What is IBD?

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IBD- Inflammatory bowel disease is the generic term for two main, very similar clinical pictures: Crohn's disease and ulcerative colitis. Chronic inflammatory what? This means that inflammation in the gastrointestinal tract (organs for digestion, esophagus, stomach, small intestine, colon, rectum) is caused. Chronic means that it will accompany you for a lifetime, but the disease progresses in batches, i.e. there are episodes in which  no symptoms (called remissions)are shown up and episodes in which you have symptoms and a hospital stay may be necessary called (relapses). How long these periods are varies from patient to patient. BID has 1000 faces. The main difference between the two types of diseases is mainly the location in the body, but more on that later.  

 

 

Why do people suffer from it?

 

The "Why" is still unclear. There are speculations such as genes, nutrition, environmental factors (smoking, nutrition, hygiene), stress / psyche, but it is currently still very difficult to trace this back. Most patients between the ages of 15 and 35, regardless of gender, are equally frequent. According to studies, around 320,000 people are currently suffering from IBD in Germany (2020), and the trend is rising dramatically. If you count that down to the population of Germany, one of 260 people has BID. IBD is an autoimmune disease, i.e. the immune system overreacts for uncertain reasons and attacks the body, in this case the intestinal mucosa or generally the mucous membrane in the gastrointestinal tract. And at this point I want to clarify right away, no, it's not contagious, as most people mistakenly think.

 

Due to researches in 2017 " we identified 147 studies that were eligible for final inclusion in the systematic review, including 119 studies of incidence and 69 studies of prevalence. The highest reported prevalence values were in Europe (ulcerative colitis 505 per 100 000 in Norway; Crohn's disease 322 per 100 000 in Germany) and North America (ulcerative colitis 286 per 100 000 in the USA; Crohn's disease 319 per 100 000 in Canada). "

 

(The Lancet   Gastroenteroly and hepatology ( October 21,2019): The global, regional, and national burden of inflammatory bowel disease in 195 countries and territorites, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 ( last view 14.05.2020). https://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30333-4/fulltext#%20)

 

 

 

How does BID affects you?

 

As already explained above, there are relapses and remissions. If you were in remission and now have a flare again, this is called a relapse. Relapses can also be divided into two levels of severity:

 

  • The acute flare-up is characterized by the typical clinical complaints, i.e. bloody diarrhea (diarrhea) and possibly persistent painful urination and stool urge (Tenesmus). Stool frequencies of around 40 times within 24 hours are not uncommon. Yes ! It's like regular gastrointestinal infection, but a lifetime!
  • With a fulminant relapse, bloody diarrhea, fever above 38.5 ° C and a reduced general condition as well as weight loss occur. In addition, rapid heartbeat (tachycardia) and anemia (anemia) can occur. The toxic megacolon is another complication.

 

 

 

What are the symptoms?

 

As mentioned above, the following can occur:

 

  • (bloody) diarrhea and therefore anemia (anemia)
  • severe stomach ache
  • fever
  • Loss of appetite and thus weight loss
  • reduced general condition
  • Fatigue

Since our body is very complex and a large organ system is affected, there can also be "extraintestinal manifestations", ie. Symptoms outside the digestive tract, such as:

  • Inflammation of the eyes, skin or joints.
  • Osteoporosis due to the impaired calcium and vitamin D intake
  • Anemia due to the impaired iron absorption
  • Dehydration (dehydration) and sodium / potassium deficiency due to the large water loss in diarrhea

 

 

 

 

 How is IBD diagnosed?

 

 

Because the symptoms are similar to other diseases, the diagnosis is difficult. Examinations as mentioned below help to make the diagnosis:

 

  • History: questioning whether there are cases in the family, what the lifestyle is, what symptoms you have etc.
  • Physical examination: observation of eyes, skin, joints, anus for signs of inflammation
  • Endoscopic examinations: in which one looks into the body with a tube and camera either through the mouth or through the anus for signs of inflammation (redness, swelling)
  • Stool samples
  • Laboratory values: especially increased inflammation values called CRP, leukocytosis (too few leukocytes (white blood platelets)) and increased lowering of blood speak for IBD, and there can also be anemia (lack of red blood cells (erythrocytes)).

 

 

 

 

                                                      Ulcerative Colitis

 

  • The disease spreads continuously, usually it begins at the rectum and spreads "upwards" towards the small intestine. At the time of diagnosis, only the rectum was affected in about 25 to 55 out of 100 patients with ulcerative colitis (proctitis).
    • Proctosigmoiditis: inflammation of the rectum and the last part of the colon, the sigma.
    • Left-sided colitis: inflammation up to the left curve of the large intestine.
    • Subtotal colitis: an expansion of the inflammation beyond this left curvature.
    • Pancolitis / total colitis: entire colon is affected by ulcers
    • Backwash ileitis: (very rare) inflammation in the last sections of the small intestine

 

 

  • here only the top layer of the mucous membrane is affected by the inflammation
  • Here the inflammation leads to ulcers
  • can be cured by careful weighing by surgery (removal of the colon)
  • Worst case is a toxic megacolon: acute abdomen (abdominal distension, abdominal pain, resistance tension, etc.) with high fever, tachycardia and ileus. It can go into shock with multi-organ failure, which can lead to intestinal breakthrough with heavy bleeding and death

                                                                 Crohn`s   disease 

 

  • The disease does not spread continuously, but can affect several, unrelated areas of the digestive tract.

 

 

 

 

 

 

 

 

 

 

 

 

 

  • It not only affects the top layer of the mucous membrane, but it can affect all layers of the intestinal wall.
  • Stenosis (narrowing) + fistulas (inflammatory gait formation), mostly in the anus area
  • It is not curable

Therapy

 

The conventional therapy

 

  • Aminosalizylates or corticosteroids: Preparations from these groups of active substances are able to prevent the production of inflammatory messenger substances. However, cortisone should not be taken permanently because long-term use can cause unpleasant side effects (moon face, acne, weight gain, osteoporosis, etc.).
  • Immunosuppressants affect the immune system by shutting down the body's defenses and causing inflammation to subside. If the aminosalizylates or corticosteroids do not work well enough or if you experience intolerance, immunosuppressive therapy is (usually) considered. . Immunosuppressants include e.g. B. thiopurines (e.g. azathioprine) and modern protein substances: the so-called biologicals. Examples of this class of active substances are the TNF-alpha (tumor necrosis factor-alpha) antagonists or an integrin inhibitor
  • In some cases, a combination of azathioprine and TNF-alpha antagonists can be beneficial.

 

 

Surgical therapy

 

As mentioned above, ulcerative colitis can be cured by removing the large intestine, although a temporary / permanent stoma and a pouch system are often required.

Crohn's disease is not curable, however, due to the inflammation, the scars and the resulting stenosis, an operation often has to be carried out to resolve this fear.

As part of the disease, secondary diseases such as skin cancer, folic acid deficiency due to the weakened immune system and colon cancer due to the increased risk with number of years of illness and relapses must be covered by annual checkups.