On the surface our bodies may seem fine, but underneath, there is a never-ending war raging on inside each of us. Within our intestinal walls we open up attacks from invaders that arrive in our food and drink, which become a major focus of the immune system’s defenses.
As humans, we all have bacteria, viruses and other potential sources of infection in our intestines that we must deal with in order to lead a healthy life. Therefore, the immune system of the intestine is always on guard, carefully regulating itself so that it can fight emerging threats without causing injury to the intestine itself.
In some people, however, the intestinal defense systems begin to overreact. The white blood cells of the gut start releasing inflammatory substances in excessive amounts, thereby causing inflammation and damage to the intestine. The result is inflammatory bowel disease (IBD). IBD is a chronic inflammatory condition of the gastrointestinal tract, similar to how rheumatoid arthritis is an inflammatory condition of the joints.
Crohn’s and Colitis
There are two main types of IBD: Crohn’s disease and Ulcerative colitis. Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the anus. The most common symptoms are abdominal pain, watery diarrhea, weight loss and fever.
Ulcerative colitis, as the name implies, is marked by ulcers, or sores in the colon. People with ulcerative colitis develop bloody diarrhea, abdominal pain and ‘false alarms,’ in which they feel the urge to go to the bathroom but they do not produce a lot of stool.
Inflammatory bowel disease affects up to 1.3 million Americans, according to the Centers for Disease Control and Prevention (CDC). Although they may appear at any time in life, they are diagnosed most frequently in their 20s and 30s, says the CDC.
Culprits in the Genes?
Studies have discovered genes that predispose people to have trouble resisting bacteria, and that patients with IBD have different populations of bacteria in their intestines than people without these diseases.
Recent research has begun to uncover the mechanisms behind IBD, in which there is an abnormal interaction between bacteria and body. Studies have discovered genes that predispose people to have trouble resisting bacteria, and that patients with IBD have different populations of bacteria in their intestines than people without these diseases. These are the current leads, but now we have to figure out exactly how the immune system is interacting with these bacteria.
Recent research also shows that viruses might play a role in inflammatory bowel disease.
Identifying the most important steps in the disease process will allow researchers to find new ways to attack the problem. The goal is to restore the normal balance between the immune system of the intestine and the bacteria that live within these walls.
Currently, medications are used to regulate the immune system, with the hope of changing a patient’s bacteria from an unhealthy profile to a healthy profile. Also, one day there is a possibility to personalize therapy, based on a person’s genes and bacteria.
In the meantime, several IBD triggers are clear. There is emerging agreement that a primary reason for the imbalance between good and bad bacteria in the intestines is our Western diet, which is high in red meat and animal fats. Another trigger is antibiotic use during periods of life when the immune system is being shaped or developed.
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) can weaken the intestinal mucosal barrier, which is the wall that protects us from the outside world. Overuse of aspirin and NSAIDs can damage this barrier, allowing harmful agents to enter the trigger inflammation.
In addition, smoking is extremely detrimental for Crohn’s disease, leading them to have a higher risk for the disease. Once a smoker develops the disease, they tend to have a more severe form compared to patients who do not smoke.
IBD can be triggered by genes, diet, bacteria, medicine, and smoking, therefore, making each case different for each person. This means treatment plans need to be individualized, as well. At the Baylor Center for Inflammatory Bowel Diseases, the multidisciplinary treatment team includes a wide range of experts specializing in IBD, including gastroenterologists, pathologists, radiologists, and surgeons on the Baylor University Medical Center medical staff, along with dedicated IBD nurses, nutritionists and social workers.
A major advance in IBD treatment came with the anti-TNF drugs, which are also used to treat other inflammatory diseases including rheumatoid arthritis and psoriasis. These drugs target a central player in the inflammation in the gut called TNF, or tumor necrosis factor.
About 50 percent of patients with Crohn’s disease will require surgery.
About 50 percent of patients with Crohn’s disease will require surgery to remove sections of bowel that have become diseased. Although the patients feel better, the disease often returns. Following surgery, patients have several treatment options to prevent the disease from coming back. It is important to halt this progression because the small intestine is essential to life, because it helps absorb all the nutrients from food.
Our team of colon and rectal surgeons on the medical staff at Baylor University Medical Center at Dallas are very experienced in removing as little of the small intestine as possible. The surgeons also specialize in managing other aspects of Crohn’s disease, including fistulas and boils around the anus, that can be very painful and hard to manage. This is where having access to a good surgeon is so important.
About 10 percent of patients with ulcerative colitis will require surgery to remove the colon, and their quality of life improves dramatically afterwards.
About 10 percent of patients with ulcerative colitis will require surgery to remove the colon, and their quality of life improves dramatically afterward. The colorectal surgeons on the medical staff at Baylor University Medical Center specialize in a procedure called an ileal pouch anal anastomosis, in which they create a reservoir (or pouch) out of the small intestine and connect it to the anus, thus preserving the natural route of defecation. The pouch serves the same role as the rectum — it stores stool until one decides to have a bowel movement.
Despite advances in treatments, the best approach to IBD is to prevent the disease in the first place. IBD runs in families, so if one or both parents have Crohn’s disease, for example, it encourages them to follow a healthy diet, not only for themselves, but also to prevent the disease in their children.
The first preventative step is to adopt a healthy, Mediterranean-type diet. This diet involves low consumption of red meat, animal fat and other types of fat, such as soy oil and corn oil. Other preventative steps are to stop smoking, avoid aspirin and other NSAIDs, manage stress (which increases inflammation in many patients), and to have a good support system in place.
There is a great deal of hope in the research taking place, along with excellent means to control the disease, allowing those diagnosed with IBD to lead normal lives.
Visit our website to learn more information about treatment options for inflammatory bowel diseases.