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Gastrointestinal Diseases

Background / Definition

Gastrointestinal Diseases or Digestive diseases are conditions affecting the gastrointestinal (GI) tract. One major type of digestive disease is called inflammatory bowel disease (IBD). Another type of digestive disease is called functional gastrointestinal (GI) disorder.

Inflammatory bowel disease (IBD) is a broad term that describes conditions with chronic or recurring immune response and inflammation of the gastrointestinal tract. In people with IBD the immune system mistakes food, bacteria, and other materials in the intestine for foreign substances and it attacks the cells of the intestines. In the process, the body sends white blood cells into the lining of the intestines where they produce chronic inflammation. IBD is a condition that gets worse over time and causes severe gastrointestinal symptoms that can affect the quality of life. The two most common inflammatory bowel diseases are ulcerative colitis and Crohn’s disease. Both illnesses are characterized by an abnormal response to the body’s immune system.

Crohn’s disease is a condition of chronic inflammation potentially involving any location of the gastrointestinal tract, but it often affects the end of the small bowel and the beginning of the large bowel. All layers of the intestine may be involved and there can be normal healthy bowel between patches of diseased bowel. Crohn’s disease may affect as many as 700,000 Americans. Men and women are equally likely to be affected and while the disease can occur at any age, it is more prevalent among adolescents and young adults between the ages of 15 to 35.

Ulcerative colitis is a chronic gastrointestinal disorder of the large intestine, also known as the colon. Ulcerative colitis only affects the lining of the colon. It may affect as many as 700,000 Americans. Men and Women are equally likely to be affected, and most people are diagnosed in their mid-30s. This disease can occur at any age and older men are more likely to be diagnosed than older women.

Functional gastrointestinal disorder is generally applied to disorders where the body’s normal activities in terms of the movement of the intestines, the sensitivity of the nerves of the intestines, or the way in which the brain controls some of these functions is impaired. However, there are no structural abnormalities that can be seen by tests. People with a functional GI disorder have frequent symptoms; however the GI tract does not become damaged. Thus it is identified by the characteristics of the symptoms and infrequently, when needed. The most common type of functional gastrointestinal disorder is irritable bowel syndrome (IBS).

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, meaning symptoms are caused by changes in how the GI tract works. IBS is a group of symptoms that occur together. In the past IBS was called spastic colon, nervous colon, and spastic bowel. The name was changed to reflect the understanding that the disorder has both physical and mental causes. IBS is best understood as a long-term or recurrent disorder of gastrointestinal functioning. It usually involves the large intestine (colon) and small intestine with disturbances of intestinal/bowel (gut) motor function (motility) and sensation. These gut related activities are regulated by the brain. This may also be impaired, which is why IBS is often called a brain-gut order.

Causes

The causes of Crohn’s disease are not well understood. Diet and stress may aggravate the disease, but they do not cause the disease on their own. Recent research suggests hereditary, genetics, and/or environmental factors contribute to the development of the disease.

Crohn’s disease tends to run in families. Studies have shown that 5 to 20 percent of affected individuals have a first degree relative like a parent, child, or sibling with the disease. The environment in which a person lives also appears to play a role. Crohn’s disease is more common in developed countries rather than undeveloped countries, in urban rather than rural areas, and in northern rather than southern climates.

Ulcerative colitis may be the result of an interaction of a virus or bacterial infection of the colon and the body’s natural immune system response. The exact cause of ulcerative colitis is unknown, but researchers believe that overactive intestinal immune system, genes, and environment are factors that may play a role in causing ulcerative colitis. Stress and certain foods may increase a person’s chance to trigger or worsen symptoms.

Ulcerative colitis studies show up to 20 percent of people with the disease will also have a close relative with the disease. The disease is more common among white people of European origin and among people of Jewish heritage.

