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Irritable Bowel Syndrome

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Irritable Bowel Syndrome Inflammatory Bowel Disease vs. Irritable Bowel Syndrome What is the Dierence Between Inammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS)? IBD and IBS are two illnesses that can a ect the gastro- intestinal (GI) tract. Both can cause abdominal pain and changes in bowel movements; however, they are not the same. While there are many similarities between IBD and IBS, it is important to highlight the di erences. IBD: IBS: • Chronic inammatory diseases • Functional GI disorder that involving the GI tract, including causes recurrent abdominal pain Crohn’s disease and ulcerative and changes in bowel movements. colitis. VS. • Symptoms may include bloating, • Immune cells cause inammation constipation, diarrhea, or mixed and ulceration in the lining of diarrhea with constipation. the intestines, which can lead to frequent and/or urgent bowel • Patients with IBS have these movements, abdominal pain, symptoms without damage diarrhea, or bleeding. to the GI tract. • In IBD, the GI tract is damaged. • Endoscopy and radiology tests Symptoms can be dierent for do not show inammation. everyone and depend on the type of IBD and where the inammation is located in the GI tract. 1 Inammatory Bowel Disease IBD is a term for chronic inammation of the gastrointestinal tract. The two most common inammatory bowel diseases are Crohn’s disease and ulcerative colitis (UC). IBD aects as many as 3.1 million Americans,1,2 most of whom are diagnosed before age 35. There are currently no cures for IBD, but there are treatments to reduce bowel inammation and control the symptoms of the disease. They may also have times of remission, when little or no symptoms are present. When bowel inammation is reduced by taking an eective medication treatment, ares are less frequent. Stricture Patchy inflammation Continuous and throughout small uniform inflammation Causes and large bowel in the large bowel The exact cause of IBD remains unknown. Crohn’s Disease Ulcerative Colitis Researchers believe that a combination of factors Age of onset: 15–35 years and 55–70 years Age of onset: 15–35 years and 55–70 years Symptoms: Depends on location of disease. Symptoms: May include stool urgency, fatigue, interact, leading a patient to develop IBD. May include abdominal pain, diarrhea, increased bowel movements, mucous in stool, weight loss and fatigue. nocturnal bowel movements and abdominal pain. Bloody stool: Variable Bloody stool: Common • Inherited genetic risk Malnutrition: Common Malnutrition: Less common • Environmental risk factors Crohn’s disease and UC cause chronic inammation • Imbalance or changes in the intestinal bacteria of the GI tract. Crohn’s disease can aect any part (gut microbiome) of the GI tract, but frequently aects the end of • An inappropriate reaction from the immune system the small intestine and the beginning of the large intestine (colon). The inammation in Crohn’s Normally, immune cells protect the body from disease can involve the entire bowel wall. UC aects infection, but in people with IBD, the immune system only the large intestine (colon) and the rectum. The mistakes harmless substances in the intestine for inammation in UC involves only the inner lining of foreign substances and launches an attack, causing the intestine. inammation. Symptoms Who Gets IBD? The symptoms of IBD vary from person-to-person, As many as 70,000 new cases of IBD are diagnosed may depend on what part of the bowel is aected in the United States each year. by inammation, and may change over time. Common symptoms for Crohn’s disease and UC • Age: IBD can occur at any age, but the median age include frequent and/or urgent bowel movements, of diagnosis is 29.5 years for Crohn’s disease and 3 diarrhea, bloody stool, abdominal pain, and cramping. 34.9 years for ulcerative colitis. • Gender: In general, IBD aects men and People with IBD may also report symptoms such women equally. as fatigue, lack of appetite, and weight loss. People with IBD may have times of active disease (are), when symptoms and bowel inammation are present. 2 • Ethnicity: IBD is more common among Caucasians, but it can aect people of any racial or ethnic group. The exact cause of Crohn’s disease and UC remains unknown. • Family history: The risk for developing IBD is between 1.5 percent and 28 percent for Researchers believe that several rst-degree relatives of an aected person.4 factors, such as genetic risk and • Cigarette smoking: Smokers are more likely to an inappropriate reaction from develop Crohn’s disease. UC is more common in the immune system, play a role non-smokers and former smokers. in their development. Diagnostic Procedures To help conrm a diagnosis of Crohn’s disease or UC, • Endoscopic procedures: Endoscopies get a one or more of the following tests and diagnostic detailed look at the inside of your digestive tract