Inflammatory Bowel Disease (IBD)

Introduction

Inflammatory bowel disease (IBD) is the collective term used for two medical conditions- Crohn’s disease and ulcerative colitis. These conditions are usually characterized by a chronic swelling of the gastrointestinal (GI) tract. Delayed diagnosis and treatment of IBD can lead to severe damage to the gastrointestinal tract. While the leading causes of IBD have not been precisely identified, practitioners believe it results from a weak immune system (Rampton & Shanahan, 2021). The condition is diagnosed by a combination of endoscopy or colonoscopy and different forms of imaging studies, blood tests, and stool samples. Finally, IBD is treated through various medications; for example, corticosteroids, 5-aminosalicylic acids, biologics, or surgeries on affected parts. This paper concisely discusses recent literature on the epidemiology, and disease process, including causes, diagnosis, and treatment of IBD.

Epidemiology

Although inflammatory bowel disease is a global menace, its prevalence and distribution differ across different regions. For instance, the prevalence in North America is relatively higher than in the South. In the US precisely, it is estimated that more than a million people suffer from IBD (Rampton & Shanahan, 2021). In addition, an estimated 30,000 emerging cases are reported annually. Both Crohn’s disease and ulcerative colitis demonstrate even distribution tendencies.

Again, the peak age of the condition among patients occurs between 15 and 30 years; however, the disease can occur at any age. Data reveals that 10 percent of reported cases occur in patients below the age of 18 years (Rampton & Shanahan, 2021). Both Crohn’s disease and ulcerative colitis demonstrate a bimodal age distribution. The subsequent peak affects individuals between 50 and 70 years, with ulcerative colitis being relatively higher in males than in females (Rampton & Shanahan, 2021). On the other hand, cases of Crohn’s disease are slightly higher in females, with the ratio range of women to men (1:1 to 1.8:1). The distribution of both conditions tends to be higher among members of social and economic groups.

Finally, IBD preference is higher in members of Caucasian and Ashkenazi Jewish origins than in people from other origins (Rampton & Shanahan, 2021). However, the disease’s distribution among racial and ethnic backgrounds has not been precisely identified because it is dynamic. In the past, most people believed the disease was more prevalent in racial and ethnic minority populations. However, the perception is slightly fading, with increased reported cases indicating a significant number of African Americans and South Asian immigrants as victims recently.

Pathophysiology

The pathogenesis of IBD depends majorly on the intestinal immune system. The intestinal epithelium contains sealed intercellular junctions that prevent the entry of bacteria into circulation. Primary barrier function failure or severe inflammations renders intercellular junctions defective, leaving affected individuals dangerously perceptible to IBD. Also, the production of mucus and secretion of a-defensins with inherent antibacterial activity by goblet and paneth cells acts as additional defense mechanisms against IBD (Rampton & Shanahan, 2021). Increased inflammation reactions sever the epithelium and aggravate exposure to intestinal microbes; consequently, inflammations deteriorate.

Both UC and CD are distinct in several ways. In ulcerative colitis, mucosal swelling causes edema, ulcers, electrolyte losses, and swelling (Rampton & Shanahan, 2021). The swelling begins in the rectum and advances to the proximal colon in a sporadic fashion. However, in Crohn’s disease, there are skip abrasions. Medical professionals estimate that the disease remains within the rectum for 20 percent of patients with UC. Fifteen percent of patients exhibit pancolitis. As the condition advances to chronic levels, the rigidity of the colon increases and is short, with a pipe-like appearance on a barium enema.

Additionally, CD can affect any part of the gastrointestinal tract and may prompt strictures and swellings or cause the development of fistulas. The fundamental characteristic of CD is that it affects all layers of the bowel (Rampton & Shanahan, 2021). In its advanced phases, the mucosa shows a cobblestone appearance between the normal mucosa due to linear ulcers. Lastly, Crohn’s condition typically affects the colon and ileum with a negligible case spreading to the gastroduodenal segments.

Finally, ulcerative colitis predisposes its victims to the extra-intestinal involvement of the skin, bones, and eyes, with inflammatory arthropathies and primary sclerosing cholangitis leading on the list. Similarly, Crohn’s disease predisposes its victims to extra-intestinal conditions; for instance, arthritis, uveitis, and erythema nodosum, among other manifestations (Rampton & Shanahan, 2021). As a final point, the malabsorption of salts and fatty acids leads to the likelihood of kidney stones among patients with CD.

Diagnosis and treatment

Diagnosing IBD is a multifaceted task requiring a combination of clinic and imaging findings, endoscopic biopsies, and laboratory markers for swellings. Also, a blood test can be initiated to determine anemia, leukocytosis, and albumin levels (Rampton & Shanahan, 2021). Physicians may also conduct abdominal X-rays to identify the presence of free air and bowel obstruction. Finally, conducting an endoscopy evaluation to get biopsies to confirm a diagnosis of inflammatory bowel disease is imperative.

Treatment of IBD depends mainly on the disease’s severity phase. The three management stages of IBD are mild, moderate, or severe. Aminosalicylate agents are recommended most for UC patients with mild disease confined to the rectum, while glucocorticoids or immunomodulators are the preferred option for patients with moderate disease. However, 25 percent of patients with UC require a total colectomy for the chronic case. On the other hand, interventions for patients with mild CD may begin with mesalamine followed by oral budesonide (Rampton & Shanahan, 2021). Physicians highly recommend anti-tumor necrosis factor (anti-TNF) for patients with moderate disease, while surgical treatment is viable for individuals with severe CD.

Conclusion

In sum, IBD is a severe condition requiring early diagnosis and intervention to mitigate patient severity.

References

Rampton, D. S., & Shanahan, F. (2021). Inflammatory bowel disease. Karger.