Doctors are not sure what causes Irritable Bowel Syndrome (IBS). Researchers are studying the following possible causes of IBS:

  • Brain-gut signal problems. Signals between the brain and the nerves of the gut, small and large intestines, control how the gut works. Problems with brain-gut signals may cause IBS symptoms, such as change in bowel habits or pain and discomfort.
  • Colon muscle problems. The muscles in the colon may contract or tighten too much. These contractions may move stool through the gut too quickly causing cramping and diarrhea, or slow the movement of stool causing constipation during or shortly after a meal.
  • Sensitive nerves. The nerves in the gut may be extra sensitive, causing more pain or discomfort that normal when gas or stool is in the gut.
  • Mental health issues. Psychological or mental health issues such as anxiety or depression may be related to IBS in some people.
  • Infections. A bacterial infection in the GI tract may cause some people to develop IBS.
  • Small intestinal bacterial overgrowth. These bacteria can produce extra gas and may also cause diarrhea and weight loss.
  • Although stress does not cause IBS, if you already have IBS, stress can make your systems worse.

Symptoms

Crohn’s Disease can affect any part of the GI tract. While symptoms vary from patient to patient and some may be more common than others, symptoms include:

  • Pain in the abdomen, often in the lower right side
  • Persistent diarrhea
  • Cramping abdominal pain
  • Fever
  • Rectal bleeding (at times)
  • Loss of appetite and weight loss
  • Fatigue
  • Children may have delayed development and stunted growth
  • Anemia
  • Joint pain or soreness
  • Eye irritation
  • Skin changes that involve red, tender bumps under the skin

About half of all patients with ulcerative colitis experience mild symptoms. Symptoms of ulcerative colitis do tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all. Signs and symptoms of ulcerative colitis include:

  • Diarrhea with blood or pus
  • Abdominal discomfort and cramps
  • Rectal bleeding
  • Urgent need to have a bowel movement
  • Feeling tired
  • Nausea or loss of appetite
  • Weight loss
  • Fever
  • Anemia
  • Joint pain or soreness
  • Eye irritation
  • Certain rashes

Irritable bowel syndrome (IBS) is a chronic disorder, meaning it lasts a long time and symptoms may come and go. The most common symptoms of IBS include pain or discomfort in the abdomen, the area between the chest and hips, and changes in bowel habits. The pain or discomfort goes away after a bowel movement. The changes in bowel habits with IBS may be diarrhea, constipation, or both. People often have symptoms after eating a meal. Other symptoms are whitish mucus in the stool, a swollen or bloated abdomen, or the feeling of not finishing a bowel movement. Although stress does not cause IBS, if IBS already exists stress cam make symptoms worse. While IBS can be painful, it doesn’t lead to other health problems or damage the GI tract.

Diagnosis

Crohn’s disease is characterized by a range of signs and symptoms, so there is no single test that can determine the diagnosis and the process can take some time. A Gastroenterologist or other health care provider can provide a diagnosis of Crohn’s Disease with the following tests:

  • Physical exam – During the physical exam the health care provider will take your medical and family history and ask you about your environment. They will ask if you have any family history of Crohn’s disease, what are your symptoms, current and past medical conditions, and current medications. They will also check for abdominal distension, or swelling, listens to sounds within the abdomen using a stethoscope, and they will tap on the abdomen to check for tenderness and pain.
  • Lab Tests – The health care provider may order blood or stool tests.
  • Upper and lower GI X-rays and CT scans – This process involves x-rays and fluoroscopy. Fluoroscopy is a form of x-ray that makes it possible to see the internal organs and their motion on a video monitor. This test is done at a hospital or an outpatient center. They may use Barium, a chemical that helps doctors see more details of your GI tract by increasing contrast of the x-ray image.
  • Intestinal Endoscopy and Biopsy – An endoscopy is the use of medical instruments to visually examine the interior of your colon with a small camera mounted to the end of a lighted tube. The three types of endoscopic examinations are colonoscopy which involves insertion of a flexible tube through the opening of the anus and allows for the examination of the colon, and upper endoscopy which involves the insertion of a flexible tube through the opening of the mouth down the esophagus into the stomach and as far as the duodenum the first part of the small intestine and capsule endoscopy which involves the patient swallowing a capsule containing a small camera. As the capsule passes through the GI system, the camera will record and transmit images to a small receiver device worn by the patient. In addition to the visual exam doctors will often obtain a biopsy of the colon or other affected areas by removing a small piece of tissue. The biopsied tissue are then analyzed to determine the presence of the disease.

