Signs of Inflammation
Inflammation occurs in response to any sort of injury, whether it is from a serious or life-threatening infection or from something as small as a paper cut. The classic signs of inflammation are pain, swelling, redness, and loss of normal function.
What Goes Wrong in IBD?
Crohn’s disease and ulcerative colitis involve inflammation of the gut. A healthy person normally has a certain degree of inflammation in the gastrointestinal tract, but in those with IBD, the inflammation is extensive and excessive.
Excessive Inflammation
Excessive or uncontrolled inflammation is central to the onset of Crohn’s disease and ulcerative colitis. As scientists learn more about the factors that control the degree of inflammation in the gut, they learn more about the causes of these disorders.
Normal Intestinal Inflammation
In the gut, the degree of inflammation that is normally present in healthy people is usually not enough to cause loss of function or to be seen by the naked eye, but when viewed under the magnification provided by a microscope, you can always see some white blood cells, called lymphocytes, present within the inner lining and just beneath the lining of the intestine.
These defensive cells are part of the intestine’s immune system and help to protect you from potentially harmful bacteria, viruses, parasites, and proteins that aren’t normally present in the body. The amount of inflammation is closely regulated so that there is just enough immune response so as to protect against these dangers, but not so much that it will cause problems.
Too much of a good thing may be bad, and the amount of inflammation in the intestinal lining is no exception. If there is too much inflammation or if it is not properly controlled, inflammation can cause swelling and damage to the tissues of the gastrointestinal tract. This damage can lead to problems with the normal functioning of the gastrointestinal tract, including absorption of nutrients and fluids and retaining and expelling stool at appropriate times.
When the damage is particularly severe, the internal lining of the gastrointestinal tract can slough off, leading to a variety of symptoms, such as abdominal pain, diarrhea, blood in the stool, weight loss, and failure of children to grow properly.
Ulcerative Colitis Signs
Inflammation in ulcerative colitis is limited to the colon, but the extent of the inflammation within the colon varies from person to person and may vary within an individual over the course of the illness.
Any portion of the colon may be inflamed in ulcerative colitis, leaving the remainder completely unaffected. However, the rectum is always inflamed or diseased.
Pancolitis
In many instances, the entire colon is inflamed. This is referred to as pancolitis. When the inflammation extends upward, it does so in a continuous fashion. In other words, there are no areas of inflammation separated from one another by normal areas of colon.
Proctitis
In some people with ulcerative colitis, only the rectum is inflamed. This particular form of the disease is often referred to as proctitis or ulcerative proctitis. Some differences have been observed between proctitis and the more extensive forms of the disease, such as pancolitis. Ulcerative proctitis is unusual in children and tends to be seen more often when the disease occurs for the first time in middle-aged or elderly individuals.
Limited Extent
Because the extent of inflammation in ulcerative proctitis is so limited — involving at most just the last 6 inches (15 cm) of the large intestine — patients suffering from that form of the disease are usually not as sick as patients with more extensive forms of ulcerative colitis.
Crohn’s Disease Signs
In Crohn’s disease, the inflammation can occur in any part of the gastrointestinal tract. Although it appears most often in the ileum and colon, Crohn’s disease can affect the esophagus, stomach, duodenum, and jejunum.
Skip Lesions
The areas of the gut affected by Crohn’s disease may not be adjacent to one another. These are called skip lesions. For example, someone with Crohn’s disease may have an area of inflammation in the middle part of the small intestine (jejunum) and another area of inflammation in the large intestine, with normal intestine in between the two areas of inflammation.
Intestinal Penetration
In ulcerative colitis, the inflammation tends to be limited to the innermost lining of the gut, but in Crohn’s disease, the inflammation has a tendency to penetrate from the innermost lining, where inflammation and ulcers first occur, right through the deeper layers of the bowel to the outer surface (serosa). This results in a defect or hole in the bowel wall, which can lead to localized infections in the abdominal cavity (abscesses) or communications (fistulas) from the bowel into other organs or into the abdominal wall or skin. The inflammation in Crohn’s disease may also form into tiny localized collections of inflammatory cells, called granulomas, which can be seen only under the magnification provided by a microscope. These granulomas are virtually diagnostic of Crohn’s disease.
Site Variation
The wide variation in the sites of the gut that are affected by Crohn’s disease can lead to important differences in the ways individual patients experience the disease and the ways in which they come to medical attention. This variation in sites also affects approaches to management of the disease.
Indeterminate Colitis Signs
In a small proportion of individuals with inflammatory bowel disease involving the colon, it is not possible, based on the disease features, to differentiate between ulcerative colitis and Crohn’s disease. In these instances, the condition is designated as indeterminate colitis or inflammatory bowel disease of undetermined type (IBDU). In some cases of indeterminate colitis, the pattern of disease will change over time, and it will become apparent that the patient, in fact, has ulcerative colitis or Crohn’s disease. However, some patients will continue to have features of both ulcerative colitis and Crohn’s disease, and distinguishing between the two will not be possible.
The approach to the management of the two conditions with medications is similar. Differentiation becomes much more important if surgery is contemplated as a means of treatment, as the surgical approaches in ulcerative colitis and Crohn’s disease can be quite different because of the fact that Crohn’s disease can come back after surgery in parts of the bowel that weren’t affected before surgery.
What Are the Possible Complications of IBD?
Complications Specific to Crohn’s Disease
•Strictures
•Abscesses
•Fistulas
There are several serious complications that can occur as a result
