Inflammatory Bowel Disease: Calming Fire in Your Belly

WebMD Live Events Transcript

Are you among the 2 million Americans with IBD? IBD (inflammatory bowel disease) is a group of disorders that causes chronic inflammation of the intestines. There are two major types of IBD: ulcerative colitis and Crohn's disease. Aaron Brzezinski, MD, joined us from The Cleveland Clinic on May 19, 2005 to answer your questions about IBD.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Brzezinski. Thank you for joining us today.

BRZEZINSKI:
Thank you.

MODERATOR:
Let's start by defining IBD. It isn't IBS, it isn't
stomach cancer.

BRZEZINSKI:
I believe this is a very important issue, because even amongst many physicians the terms can be misunderstood.

It is not uncommon for patients to tell you they have colitis when what they really have is irritable bowel syndrome. The main difference is IBS is a functional disease; it's a problem with how the bowel contracts and relaxes, but there isn't a significant inflammatory component to it. Inflammatory bowel disease has two main groups -- Crohn's disease and ulcerative colitis -- and is characterized by inflammation.

Irritable bowel syndrome is very common. It is usually manifested by intermittent episodes of diarrhea, constipation and abdominal bloating, but patients do not have what we call red flags. A red flag is something that tells us that there's something else going that needs attention. Red flags include bleeding with bowel movements, weight loss, fever, palpable abdominal mass, bowel movements at night when patients actually wake up to have a bowel movement, and anemia.

In inflammatory bowel disease, the symptoms depend on which type of illness the patient has. The main symptom in ulcerative colitis is bloody diarrhea and depending on the extent of the disease, patients may have other symptoms. If the disease is only in the rectum, patients have urgency to have a bowel movement and they have very frequent trips to the toilet, but they pass only very small amounts of mucus or blood. When the disease is extensive, involving the entire colon, patients have larger bowel movements that are still bloody. They may also have diffuse abdominal pain, weight loss, fever, and other systemic symptoms like dehydration or rapid heart rate.

Crohn's disease, on the other hand, can involve any segment of the gastrointestinal system. The symptoms are determined by which parts of the gastrointestinal system are involved. The most common site of involvement is the small bowel. In the small bowel it's particularly the terminal ilium, which is the most distal part of the small intestine, essentially where the small intestine joins with the large intestine with the colon. Patients that have disease in the terminal ilium usually have abdominal pain in the right lower quadrant, they have weight loss, diarrhea, poor appetite, abdominal bloating or distention, especially after meals, and on exam, they may have a palpable mass in the right lower quadrant of the abdomen. The next most common site of involvement is having both the small bowel and the colon, and these patients usually have a combination of symptoms that include the same symptoms of terminal ilium, but they may have more diarrhea and they can also have disease around the rectal area, where they may develop fistulas or abscesses. Patients who only have involvement of the large intestine primarily have diarrhea (which is usually nonbloody), abdominal pain, and weight loss. Patients with Crohn's disease can also have involvement of the esophagus (which is the swallowing pipe), the stomach, or the more proximal small intestine.

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