November 13, 2010

Disease trumps Syndrome. Discuss.

Inflammatory Bowel Disease vs Irritable Bowel Syndrome

There are two types of Inflammatory Bowel Disease - Ulcerative Colitis (UC) and Crohn's Disease (CD). UC is arguably the lesser of two evils; unlike in Crohn's, inflammation from Colitis is far more localized in nature. Typically, the disease affects the colon (large bowel) including the rectum and anus, and only invades the inner lining of bowel tissue. It almost always starts at the rectum, extending upwards in a continuous manner through the colon.  UC can be controlled with medication and in severe cases (aka mine), can even be functionally "cured" by surgical removal of the entire large intestine.

The inflammation from CD can strike anywhere in the gastrointestinal (GI) tract, from mouth to anus, but is usually located in the lower part of the small bowel and the upper end of the colon. Patches of inflammation are interspersed between healthy portions of the gut, and can penetrate the intestinal layers from inner to outer lining. CD can also affect the mesentery, which is the network of tissue that holds the small bowel to the abdomen and contains the main intestinal blood vessels and lymph glands.

The symptoms for both UC and CD are oftentimes shared, making it difficult for a definitive diagnosis without biopsy or pathology results. Typically though, people with CD will experience more varied symptoms because the disease can be located anywhere in the GI tract.  On the whole however, Crohn’s patients often present with abdominal pain, cramping, diarrhea, nausea, vomiting and not surprisingly, weight loss and lack of energy. People who have CD will experience periods of acute flare-ups, when their symptoms are active and other times when their symptoms go into remission. The average risk of a flare-up in any one year is approximately 30%.
UC patients experience severe and bloody diarrhea, false urges to have a bowel movement, abdominal pain and cramping, nausea and vomiting, decreased appetite, weight loss, mild fever, anemia and loss of body fluids. Like CD, people with UC have acute periods of active symptoms, and other times when their symptoms are absent (remission). Unlike CD, there is usually not any pain during remission. During flare-ups, the pain is usually not constant but does seem to arise coincidentally with the urge to have a bowel movement.

Irritable Bowel Syndrome (IBS) on the other hand, can loosely (and highly unscientifically) be understood as IBD’s milder but still annoying, tag-along cousin (you know, the one who bugs you to take them to the amusement park but then won’t go on any of the really scary roller coasters. Instead they would rather play it safe and play on the kiddy rides.) The first difference is more than semantics: IBD is a disease and IBS is a syndrome. That means that in IBD, the GI tract is actually diseased; there is something physically, definitively and observably wrong with it. What this is, precisely, remains a mystery to researchers. Is it a result of genetics, the environment, microorganisms out of whack in the GI tract, diet, stress, or some other x factor that has yet to be identified? IBS sufferers, conversely, do not have a disease but rather a combination of symptoms related to intestinal discomfort, which can usually be treated.  

IBS sufferers can often experience similar symptoms to IBD patients, such as diarrhea, abdominal pain and cramping. However, there are significant differences that help distinguish between IBD and IBS (aside from the names). UC and CD are auto-immune diseases, which means that for whatever reason the immune system actually attacks the GI tract rather than defend it. IBS patients have healthy immune systems that function in the way that they were designed to: fight off infection and promote general health and well-being.  IBD causes bleeding and ulcers in the GI tract; IBS does not. IBD sufferers often experience fever, anemia and blood loss; IBS patients do not. IBD also does not tend to produce or prompt production of large amounts of mucus; in IBS it is often seen, perhaps as a way to help ease the elimination of waste materials.  

Another significant difference between IBD and IBS can be found in their causation and treatment options. With regard to IBD, the treatment options are limited, rife with side-effects and usually designed to improve quality of life without curing the underlying inflammatory processes that fuel the disease’s progression.* IBS sufferers, by comparison, have been diagnosed with a myriad of contributory factors. For example, gluten intolerance (celiac), lactose intolerance, improper levels of dietary fat, poor digestion, and anxiety issues can all interrupt the natural processes of digestion and gastrointestinal health.  As such, an equally diverse set of treatment protocols has been recommended for IBS patients:  high fiber diets (to help aid the passage of stool through the GI tract), stress reduction exercises, avoiding laxatives as well as the elimination of dairy and gluten products (where indicated).
So, what’s the big deal? The big deal is that I’m very competitive. If I’m going to be sick, I’m going to be sicker than you. So, ha! My disease trumps your syndrome. I guess I showed you… **


*Watch for the next two entries on UC/CD medication protocols, which follow the adventures of “Enormo Face”.
 **You are correct in surmising that I am not entirely right in the head. But, this preceded illness-palooza, so I have not included any mental symptoms (as of yet) to my IBD and PSC whine-fest. I am, however, always in the market for a new doctor, so maybe a psychiatrist is the way forward…?

 

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