Project #88211 - Response

Response # 1 to Anthony

 

 

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two digestive disorders that can be confused with each other due to some similarities of symptoms. The purpose of this paper is to discuss the difference between the two conditions which incorporate factors like genetics and behavior that affect treatments and each pathophysiology.

Inflammatory Bowel Disease

IBD is an idiopathic chronic inflammatory gastrointestinal (GI) disease used to describe Crohn’s disease (CD) and ulcerative colitis (UC) (Greveson & Woodward, 2013). IBD is a lifelong condition triggered by both genetic and environmental involvement. UC can have lesions or ulceration of the colonic mucosa in the rectum and sigmoid (Huether & McCance, 2012). UC’s genetic theory is supported its prevalence in the Jewish and white population with ages of 10 – 40 years old. Lymphocytes in persons with UC may have cytotoxic effects on the epithelial cells of the colon. The mucosa of the large intestine in UC becomes hyperemic due to the swelling and can lead to ulcers and abscess formation. Mucosal destruction with swelling causes bleeding, cramping pain, and frequent diarrhea with small blood and purulent mucus is common. Dehydration, weight loss, anemia, and fever can ensue. Anal fissures, hemorrhoids, and a perirectal abscess can complicate UC. Diagnosis is made based on history and clinical indicators (Huether & McCance, 2012). CD, on the other hand, is the transmural swelling of any part of the GI tract, but rectal involvement is rare. CD affects those 10-30 years of age mostly with a higher risk for nicotine users. The inflammation is thought to be from increased levels of interferon-gamma and TNF-alpha due to a cell-mediated response. The ascending and transverse colons are the most common sites. Segmental involvement and not the entire tract is affected by the lesions typically granuloma. Fistulae, fissures, and strictures can also form due to the combined effect of the disease (Huether & McCance, 2012). Symptoms can include weight loss, abdominal pain, diarrhea or rectal bleeding if the colon is involved. There can be anemia due to B12 malabsorption and also folic acid and vitamin D deficiencies.Both UC and CD may make an individual predisposed to celiac disease (Cope, 2014)

The usual drug treatment for IBD is long-term systemic and local corticosteroids and immunosuppressive agents (Cope, 2014). Mild to moderate UC is started on oral or topical aminosalicylates plus corticosteroids if symptoms persist. Thiopurine maintenance therapy is used for those requiring multiple courses of steroids. Anti-tumor necrosis factor (TNF) like infliximab and adalimumab are effective in inducing and maintaining remission in some patients. TPN might be required for those with malnutrition. Surgical resection of the colon may be done for severe, unremitting UC (Huether & McCance, 2012). Immune-modifying agents like mercaptopurine and azathioprine are alternatives if the first-line drug treatment fails (Cope, 2014). Smoking cessationshould be started for people with IBD especially those with CD.

Irritable Bowel Syndrome

IBS is characterized by recurrent abdominal bloating, cramping, abdominal pain leading to diarrhea, constipation or both more common in women (Huether & McCance, 2012). IBS affects 10-20% adults in the United States mostly women. IBS usually starts in late adolescence or early adulthood usually when having emotional stress. IBS is an illness without a definite cause and can have a profound negative effect mentally, psychologically, emotionally, and economically on the afflicted person (Andresen et al., 2011). Evidence points to several mechanisms as the causes of symptoms. GI motility, secretion, and perception are disturbed. Molecular and cellular alterations at the mucosal level, changes in the gut flora, altered superordinated regulatory systems, and increased prevalence of psychological co-morbidities is manifested (Andresen et al., 2011). IBS is a clinical diagnosis made after reliably ruling out other differential diagnoses. Detailed medical history and thorough physical examination are required for accurate diagnosis. Confirmation of IBS in an adult needs an ileocolonoscopy and other procedures to rule out other candidate diagnoses. There is no cure for IBS and treatments are individualized. Drug therapy for symptom relief includes laxatives, antispasmodic, antidiarrheal, low-dose antidepressant, visceral analgesics, and serotonin agonist or antagonist. There is no general prescription as to nutrition and lifestyle (Andresen et al., 2011). However, nutritional and behavioral advice should be rendered to prevent specific symptom triggers. If appropriate, the patient should be referred to a psychiatrist if any relevant sign of psychological stress is manifested.

IBD and IBS Compared

Based on my research, IBD is marked by swelling while IBS is not. IBS is not classified as a true disease but a functional GI disorder despite sharing some symptoms like urgent bowel movements similar with IBD. IBS is not a disease, but a syndrome meaning a group of symptoms. IBD involves swelling that can lead to GI ulceration and damage, anemia, bleeding, weight loss or fever that IBS do not have (Huether & McCance, 2012). IBD treatments include corticosteroids and immunosuppressant that are not used with IBS. IBS does not show signs of an abnormality of the colon when examined. IBS is a less serious condition that does not result in intestinal bleeding or harmful complications, hence, not requiring strong medications, hospitalization and surgery (Huether & McCance, 2012). Both IBS and IBD have been associated with stress that can precipitate exacerbation, but no definite connection have been established yet. This association might be helped by seeing a therapist for stress management and relaxation training. Other treatments like cognitive behavioral therapy or hypnotherapy can be costly and not possible for those uninsured. IBD has no gender preference, but IBS was noted to be more prevalent among women. IBS is common worldwide compared to IBD’s UC, which is prevalent more among white Jewish population (Huether & McCance, 2012). If possible, early detection should be made using available screening tools to prevent severe forms of the condition from happening. Patient’s eating habits should conform or adjust whether they have IBS or IBD to mitigate the symptoms arising from either one. Living a healthier lifestyle by refraining from smoking tobacco and drinking alcohol can help their body maximize the absorption of the nutrients, vitamins, and minerals from the food they eat.


References

Andresen, V., Keller, J., Pehl, C., Schemann, M., Preiss, J., & Layer, P. (2011). Irritable bowel syndrome—the main recommendations. Deutsches Aerzteblatt International108(44), 751-760 10p. http://dx.doi.org/doi:10.3238/arztebl.2011.0751

Cope, G. (2014). Managing ulcerative colitis and Crohn’s disease. Nursing & Residential Care16(12), 687-691 5p. Retrieved from Walden Library databases

Greveson, K., & Woodward, S. (2013). Exploring the role of the inflammatory bowel disease nurse specialist. British Journal of Nursing22(16), 952-958 7p. Retrieved from Walden Library databases

Huether, S., & McCance, K. (2012). Understanding Pathophysiology (Fifth ed.). St. Louis, Missouri 63043: Elsevier Mosby.

 

 

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