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IBD - Inflammatory Bowel Disease

Dr. Adrian Weingart

IBD - Inflammatory Bowel Disease

The abbreviation IBD stands for chronic inflammatory bowel disease. This group includes Crohn's disease and ulcerative colitis, among others. Although they are different diseases, they also have some similarities. For this reason, they cannot always be clearly distinguished from one another. One speaks then of an indeterminate colitis - also called colitis indeterminata. This term refers to the inflammation of the large intestine - colitis, which cannot be clearly assigned, i.e. it is indeterminate.
In Germany, 12 out of 100 develop.000 people a new IBD. It is striking that most of those affected live in Northern Europe and North America. Our western lifestyle seems to be a risk factor for inflammatory bowel disease. Unfortunately, the exact cause of IBD is still not scientifically clarified.

What happens with IBD?

The defense system of the intestine has to decide again and again whether the contents of the intestine are useful nutrients or harmful foreign substances. The intestinal mucosa is the barrier for such foreign substances and prevents them from entering the intestinal wall. In the case of IBD, the intestinal mucosa is altered and this barrier is weakened. In this way, both harmless and harmful substances can get into the intestinal wall. In either case, this triggers a defensive response from the immune system that leads to inflammation. This inflammation damages the intestinal tissue.

How do you spot IBD?

Once the intestines become inflamed, symptoms such as persistent diarrhea, abdominal pain and persistent weakness are very likely. IBDs occur periodically, i.H Phases with symptoms alternate with symptom-free intervals. The strength, duration and frequency of such relapses vary greatly and are therefore difficult to predict. Typical symptoms are, for example, mucous diarrhea and stomach pain. In addition, around 35% of those affected suffer from symptoms outside the digestive tract. These include, for example, symptoms in the joints, skin, eyes, liver and bones. In children and adolescents, this disease can lead to severe weight loss and stunted growth.

What are the differences between ulcerative colitis and Crohn's disease?

The two diseases differ significantly in terms of which parts of the digestive tract are affected. You can find out more about the two clinical pictures now:

Crohn's disease:

Crohn's disease can attack the entire digestive tract - i.e. the entire area from the mouth to the anus. However, the disease most commonly occurs in the terminal sections of the small intestine. The special feature of Crohn's disease is that the affected parts of the digestive tract are usually not related. This means that healthy and unhealthy parts of the intestine alternate - a kind of "patchwork" of healthy and diseased parts of the intestine.
If a patient has Crohn's disease, the result is that all layers of the intestine are affected in the inflamed areas. Some of them are even downright destroyed! A consequence of this are, for example, abscesses, i.e. pus inclusions or fistulas. If fistulas occur, the inflammation has dug “ducts” into the intestinal wall and the surrounding tissue. In addition, so-called stenosis can occur - this is what scarred constrictions in the intestine are called.
It has been scientifically proven that Crohn's disease has a strong genetic component. However, other influences on the organism such as personal hygiene, diet and the psyche also play an important role.

A brief summary again:

  • Can occur anywhere in the digestive tract (mouth to anus).
  • There is a segmental-discontinuous infestation, i.e. inflamed segments of the digestive tract alternate with non-inflammatory segments.
  • Inflammation of the intestinal wall extends through all layers of the intestinal wall.

Ulcerative colitis:

This chronic intestinal disease translates to "colon inflammation with ulcers".
It differs from Crohn's disease explained above in that the inflammation caused only occurs in the colon. Another difference is that the patients' intestines are continuously diseased. This means that there are no inflammation-free sections in the intestine once the disease has broken out. Another interesting fact is that ulcerative colitis starts in the rectum and from there spreads orally. In addition, this disease only affects the uppermost layer of the intestine and does not invade the deeper layers of the intestine like Crohn's disease.

A brief summary again:

  • Only affects the colon and rectum.
  • The inflammation spreads continuously from "back" to "front" (i.e.H from anal to oral).
  • Only the uppermost layer of the intestinal wall, the intestinal mucosa, is inflamed.

However, the two diseases have one thing in common - if they occur, the natural barrier function of the intestine is disturbed. This has some negative consequences, as it is responsible for preventing pathogenic, harmful bacteria or other "invaders" from entering the intestinal mucosa.
If the intestinal barrier is not intact, this results in impaired resistance. This allows bacteria to enter the body more easily and cause systemic inflammatory responses - just as is the case with the two diseases discussed previously. Unfortunately, over time, systemic inflammation can even become chronic. This, in turn, can lead to symptoms that also occur outside of the gut. This includes inflammation in joints, ligaments, muscles, skin, eyes and the liver. In addition, a long-lasting disease of the colon increases the probability of colon cancer noticeably.

How can IBD be treated?

In general, chronic inflammatory bowel diseases are classified according to their intensity and treated accordingly. If the disease is acute, doctors usually prescribe drugs that are intended to inhibit the symptoms and inflammation that occur, as these can cause very severe pain. The main goal of treating IBD patients is therefore to enable them to live as symptom-free as possible.
Recent studies show that probiotics have positive effects on the course of the disease, as they can reduce various symptoms. This involves therapy methods that aim to positively influence the composition of the intestinal mucosa through various microbiological corrections.
There is currently no cure for Crohn's disease, but ulcerative colitis can be cured by surgical removal of the colon and rectum. Treatment is multimodal and can provide good symptom control and a high quality of life in many patients. Probiotics can also be used in the treatment.


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