal pain. Diarrhea can range from mild to severe (as many as 20 or more trips to the bathroom a day). If the diarrhea is extreme, it can lead to dehydration, rapid heartbeat, and a drop in blood pressure. And continued loss of small amounts of blood in the stool can lead to anemia.
At times, those with inflammatory bowel disease may also have constipation. With Crohn's disease, this can happen as a result of a partial obstruction (called stricture) in the intestines. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum (also known as proctitis).
Because of the loss of fluid and nutrients from diarrhea and chronic inflammation of the bowel, someone with inflammatory bowel disease may also experience fever, fatigue, weight loss, dehydration, and malnutrition. Pain usually results from the abdominal cramping, which is caused by irritation of the nerves and muscles that control intestinal contractions.
But inflammatory bowel disease can cause other health problems that occur outside the digestive system. Although medical researchers don't know why these complications happen, some people with the disease may show signs of inflammation elsewhere in the body, such as in the joints, eyes, skin, and liver. Skin tags that look like hemorrhoids or abscesses may also develop around the anus.
Inflammatory bowel disease may also cause a delay in puberty or growth problems for some kids and teens with the condition, because it can interfere with a person getting nutrients from the foods he or she eats.
How Is It Diagnosed?
Inflammatory bowel disease can be hard to diagnose because there may be no symptoms, even if the person's bowel has become increasingly damaged for years. Once symptoms do appear, they often resemble those of other conditions, which may make it difficult for doctors to diagnose.
If your child has any of the symptoms of the disease, it's important to see your child's doctor. In addition to doing a physical examination, the doctor will ask you and your child about any concerns and symptoms your child has, your child's past health, your family's health, any medications your child is taking, any allergies your child may have, and other issues. This is called the medical history.
After hearing your child's symptoms, if the doctor suspects inflammatory bowel disease, he or she may suggest certain tests. Blood tests may be done to determine if there are signs of inflammation in your child's body, which are often present with the disease. The doctor may also check for anemia and for other causes of your symptoms, like infection.
The doctor will examine your child's stool for the presence of blood. He or she may look at your child's colon with an instrument called an endoscope. Also called a colonoscope or coloscope, this instrument is a long, thin tube inserted through the anus and attached to a TV monitor. This procedure is called a colonoscopy, which allows the doctor to see inflammation, bleeding, or ulcers on the wall of your child's colon.
The doctor may also do a test called an upper endoscopy to check the esophagus, stomach, and upper small intestine for inflammation, bleeding, or ulcers. During the exam, the doctor may perform a biopsy, which involves taking a small sample of tissue from part of the colon so it can be viewed with a microscope or sent to a laboratory for other kinds of analysis.
A doctor may also order a barium study of the intestines. This procedure involves drinking a thick white solution called barium, which shows up white on an X-ray film, allowing a doctor to get a better look at what's going on in a person's intestines.
How Is It Treated?
Drug treatment is the main method for relieving the symptoms of both ulcerative colitis and Crohn's disease. Great progress is being made in the development of medications for treating inflammatory bowel disease. Your child's doctor may prescribe:
- anti-inflammatory drugs (used to decrease the inflammation caused by the disease)
- immunosuppressive agents (which work to restrain the immune system from attacking the body's own tissues and causing further inflammation)
If a child with inflammatory bowel disease doesn't respond to either of these medicines, your child's doctor may suggest surgery. But surgical procedures for ulcerative colitis and Crohn's disease are quite different.
With Crohn's disease, doctors make every attempt to avoid surgery because of the recurring nature of the disease. There's also a concern that an aggressive surgical approach to Crohn's disease will cause further complications, such as short bowel syndrome (which involves growth failure and a reduced ability to absorb nutrients).
In the case of ulcerative colitis, removal of the colon (large intestine) may be necessary, along with a surgical procedure called an ileoanal anastomosis (also called an ileoanal pull-through) in which doctors form a pouch from the small bowel to collect stool in the pelvis. This allows the stool to pass through the anus.
Caring for Your Child
How can you help your child cope with inflammatory bowel disease? Because of the unpredictable nature of the disease, it's easy to feel helpless. Your child will likely be fatigued, irritable, and anxious - the best way to help your child is to seek treatment as soon as symptoms appear to help relieve as much discomfort as possible.
Although it can be difficult to get any child to eat properly, a balanced diet with adequate calories becomes even more important for kids with inflammatory bowel disease. Diarrhea, loss of nutrients, and the side effects of drug treatment may all lead to malnutrition.
Encourage your child to eat small meals throughout the day to help lessen any symptoms. Pack nutritious snacks and lunches so your child won't be tempted to indulge in junk food that's high in fat and sodium, which can intensify the symptoms of the disease. Eventually, your child may be able to determine which foods provoke symptoms and learn to avoid those foods.
If your child begins to lose weight quickly, has repeated bouts of diarrhea, or complains of abdominal cramping, inflammatory bowel disease may be the cause. Call your child's doctor if you notice any of these symptoms to ensure that your child gets proper evaluation and treatment.
Inflammatory bowel disease is a serious condition, but with proper treatment and medical care, your child can enjoy a productive, normal life.