World Gastroenterology organization is observing 29th May 2010 as Inflammatory bowel disease” (IBD) day to create awareness regarding this disease. The incidence of IBD is rising gradually, especially in developing countries including India. Many countries are actively taking part in creating this awareness programme.
The two major types of IBD are ulcerative colitis and Crohn’s disease. Both these diseases are chronic conditions that can last from years to decades. They most commonly begin during adolescence or early adulthood.
In ulcerative colitis the large intestine becomes inflamed and ulcers may develop. Ulcerative colitis affects only the large intestine. However, Crohn’s disease can occur in any part of digestive system from oral cavity to anus. Ulcerative colitis affects superficial lining of large intestine but Crohn’s disease can cause damage to the entire wall of digestive tract. In ulcerative colitis inflammation begins in the rectum (the last few inches of the large intestine where faeces are stored before they leave the body).The most common symptoms of Ulcerative colitis are abdominal pain and bloody diarrhea. Patients with Crohn’s disease usually have abdominal pain or cramps, diarrhea, sometimes with blood in stool, fever and weight loss. As Crohn’s disease involves entire thickness of bowel wall, it can cause more serious problems than ulcerative colitis. In Crohn’s disease swelling and scar tissue can thicken the intestine wall. This narrows the passageway for food that is being digested. The area of the intestine that has narrowed is called a stricture. Deep ulcers may turn into tunnels called fistulas that connect different parts of the intestine. Among the many complications of Crohn's disease, the development of fistulas is one of the most distressing to patients because it decreases their quality of life and one of the most frustrating to physicians because of the dishearteningly high rate of management failure. IBD is not the same as IBS (irritable bowel syndrome) although the symptoms can be similar. Unlike in inflammatory bowel disease irritable bowel syndrome does not cause inflammation or damage the intestines.
IBD runs in families that suggests that inherited factors called genes play a role in causing IBD .Stress and eating certain foods does not cause IBD but both can make IBD symptoms worse
IBD is best diagnosed by a colonoscope, a long thin tube attached to TV monitor is inserted through the anus to visualizes inner lining of large bowel and part of small bowel. During the examination the Doctor may perform a biopsy which involves taking a small sample of tissue from part of the colon so it can be viewed with a microscope for confirmation of diagnosis.
Once this disease was considered very rare in our part of world but most of Gastroenterologists in India are seeing more cases of IBD. Ulcerative Colitis is 8 times more common that Crohn’s disease in India. When I started my practice in Pune almost 15 years ago I used to see 4-5 cases of IBD per month but now I see almost the same number of new cases per week that shows almost 4-5 fold increase in incidence of these diseases. There are various factors responsible for rising incidence of IBD in our area.
a) Sophisticated diagnostic instruments such as Video colonoscope readily available in all major hospitals and private clinics.
b) More experts are available to diagnose these conditions at an early stage. Before, bleeding per rectum was considered to be due to bleeding piles and treated for the same only to eventually realize that the cause of bleeding was IBD.
c) Hygiene hypothesis:- This is paradoxical but true. As per capita income and sanitary conditions are improving all over our country, the incidence of Crohn’s disease is also increasing. This is because of immunity that develops with ingestion of parasites and microbes through contaminated water or through poor sanitation in childhood. This acquired immunity lasts far decades and plays crucial role in protecting individuals from damage to intestine, even if exposed at later age to these germs. If the body doesn’t encounter these microbes in childhood, due to high standard of sanitation and water free of these organisms, then strong immunity is not developed to counter attack these microbes at a later age, thus causing damage to the intestine. Please log on