A Gastroenterologist or other health care provider diagnoses ulcerative colitis by the following tests. In addition to making the initial diagnosis, the tests will also help determine the type of ulcerative colitis since each type has its own specific symptoms and associated complications.

  • Physical exam – During the physical exam the health care provider will take your medical and family history. They will ask about your symptoms, current and past medical conditions and medications. They will also check for abdominal distension, or swelling, listens to sounds within the abdomen using a stethoscope, and they will tap on the abdomen to check for tenderness and pain.
  • Lab Tests – The health care provider may order blood or stool tests. The blood test looks for makers that show ongoing inflammation, and low albumin, or protein- common in patients with severe ulcerative colitis.
  • Endoscopy and Biopsy- Endoscopy is the use of medical instruments to visually examine the interior of the colon with a lighted tube that is inserted through the anus. There are two types of endoscopic examinations: a sigmoidoscopy which involves the insertion of a flexible instrument into the rectum and lower colon that allows the doctor to visualize the extent and degree of the inflammation in these areas, and a total colonoscopy is a similar exam, but it visualizes the entire colon and can show irritated and swollen tissue, ulcers, and abnormal growths such as polyps. During these procedures, the doctor may obtain a sample of affected tissue, called a biopsy. The biopsy tissues are then analyzed to determine the presence of disease.

A Gastroenterologist or other healthcare provider may be able to diagnose IBS based on the symptoms. The doctor may not need to do medical tests or may do a limited number of tests.

  • Physical exam – During the exam the doctor will ask about medial history, eating habits, and medicine use. The doctor can then use the symptom-based standards (Rome criteria): If the symptoms started at least 6 months ago, have had abdominal pain or discomfort at least 3 times a month for the past 3 months, and abdominal pain or discomfort has 2 out of the 3 features, pain or discomfort improves after a bowel movement, when the pain or discomfort starts there is a change in how often you have a bowel movement , when the pain or discomfort starts there is a change in the way your stool looks.
  • Lab test – The doctor may perform blood tests to make sure you don’t have other health problems.

IBS can have the same symptoms as other health problems, so more tests may be needed. If any blood tests suggest you may have another health problem your doctor may perform the following tests:

  • Stool Test- This tests for blood or parasites
  • Endoscopic examinations: a sigmoidoscopy which involves the insertion of a flexible instrument into the rectum and lower colon that allows the doctor to visualize the extent and degree of the inflammation in these areas, and a total colonoscopy is a similar exam, but it visualizes the entire colon and can show irritated and swollen tissue, ulcers, and abnormal growths such as polyps.

Treatments

Treatment for Crohn’s disease and other inflammatory bowel disease (IBD) varies, it can include the use of medication, alterations in diet and nutrition, bowel rest, and sometimes surgical procedures are needed to repair or remove the affected portions of the GI tract. A combination of treatment options can help stay in control of the disease and help lead to a full and rewarding life.

No medication cures Crohn’s disease, but many can reduce symptoms. The goals of medication therapy are inducing and maintaining remission, and improving the quality of life. Gastroenterologist or other healthcare provider will prescribe medications depending on the patient’s symptoms.

Some things to know about medications include:

  • Aminosalicylates are medications that help control inflammation.
  • Corticosteroids help reduce the activity of the immune system and decrease inflammation
  • Immunomodulators reduce immune system activity, resulting in less inflammation in the GI tract.
  • Biologic therapies are medications that target a protein made by the immune system, by neutralizing this protein it will decrease inflammation in the intestine.
  • Other medications may be used to treat the symptoms and or complications.

