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Inflammatory diseases of the bowel

These are disorders where the bowel becomes red and inflamed. In ulcerative colitis the lining of the large bowel is involved. In Crohn’s disease (named after an American physician) any part of the digestive tract can be affected and the full thickness of the bowel wall can become inflamed. Crohn’s disease, when it affects the colon and ulcerative colitis are similar so it is sometimes hard to tell which one the patient has.

The causes of Crohn’s disease or ulcerative colitis

The reasons for the onset of these conditions are not known. People who suffer from them may have a defence mechanism against normally present gut bacteria which acts abnormally. A longstanding reaction to a specific virus or bacterium may be significant. There may be an increased susceptibility in some families but the likelihood of transferring the problem to children is low.

What are the symptoms of ulcerative colitis?

The disease can give trouble on and off throughout life. Most of the time most sufferers feel well with no symptoms ” this means the disease is inactive (in remission). The disease flares up from time to time and becomes active (a relapse). At each flare-up the symptoms can be better, worse or the same as the time before. The main symptoms are frequent and urgent need to pass blood and mucus with perhaps some stool as well, diarrhoea is more severe cases, abdominal pain often just before a stool is passed and a general feeling of tiredness. If only the final part of the bowel (rectum) is involved, the disease is called proctitis and the usual symptoms are passage of blood and mucus without diarrhoea.

Crohn’s disease symptoms

Crohn’s disease also tends to be a life-long problem. It has similar flare-ups and times of inactivity as ulcerative colitis. The symptoms are variable because Crohn’s can affect any part of the bowel. The most common symptoms are:

Abdominal pain caused by direct inflammation which results in pain or results in a stricture (bowel narrowing), causing griping type pains and distension with bloating and wind.

Abdominal pain. The inflammation either causes pain directly or causes narrowing of the bowel (stricture) resulting in gripey pains and bloating (distension) with wind.

Bowel obstruction due to severe stricture formation. This may cause vomiting as well as pain and distension.

A severe stricture of the bowel can cause bowel obstruction with consequent distension, vomiting and pain.

Fistulas, ulceration or inflammation can occur around the anus.

Inflammation, ulceration or fistulas around the anus.

The causes of relapses of the disease

Normally there is no obvious cause for a relapse. In a few cases a triggering event can be identified but this is not the cause of the disease. Examples are:

Personal stress or worry.

Common infections such as colds, flu and gastroenteritis.

Some drugs such as antibiotics, aspirin and anti-arthritis drugs.

Drugs, for example aspirin, anti-arthritis drugs and antibiotics.

The diagnosis of inflammatory bowel disease

If the doctors suspects that the large bowel is suffering from Crohn’s disease (Crohn’s colitis) or ulcerative colitis they may order a sigmoidoscopy. The narrow tube with a light attached is place up the anus (back passage) and the mucosa (bowel lining) is inspected, with a small biopsy taken for microscopic examination. Other tests available are:

Stool specimens to exclude infection.

A colonoscopy is performed by passing an endoscope up the anus to examine the whole of the colon. Done under sedation.

Colonoscopy. In this investigation the patient is sedated and a flexible endoscope is inserted past the anus and up through the whole colon.

Colonoscopy where under sedation a flexible telescope is passed through the anus all round the colon.

If Crohn’s disease of the upper gut is suspected:

An x-ray examination of the small intestine may be ordered, using barium.

A flexible telescope may be passed through the mouth to inspect and take samples from the stomach and upper intestine (upper gastrointestinal endoscopy).