I hope for this post to provide some introductory information about Inflammatory Bowel Disease (of which the two major diagnosed disease states are Crohn's Disease and Ulcerative Colitis) and to touch on some potential discussion topics for the next couple weeks. IBD is of particular interest to me because my younger brother was diagnosed with Crohn's Disease six years ago, so I've seen the dramatic difference between a Crohn's flare up and remission.
IBD is commonly described as an autoimmune disorder, since it is speculated that the inflammation cascades and resulting symptoms are the result of an immune system response to the constituent bacterial flora in the human body. This bacterial makeup is important in proper nutrition and absorption, but in the IBD disease states the bacteria are recognized as foreign and treated as pathogens. Since the body cannot afford to lose this bacteria, the inflammation state is persistent. This leads to the clinical expressions of Crohn's and Colitis.
Crohn's and ulcerative colitis differ diagnostically, as they are manifested in different locations and with different tissues affected. Crohn's can affect any portion of the GI tract (from mouth to anus), and is an inflammatory response associated with multiple layers of the intestinal wall. Colitis is an inflammatory response isolated to the mucosa, and is contained to the colon and rectum.
Symptomatically, Crohn's Disease can vary widely (since the inflammation can occur at any point along the GI tract), but since most cases arise in the ileum, some common symptoms can be considered 'red flags' for diagnosis, such as sudden unexplained weight loss, diarrhea, abdominal pain, and bleeding. As Crohn's Disease involves a number of inflammatory mediators, it is also common to have arthritis, skin problems, persistent fever and anemia. Crohn's Disease frequently leads to nutritional absorption problems, so a whole series of complications are common, including osteopenia (precursor osteoperosis), stunted growth, early age low bone density, postural problems, and a decreased appetite.
Symptoms of ulcerative colitis tend to be more consistent, including sharp abdominal pain, weight loss, bloody or mucousy discharge and diarrhea. Many of the same secondary symptoms associated with malabsorption and systemic inflammation seen in Crohn's are seen in Colitis, which can make diagnosis and therapy difficult.
Both diseases are commonly diagnosed by endoscopy, as there are characteristic patterns of ulcer formation and inflammation for each disease state. But again, since the symptoms can be fairly common and indicative of more common problems, it sometimes can take awhile for an accurate diagnosis of Crohn's or Colitis. This makes the current genetic work particularly important.
In class I hope to discuss the current proposed models of inflammatory cascades that are expressed in IBD, the current genetic research aimed at locating a possible single IBD gene, the effects of smoking on the supression of Colitis/simultaneous increase in Crohn's activity (something that's REALLY interesting), and the relationship between intestinal bacteria and immune system development. Let me know if you have any other areas of interest that you'd like us to look into.
3 comments:
From reading about smoking and IBD, it seems as if it's the smoke, rather than the nicotine that makes the difference. Is that your reading of it as well? If so, I wonder what is in the smoke that makes the difference and whether this could be given to Crohn's patients without the detrimental effects of cigarettes.
From what I've read up on, they haven't been able to decipher the difference between the effects of nicotine and the effects of the actual smoke on these various side effects. This is just my estimation, but it seems like all of these side effects are just part of the whole-body response to cigarette smoke, and really nothing more than coincidence that some of the effects are beneficial for UC and detrimental for CD. I certainly haven't been able to find published research suggesting that smoking/cigarette smoke/nicotine should be considered for treatment.
I've heard of Crohn's disease, but I never knew how detrimental it could be. What is the life expectancy for some one with Crohn's disease treated and untreated and what does the genetic screening consist of (are they looking for a mutation in a certain gene, multiple genes)?
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