Other treatments include:

  • Diet and Nutrition – Patients with Crohn’s disease paying special attention to the diet may help reduce symptoms, replace lost nutrients, and promote healing. It is essential to maintain good nutrition because the disease often reduces the patient’s appetite while increasing the body’s energy needs. Additionally symptoms can reduce the body’s ability to absorb protein, fat, carbohydrates, water, vitamins, and minerals.
  • Bowel Rest- Sometimes Crohn’s disease symptoms are severe and a person may need to rest their bowels for a few days to several weeks. Bowel rest involves drinking only clear liquids or having no oral intake of food. The patient’s nutrients are delivered through a IV by a special catheter, or tube inserted into a vein in the patients arm. Some patients stay in the hospital or are able to receive the treatment at home.
  • Surgery- Even with proper medication and diet, as many as two-thirds to three-quarters people with Crohn’s disease will require surgery at some point during their lives. Surgery doesn’t cure the disease, it can conserve portions of the GI tract and return the patients to the best possible quality of life. Gastroenterologists most often recommend surgery to treat fistulas, bleeding that is life threatening, bowel obstructions, side effects from medications when they threaten a person’s life, symptoms when medications do not improve a person’s condition.

A surgeon can perform different types of operations to treat Crohn’s disease:

  • Small bowel resection – is surgery to remove part of a patient’s small intestine.
  • Subtotal colectomy – is also called a large bowel resection, is surgery to remove part of a patient’s large intestine.
  • Proctocolectomy and ileostomy- is surgery to remove a patient’s entire colon and rectum. An ileostomy is a stoma or opening in the abdomen that a surgeon creates form a part of the ileum. The surgeon brings the end of the ileum through an opening in the patient’s abdomen and attached it to the skin, creating an opening outside the body. A removable external collection pouch, called an ostomy pouch or appliance connects to the stoma and collects intestinal contents outside the patient’s body. Patients that have this type of surgery will have the ileostomy for the rest of their lives.

Treatment for ulcerative colitis and other inflammatory bowel disease (IBD) varies, it can include the use of medication, alterations in diet and nutrition, and sometimes surgical procedures are needed to repair or remove the affected portions of the GI tract. The primary goal in treating ulcerative colitis is to help patients regulate their immune system better. While there is no cure for ulcerative colitis and flare ups may recur, a combination of treatment options can help the patient stay in control of the disease and lead a full rewarding life.

No medication cures ulcerative colitis, many can reduce symptoms. The goals of medication therapy are inducing and maintaining remission, and improving the quality of life. Your gastroenterologist or other healthcare provider will prescribe medications depending on the patient’s symptoms.

  • Aminosalicylates are medications that help control inflammation.
  • Corticosteroids help reduce the activity of the immune system and decrease inflammation.
  • Immunomodulators reduce immune system activity, resulting in less inflammation in the GI tract.

Biologic therapies are medications that target a protein made by the immune system called tumor necrosis factor (TNF), by neutralizing the TNF the medication will decrease inflammation in the large intestine. Anti-TNF therapies work quickly to bring on remission, especially in patients who do not respond to other medications. These medications can be given through an IV or by injections.

Other medications may be used to treat the symptoms and or complications.

  • Diet and Nutrition – Patients with ulcerative colitis paying special attention to the diet may help reduce symptoms, replace lost nutrients, and promote healing. It is essential to maintain good nutrition because the disease often reduces the patient’s appetite while increasing the body’s energy needs. Additionally symptoms can reduce the body’s ability to absorb protein, fat, carbohydrates, water, vitamins, and minerals.
  • Surgery – In one quarter to one third of patients with ulcerative colitis, medical therapy is not completely successful or complications like colon cancer, dysplasia, or precancerous cells in the colon, megacolon or bleeding that is life threatening, no improvement in symptoms or condition despite treatment, continued dependency on steroids, side effects from medications that threaten the patient’s health. Under these circumstances, surgery may be considered. Ulcerative colitis is cured once the surgery is done.

A surgeon can perform 2 different types of surgery to remove a patient’s colon and treat ulcerative colitis:

  • Proctocolectomy and ileostomy – is surgery to remove a patient’s entire colon and rectum. An ileostomy is a stoma or opening in the abdomen that a surgeon creates form a part of the ileum. The surgeon brings the end of the ileum through an opening in the patient’s abdomen and attached it to the skin, creating an opening outside the body. A removable external collection pouch, called an ostomy pouch or appliance connects to the stoma and collects intestinal contents outside the patient’s body. Patients that have this type of surgery will have the ileostomy for the rest of their lives.
  • Proctocolectomy and ileanal reservoir – This surgery is a common alternative to an ileostomy and does not have a permanent stome. An ileoanal reservoir is an internal pouch made from the patient’s ileum. The ileoanal reservoir connects the ileum to the anus and it eliminates the need for the patient to wear an external ostomy appliance.

