Chronic inflammatory bowel disease

What is chronic inflammatory bowel disease?

Crohn’s disease and ulcerative colitis are the two main chronic inflammatory bowel diseases. They are characterised by an episodic progress: phases of illness with inflammatory activity are often interrupted by periods without any symptoms. These intervals of remission may last for a long time.

Even today it is still uncertain why chronic bowel diseases occur. A complete cure is not possible with the current state of knowledge.

Characteristic features of Crohn’s disease

Crohn’s disease may affect all parts of the digestive system. The inflammation may spread throughout all layers of the walls of the intestinal sections affected. The spread is irregular, with alternating healthy and inflammatory sections.

Crohn’s disease usually appears for the first time between the ages of 15 and 35. It affects men and women to roughly the same extent. In Germany, about five new cases of Crohn‘s disease occur per 100,000 people each year. It is not possible to cure Crohn’s disease today, only to alleviate the symptoms.

Crohn’s disease is a serious illness. Although normal everyday life is possible in the remission periods, an acute episode is often not only painful, but also forces the patient to stay in bed or even requires admission to hospital. Crohn’s disease increases the risk of developing bowel cancer.

Characteristic features of ulcerative colitis

In ulcerative colitis, inflammation is restricted to the large intestine (colon) and is episodic. It primarily affects the superficial mucous membrane linings in the large intestine. The inflammation spreads uniformly from the rectum along the large intestine in the direction of the mouth. Inflammatory ulcers may develop that bleed easily. Typical signs of the disease are blood in the stool, diarrhoea and abdominal pain.

Ulcerative colitis is a serious illness. Although normal everyday life is possible in the remission periods, an acute episode is often not only painful, but forces the patient to stay in bed or even requires admission to hospital. Ulcerative colitis increases the risk of developing bowel cancer.

Young adults between 16 and 25 years of age are more likely to suffer from ulcerative colitis. The disease occurs about four times per 100,000 people each year in Germany. Men are slightly more frequently affected than women. Children may also suffer from this disease.

Physical symptoms of chronic inflammatory bowel disease

Typical symptoms are diarrhoea and abdominal pain or cramps. Mucus and blood may also be excreted. A characteristic intestinal blockage may occur. In addition, the patient may suffer from symptoms such as fever, weight loss, fatigue and exhaustion. Functional performance is often significantly impaired during an acute episode.

Both diseases also result in changes in regions outside the digestive system in about half of patients: the areas particularly at risk are joints, skin, eyes, liver and bile ducts.

What are the causes and risks for the development of chronic inflammatory bowel disease?

The precise cause of chronic inflammatory bowel disease has not yet been clarified. However, it is considered certain that the inflammations are caused by the interaction of various factors:

Ulcerative colitis and Crohn’s disease are not typical hereditary diseases, but various genes do seem to contain the basis for a degree of susceptibility to these diseases.

It is likely that there is a malfunction of the immune system in dealing with bacteria in the intestinal flora. Dietary habits may cause the diseases. Most of the patients are intolerant to certain foods. Experts suspect that smoking increases the risk of developing the diseases. Psychosocial stress is suspected of activating chronic inflammatory bowel disease if someone is predisposed to its development.

What role does lifestyle play in chronic inflammatory bowel disease?

There is no special diet or nutritional intervention that will lead to remission of Crohn’s disease or ulcerative colitis. However, the symptoms during periods of acute inflammation can be alleviated by temporarily switching to an easily digested, low-fibre diet. Intolerances to certain foods are also present in many cases.

Many patients develop specific deficiencies in the course of the disease, such as anaemia, iron or folic acid deficiency or reduced bone density. There are various supportive products available that might ameliorate these symptoms.

Patients should always ensure sufficient recovery periods in their everyday lives and avoid stress where possible.

How is chronic inflammatory bowel disease diagnosed?

In the course of a physical examination, the doctor checks whether putting pressure on the abdomen results in pain for the patient. He also examines the patient's mouth and anus for the typical signs of the disease.

A blood test indicates the severity of the intestinal inflammation and the extent of blood loss. Inflammation parameters (CRP) are measured and a blood picture is drawn up. The doctor may also examine the blood for elevated liver values.

The doctor will further examine the abdomen in an ultrasound scan (sonography), both for initial diagnostic purposes and to diagnose the progress of the disease.

A bacteriological examination of the stool is used to rule out the possibility of an infection with pathological intestinal bacteria causing the symptoms.

The most common method of investigation to diagnose Crohn’s disease or ulcerative colitis is a colonoscopy. This involves taking samples of the mucous membrane from each investigated segment of the bowel and assessing these in the laboratory to determine whether an inflammation is present and what its characteristics are.

In some cases, the diagnostic procedure must be repeated in the course of the disease. When making a diagnosis it is important to rule out other inflammatory, toxic, vascular- or pathogen-induced causes.

How is chronic inflammatory bowel disease treated?

The primary treatment for chronic inflammatory bowel disease involves the use of drugs. The aim of the treatment is to alleviate the symptoms for the patient. The inflammatory activity must be suppressed and the aim is to achieve long periods without symptoms.

Optimal treatment always depends on the severity, the pattern of distribution of the disease, response to previous treatment and the individual situation of the patient.

In some cases, chronic inflammatory bowel disease can no longer be controlled using drugs. In this event, or if bowel cancer or precursors of cancer have been detected, surgery cannot be avoided.