colonic mucosa,
COLLAPSE
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Inflammatory bowel disease (IBD) is made up of two chronic relapsing inflammatory disorders, Ulcerative colitis (UC), and Crohn disease (CD). UC is inflammation that is found in the colonic mucosa, whereas CD can affect any part of the gastrointestinal tract (Huether & McCance, 2017). The exact pathophysiology of UC is unknown, but the condition is probably caused by an inappropriate immune response to an unknown environmental stimulus within the colon (Ford, Moayyedi, & Hanauer, 2013). Chronic inflammation from T-cell activation leading to tissue injury is implicated in the pathogenesis of Crohn disease (Ghazi, 2018). Patients with UC and CD present with abdominal pain, diarrhea, rectal bleeding, and weight loss. Additionally, patients with UC may also suffer from urgency, fever, dehydration, and anemia (Huether & McCance, 2017).
Irritable bowel syndrome (IBS) is a condition of abdominal pain and altered bowel habits without any organic pathological process or specific motility or structural abnormalities (Hammer & McPhee, 2019). The pathophysiology of IBS is unknown, but it is thought to be from altered gastrointestinal motility, visceral hyperalgesia, and psychopathology (Lehrer, 2018). Patients complain of abdominal pain, bloating, constipation, and/or diarrhea.
Both of these conditions have very similar symptoms, and their causes are speculated. Testing can be done to confirm IBD, but IBS is diagnosed by excluding other conditions. Treatments for IBD include 5-aminosalicylate therapy followed by steroids if the condition is mild. For worsening disease, the patient may require Thioprine and immunomodulatory agents. If patients have severe disease, they may require surgery, intravenous fluids (IV) or possibly total parenteral nutrition (Huether & McCance, 2017). Patients with IBS may be treated with laxatives, fiber, antidiarrheals, antidepressants, prosecretory drugs, anti-spasmodic, visceral analgesics, and serotonin agonists or antagonists (Huether & McCance, 2017). Most of the medications are not used in both IBS and IBD, but if the patient has continuous diarrhea, they may require IV fluids and possibly electrolyte replacement.
Several of the genes that may be associated with ulcerative colitis are involved in the protective function of the intestines. Changes in the intestinal lining’s protective function or an abnormal immune response to the normal bacteria in the digestive tract, both may be influenced by genetic variations. Researchers have identified at least 200 genetic variations that influence Crohn disease risk. The majority of these variations are thought to act by subtly changing the amount, timing, and location of gene activity (Genetics Home Reference, 2019). Genetic changes are not well documented in IBS, but it runs in families, so a genetic link is still being researched. When patients are diagnosed with these disorders, they should be educated there is a genetic link, and they may pass on the disease if they procreate.
References
Ford, A. C., Moayyedi, P., & Hanauer, S. B. (2013). Ulcerative colitis. BMJ,346, 29-36.
Genetics Home Reference. (2019). Crohn disease. Retrieved from https://ghr.nlm.nih.gov/condition/crohn-disease#genes
Ghazi, L. J. (2018). Crohn Disease. Retrieved from https://emedicine.medscape.com/article/172940-overview#a3
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of Disease: An Introduction to Clinical Medicine(8th ed.). New York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology(6th ed.). St. Louis, MO: Elsevier.
Lehrer, J. K. (2018). Irritable Bowel Syndrome. Retrieved from https://emedicine.medscape.com/article/180389-overview#a3
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