Irritable bowel syndrome is treated by relieving symptoms through changes in eating, diet, and nutrition, medications, probiotics, and psychological therapy.

Side Effects

Crohn’s disease treatments can cause side effects, but it is important not to change or stop the therapy without talking to their doctor or pharmacist. The most common side effects for the treatments of Crohn’s disease include:

  • Aminosalicylates side effects are abdominal pain, diarrhea, headaches, heartburn, nausea and vomiting.
  • Corticosteroids side effects are acne, higher chance of developing infections, bone mass loss, high blood glucose, high blood pressure, mood swings, and weight gain.
  • Immunomodulators side effects are a low white blood count, higher chance of infection, fatigue or feeling tired, nausea and vomiting, pancreatitis.
  • Biologic therapies side effects are a toxic reaction to the medication and a higher chance of developing infections particularly tuberculosis.

Ulcerative Colitis treatments can cause side effects, but it is important not to change or stop the therapy without talking to their doctor or pharmacist. The most common side effects for the treatments of ulcerative colitis include:

  • Aminosalicylates side effects are abdominal pain, diarrhea, headaches, heartburn, nausea and vomiting.
  • Corticosteroids side effects are acne, higher chance of developing infections, bone mass loss, high blood glucose, high blood pressure, mood swings, and weight gain.
  • Immunomodulators side effects are abnormal liver tests, low white blood count, higher chance of infection, fatigue or feeling tired, nausea and vomiting, pancreatitis, slightly increased chance of lymphoma, and slightly increased chance of nonmelanoma skin cancers.
  • Biologic therapies(anti-TNF therapies) side effects are higher chance of developing infections especially tuberculosis or fungal infection, skin cancer like melanoma, and psoriasis.

Symptoms

Crohn’s Disease can affect any part of the GI tract.  While symptoms vary from patient to patient and some may be more common than others, symptoms include:

  • Pain in the abdomen, often in the lower right side
  • Persistent diarrhea
  • Cramping abdominal pain
  • Fever
  • Rectal bleeding (at times)
  • Loss of appetite and weight loss
  • Fatigue
  • Children may have delayed development and stunted growth
  • Anemia
  • Joint pain or soreness
  • Eye irritation
  • Skin changes that involve red, tender bumps under the skin

About half of all patients with ulcerative colitis experience mild symptoms.  Symptoms of ulcerative colitis do tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all.  Signs and symptoms of ulcerative colitis include:

  • Diarrhea with blood or pus
  • Abdominal discomfort and cramps
  • Rectal bleeding
  • Urgent need to have a bowel movement
  • Feeling tired
  • Nausea or loss of appetite
  • Weight loss
  • Fever
  • Anemia
  • Joint pain or soreness
  • Eye irritation
  • Certain rashes

Irritable bowel syndrome (IBS) is a chronic disorder, meaning it lasts a long time and symptoms may come and go.  The most common symptoms of IBS include pain or discomfort in the abdomen, the area between the chest and hips, and changes in bowel habits.  The pain or discomfort goes away after a bowel movement.

The changes in bowel habits with IBS may be diarrhea, constipation, or both.  People often have symptoms after eating a meal.  Other symptoms are whitish mucus in the stool, a swollen or bloated abdomen, or the feeling of not finishing a bowel movement. Although stress does not cause IBS, if IBS already exists stress cam make symptoms worse.  While IBS can be painful, it doesn’t lead to other health problems or damage the GI tract.

Sources

American Gastroenterological Association
Centers for Disease Control
Crohn’s and Colitis Foundation of America
National Institute of Diabetes and Digestive and Kidney Diseases
International Foundation for Functional Gastrointestinal Disorders