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| | ==[[Inflammatory bowel disease overview|Overview]]== |
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| | ==[[Inflammatory bowel disease classification|Classification]]== |
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| ==Overview== | | ==[[Inflammatory bowel disease pathophysiology|Pathophysiology]]== |
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| In [[medicine]], '''inflammatory bowel disease''' ('''[[IBD]]''') is a group of [[inflammation|inflammatory]] conditions of the [[colon (anatomy)|large intestine]] and, in some cases, the [[small intestine]]. It should not be confused with IBS, [[irritable bowel syndrome]], which is less severe.
| | ==[[Inflammatory bowel disease causes|Causes]]== |
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| ==Forms== | | ==[[Inflammatory bowel disease differential diagnosis|Differentiating Inflammatory bowel disease from other Diseases]]== |
| The main forms of IBD are [[Crohn's disease]] and [[ulcerative colitis]] (UC).
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| Accounting for far fewer cases are other forms of IBD:
| | ==[[Inflammatory bowel disease risk factors|Risk Factors]]== |
| * [[Collagenous colitis]]
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| * [[Lymphocytic colitis]]
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| * [[Ischemic colitis|Ischaemic colitis]]
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| * [[Diversion colitis]]
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| * [[Behçet's disease|Behçet's syndrome]]
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| * [[Colitis|Infective colitis]]
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| * Indeterminate colitis
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| The main difference between Crohn's disease and UC is the ''location'' and ''nature'' of the inflammatory changes. Crohn's can affect any part of the [[gastrointestinal tract]], from [[mouth]] to [[anus]] (''skip lesions''), although a majority of the cases start in the [[terminal ileum|terminal]] [[ileum]]. Ulcerative colitis, in contrast, is restricted to the [[colon (anatomy)|colon]] and the anus. [http://www.ccfa.org]
| | ==[[Inflammatory bowel disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| [[Light microscopy|Microscopically]], ulcerative colitis is restricted to the [[mucosa]] ([[epithelium|epithelial lining]] of the gut), while Crohn's disease affects the whole bowel wall.
| | ==Diagnosis== |
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| Finally, [[Crohn's disease]] and [[ulcerative colitis]] present with extra-intestinal manifestations (such as liver problems, arthritis, skin manifestations and eye problems) in different proportions.
| | [[Inflammatory bowel disease history and symptoms|History and Symptoms]] | [[Inflammatory bowel disease physical examination|Physical Examination]] | [[Inflammatory bowel disease laboratory findings|Laboratory Findings]] | [[Inflammatory bowel disease other diagnostic studies|Other Diagnostic Studies]] |
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| In rare cases, patients have been diagnosed with both [[Crohn's disease]] and ulcerative colitis, which is really called [[Crohn's disease|Crohn's colitis]].
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| ==Diagnosis==
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| Although very different diseases, both may present with any of the following symptoms: abdominal pain, [[vomiting]], [[diarrhea]], [[hematochezia]], [[weight loss]], [[weight gain]] and various associated complaints or diseases ([[arthritis]], [[pyoderma gangrenosum]], [[primary sclerosing cholangitis]]). Diagnosis is generally by [[colonoscopy]] with [[biopsy]] of pathological lesions.
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| ==Treatment== | | ==Treatment== |
| Depending on the level of severity, IBD may require [[immunosuppression]] to control the symptoms. such as [[azathioprine]], [[methotrexate]], or [[Mercaptopurine|6-mercaptopurine]]. More commonly, treatment of IBD requires a form of [[mesalamine]]. Often, [[steroid]]s are used to control disease flares and were once acceptable as a maintenance drug. In use for several years in Crohns disease patients and recently in patients with Ulcerative Colitis, [[Biological therapy for inflammatory bowel disease|biologicals]] has been used such as the intravenously administered Remicade. Severe cases may require [[surgery]], such as [[bowel resection]], [[strictureplasty]] or a temporary or permanent [[colostomy]] or [[ileostomy]]. [[Alternative medicine]] treatments for bowel disease exist in various forms, however such methods concentrate on controlling underlying pathology in order to avoid prolonged steroidal exposure or surgical excisement[http://www.gaiagarden.com/articles/therapeuticapplications/ta_treating_bowel_disease.php].
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| Usually the treatment is started by administering drugs with high anti-inflammatory affects, such as [[Prednisone]]. Once the inflammation is successfully controlled, the patient is usually switched to a lighter drug to keep the disease in remission, such as [[Mesalazine|Asacol]], a [[mesalamine]]. If unsuccessful, a combination of the aforementioned immunosurpression drugs with a [[mesalamine]] (which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.
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| ==Prognosis==
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| While IBD can limit quality of life due to pain, vomiting, diarrhea, and other socially unacceptable symptoms, it is rarely fatal on its own. Fatalities due to complications such as [[toxic megacolon]], [[Gastrointestinal perforation|bowel perforation]] and surgical complications are also rare.
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| While patients of IBD do have an increased risk of [[colorectal cancer]] this is usually caught much earlier than the general population in routine surveillance of the colon by [[colonoscopy]], and therefore patients are much more likely to survive.
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| After treatment, the patient is usually switched to a lighter drug with fewer side effects. Every so often an acute resurgence of the original symptoms may appear: this is known as a "flare-up". Depending on the circumstances, it may go away on its own or require medication. The time between flare-ups may be anywhere from weeks to years, and varies wildly between patients - a few have never experienced a flare-up.
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| ==Recent findings==
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| A recent hypothesis posits that some IBD cases are caused by an overactive [[immune system]] attacking various tissues of the digestive tract because of the lack of traditional targets such as [[parasite]]s and worms. The number of people being diagnosed with IBD has increased as the number of infections by parasites, such as [[Nematode|roundworm]], [[hookworm]] and [[Whipworm|human whipworm]]s, has fallen, and the condition is still rare in countries where parasitic infections are common. This is similar to the [[hygiene hypothesis]] applied to [[allergy|allergies]].
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| Initial reports (Summers ''et al'' 2003) suggest that "[[helminthic therapy]]" may not only prevent but even cure (or control) IBD: a drink with roughly 2,500 ova of the ''[[Trichuris suis]]'' helminth taken twice monthly decreased symptoms markedly in many patients. It is even speculated that an effective "immunization" procedure could be developed—by ingesting the cocktail at an early age.
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| Prebiotics and probiotics are showing increasing promise as treatments for IBD (Furrie, 2005) and in some studies have proven to be as effective as prescription drugs (Kruis, 2004).
| | [[Inflammatory bowel disease medical therapy|Medical Therapy]] | [[Inflammatory bowel disease surgery|Surgery]] | [[Inflammatory bowel disease prevention|Prevention]] |
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| More recently, research (Hue et al 2006) has shown that IL-23 is overexpressed in tissues taken from Mouse models of IBD. The group showed that knocking out IL-23 (heterodimer of IL-12p40 and IL-23p19) severely reduced inflammation of the bowel, both in terms of cells and proinflammatory cytokine production. Also, they found that a novel group of CD4<sup>+</sup> T lymphocytes, Th17 T cells, are highly upregulated in bowels of diseased mice. Taken together, the group shows that IL-23 but not IL-12 (IL-12p40 and IL-12p35; share a subunit) drives innate and T cell mediated intestinal inflammation.
| | ==Case Studies== |
| | [[Inflammatory bowel disease case study one|Case #1]] |
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| ==References== | | ==References== |