The long journey of the intestine: Unveiling the "inflammation" of inflammatory bowel disease

Author: Anqi Qinghai University Affiliated Hospital

Reviewer: Ma Zhenqi, Chief Physician, Affiliated Hospital of Qinghai University, Director of Department of Gastroenterology, Member of the Digestive Disease Branch of the Chinese Medical Association, Chairman of the Digestive Disease Branch of the Qinghai Medical Association

Inflammatory bowel disease (IBD) is a general term for a class of diseases, mainly including two related but distinct diseases: Crohn's disease and ulcerative colitis. The two diseases have their own characteristics in terms of the site and range of onset. Crohn's disease has a wide range of onset, and can affect any part of the body from the mouth to the esophagus, stomach, small intestine, and even the large intestine and anus, with one or more lesions, and the lesions can affect the entire intestinal wall. Ulcerative colitis, on the other hand, is mainly confined to the colon, mainly invading the superficial layer of the intestinal mucosa, and rarely involving the entire layer.

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The clinical symptoms of inflammatory bowel disease are diverse, the most common of which are abdominal pain, diarrhea, frequent bowel movements, weight and appetite loss, fatigue and fever. It is worth noting that the same disease may show one or more symptoms in different patients.

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There are two states of inflammatory bowel disease patients: the onset phase and the remission phase. During the onset phase, the symptoms are obvious and seriously affect daily work and life; while during the remission phase, the patient is no different from ordinary people and can live and study normally.

Inflammatory bowel disease may also affect multiple organs, including the eyes, skin, liver, and joints. Because the lesions of patients with ulcerative colitis are mostly concentrated in the superficial mucosa of the colon, the symptoms are often frequent abdominal pain, diarrhea, and bloody stools. Crohn's disease, on the other hand, will show more severe abdominal pain, and even nausea, vomiting, and other symptoms because the inflammation affects the entire intestinal wall. Some children with inflammatory bowel disease who develop the disease at an early age may even experience growth retardation.

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Another characteristic of Crohn's disease is that inflammation can invade the entire intestinal wall, leading to penetrating lesions of the intestinal wall, forming fistulas, and even lesions that penetrate the abdomen and communicate with the outside world. Repeated attacks can lead to segmental stenosis of the intestine, and in the later stages, it may lead to difficulty in smooth bowel movements. Crohn's disease and some ulcerative colitis patients often require surgical treatment to remove the diseased intestine and improve intestinal obstruction and intestinal fistulas when serious complications occur.

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Inflammatory bowel disease occurs in different age groups, and currently it mainly affects young people. If someone in the family has the disease, the risk of developing the disease is greatly increased, suggesting that the disease may be hereditary. In addition, inflammatory bowel disease has racial and regional characteristics, with the highest incidence rate among white people in Europe and America. With the progress of our society and changes in our living and eating environment, the number of patients has also increased year by year, and the incidence rate in the south is generally higher than in the north.

The diagnosis of inflammatory bowel disease is more difficult. The doctor will ask the patient in detail about all disease-related conditions, including symptoms, past medical history, family history, allergy history, etc., and prescribe various examinations according to the situation, such as blood tests, X-rays, stool tests, colonoscopy, etc.

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So far, the cause of inflammatory bowel disease is still not fully understood. Its pathogenesis is complex and is generally believed to be related to the mutation of the human immune system, that is, the immune system that originally protected the human body from external invasion begins to attack the human body itself for some reason, causing damage to the digestive tract and other organs.

Since inflammatory bowel disease mainly affects the digestive tract, patients have certain dietary requirements, and sometimes need to develop a diet that suits them and replenish water in time. The disease brings many troubles to the patient's life, such as frequent trips to the toilet, difficulty explaining the disease to others, and facing misunderstandings from family and relatives. Family support is crucial to the relief and recovery of the patient's condition, and it also helps reduce the occurrence of negative emotions.

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At present, inflammatory bowel disease cannot be cured, and controlling the disease and reducing attacks are still the treatment goals. Thank you for listening, and I hope that more and more people will understand this type of disease and get more attention!

References:

[1] Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology. Chinese Guidelines for the Diagnosis and Treatment of Crohn's Disease (Guangzhou, 2023). Chinese Journal of Inflammatory Bowel Diseases, 2024, 8(1): 2-32.

[2] Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology. Chinese Guidelines for the Diagnosis and Treatment of Ulcerative Colitis (Guangzhou, 2023). Chinese Journal of Inflammatory Bowel Diseases, 2024, 8(1): 33-58.