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Vol. 66, No. 4 2015
Northeast Florida Medicine
DCMS online
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Patient Page
Patient Page
Inflammatory Bowel Disease
Reprinted with permission from Mark Fleisher, MD, Borland-Groover Clinic. For more information contact:
research@bgclinic.com.Inflammatory bowel disease (IBD) is a chronic inflammatory disorder potentially affecting any portion of the gastrointestinal
tract from the mouth to the anus. It is characterized by relapses and remissions and afflicts an estimated 500,000-2,000,000
people in the United States. The incidence of IBD is approximately equal in men and women. Most research has found the
age of onset in adolescence and young adulthood, although there is a second peak incidence between the ages of 50 and 60.
IBD is classified as two major disease entities:
•
Ulcerative colitis (UC)
is mucosal inflammation that affects only the colon; it may involve the entire colon or only the
distal colon/rectum. The severity of the inflammation can vary. Bloody diarrhea associated with mucosal inflammation
is a classic symptom. Other symptoms include urgency, tenesmus, weight loss, fatigue, fever and night sweats.
•
Crohn’s disease (CD),
in contrast to UC, can affect any segment of the gastrointestinal tract. It most often presents
in the ileum (ileitis), the ileum and the colon (ileocolitis) or colon alone (Crohn’s colitis). Patients with CD typically
have diarrhea, abdominal pain and weight loss; bleeding also often occurs. Although exacerbations and remissions
are difficult to predict, nearly all patients experience a recurrence within 10 years of the first episode.
Extraintestinal Manifestations:
• Mouth sores may develop during flares of Crohn’s disease or ulcerative colitis. These lesions are most commonly
between the gums and lower lip or on the sides and underneath the tongue. These lesions are typically painful.
• Skin lesions, most commonly affecting the lower extremities, may occur.
• Eye inflammation, known as uveitis or scleritis, occurs in up to five percent of those with Crohn’s disease or ulcerative
colitis. The symptoms of uveitis include floaters in the vision, eye pain, and sensitivity to light. Scleritis is manifested
by burning and itching of the affected eye (one or both eyes may be affected).
• Anal disease is more common in Crohn’s disease than ulcerative colitis.
• Liver disease, specifically a condition known as primary sclerosing cholangitis (PSC), is increased in inflammatory
bowel disease, in particular ulcerative colitis. PSC may also result in symptoms such as yellowing of the skin (jaundice),
eyes (scleral icterus) and itching. Eventually PSC may result in liver failure.
Management Strategies
There are numerous treatment approaches to inducing and maintaining remission in patients with IBD. These
treatments focus on suppressing the inflammation involved in the disease process. Your physician will discuss this with
you in more detail.
References
1.
Lichtenstein, GR, Hanauer, SB, Sandborn, WJ. Management
of Crohn’s disease in adults.
Am J Gastroenterol
2009; 104:465.
2. Su, C, Salzberg, BA, Lewis, JD, et al. Efficacy of anti-tumor
necrosis factor therapy in patients with ulcerative colitis.
Am
J Gastroenterol
2002; 97:2577.
3. Cima, RR, Pemberton, JH. Medical and surgical manage-
ment of chronic ulcerative colitis.
Arch Surg
2005; 140:300.
4.
Veloso, FT, Carvalho, J, Magro, F. Immune-related
systemic manifestations of inflammatory bowel disease. A pro-
spective study of 792 patients.
J Clin Gastroenterol
1996; 23:29.