procedures may be performed: using a small camera mounted to the end of a • Blood tests: The presence of inammation in the lighted tube. body can be identied by examining the levels of Crohn’s disease: several factors in the blood, including red and white An upper endoscopy lets doctors see the GI tract blood cells, platelets, and C-reactive protein (CRP) from the top down, using a exible, lighted tube — a protein made by your liver that is sent into your that’s inserted through your mouth, down the bloodstream in response to inammation. esophagus, into your stomach, and as far down as Tests may be performed to help healthcare pro- the duodenum, which is the rst section of your viders dierentiate IBD from non-IBD. Blood tests small intestine. can be used to evaluate a patient’s risk of develop- Ulcerative colitis: ing disease complications, or to check if and how A sigmoidoscopy allows your doctor to examine medications are working in the body. the extent of the inammation in your lower colon • Stool tests: Stool tests may check for infection and rectum. or inammation (fecal calprotectin) in the GI tract Crohn’s disease and ulcerative colitis: by examining levels of a protein in the stool called A colonoscopy allows doctors to examine the fecal calprotectin. colon, the lowest part of your large intestine, by inserting a exible, lighted tube through the opening to your anus. • External imaging procedures: Images of the digestive organs and other soft tissues are taken from outside the body. Examples include computerized tomography (CT) scans and magnetic resonance imaging (MRI). IBD Complications Possible complications of IBD can include: • Bowel obstruction • Deep ulcerations • Extraintestinal manifestations • Infection • Malnutrition • Precancerous changes in the colon or colon cancer 3 Irritable Bowel Syndrome IBS is a condition that aects the function and behavior of the intestines. Normally, the muscles lining the intestines contract and relax to move food along the digestive tract. In IBS, this pattern is disturbed, resulting in uncomfortable symptoms. In addition, there can be a disturbance in sensation, with heightened sensitivity to normal gas or stool passing through the GI tract. It is important to remember that patients with IBD can also have IBS, but having IBS does not lead to IBD. Symptoms Many people experience mild symptoms of IBS, but • Family history: Research shows that many people for some, symptoms can be severe. Symptoms can with IBS have a rst-degree relative (parent, child, include cramping, abdominal pain, bloating, gas, or sibling) with the disorder. mucus in the stool, diarrhea, and/or constipation. Much like IBD, there may be times when symptoms • Infection: Around 40% of people who develop IBS are present and times when little or no symptoms do so after an infection in their digestive system. are present. But, unlike IBD, IBS does not cause After the infection clears, the symptoms remain inammation, does not cause permanent damage (i.e., post-infectious IBS). to the GI tract, and does not increase the risk of • Psychological history: Some studies indicate that colorectal cancer. psychological distress, especially anxiety, depres- sion, and childhood trauma, may be risk factors. Causes The exact cause of IBS is unknown. Potential causes Diagnostic Procedures may include sensitivity of the GI tract to gas and Diagnosing IBS typically involves a physical exam bloating, changes in the microbiome (organisms and medical history. It is important to exclude other in the gut), or changes in the levels of specic GI conditions. The Rome IV criteria denes IBS compounds or chemicals within the body, such as as recurrent abdominal pain, on average one day serotonin—a chemical in the body that helps a week in the last three months, associated with regulate mood and social behavior. Although stress at least two of the following:6 does not cause IBS, many people with IBS notice that stress does aggravate their symptoms. Having 1) Relation to defecation (discharging feces) IBD or a recent GI tract infection (like gastroenteritis) can increase the risk for developing IBS. 2) Change in frequency of stool Who Gets IBS? 3) Change in the form (appearance) of the stool. IBS aects 10–12% of adults in North America.5 The evaluation may include blood tests, stool samples, • Age: IBS occurs in all age groups, but is most endoscopic procedures, or imaging procedures commonly diagnosed in individuals under age 50.5 (like a CT scan or MRI). In patients with IBS, anemia • Gender: IBS is more common in women. is not apparent, stool calprotectin is normal, and no inammation is seen on endoscopy or imaging tests. IBS does not cause inammation, Complications damage the GI tract, or increase IBS can signicantly aect quality of life. Research shows that patients with IBS may undergo the risk of colorectal cancer. more medical testing, as compared with patients without IBS.
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