Question

Compare and contrast the following gastrointestinal disorders: Irritable Bowel Syndrome, Colitis, and Crohn’s Disease. In your answer, be sure to include what is similar about these conditions, and what is different. Be sure to comment on the etiology of these conditions, the location of impact, pathogenesis, and signs and symptoms. Discuss some of the varying treatment options for each condition.

Answer 1

Irritable bowel syndrome (IBS)

is a common disorder that affects the large intestine

The signs and symptoms of IBS vary. The most common include:

• Abdominal pain, cramping or bloating that is typically relieved or partially relieved by passing a bowel movement
• Excess gas
• Diarrhea or constipation — sometimes alternating bouts of diarrhea and constipation
• Mucus in the stool

• ETIOLOGY
• Muscle contractions in the intestine. The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Contractions that are stronger and last longer than normal can cause gas, bloating and diarrhea. Weak intestinal contractions can slow food passage and lead to hard, dry stools.
• Nervous system. Abnormalities in the nerves in your digestive system may cause you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive process, resulting in pain, diarrhea or constipation.
• Inflammation in the intestines. Some people with IBS have an increased number of immune-system cells in their intestines. This immune-system response is associated with pain and diarrhea.
• Severe infection. IBS can develop after a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).
• Changes in bacteria in the gut (microflora). Microflora are the "good" bacteria that reside in the intestines and play a key role in health

Risk factors

• Are young. IBS occurs more frequently in people under age 50.
• Are female. In the United States, IBS is more common among women. Estrogen therapy before or after menopause also is a risk factor for IBS.
• Have a family history of IBS. Genes may play a role, as may shared factors in a family's environment or a combination of genes and environment.
• Have a mental health problem. Anxiety, depression and other mental health issues are associated with IBS. A history of sexual, physical or emotional abuse also might be a risk factor.

TREATMENT

Mild signs and symptoms can often be controlled by managing stress and by making changes in your diet and lifestyle. Try to:

• Avoid foods that trigger your symptoms
• Eat high-fiber foods
• Drink plenty of fluids
• Exercise regularly
• Get enough sleep

Your doctor might suggest that you eliminate from your diet:

• High-gas foods. If you experience bloating or gas, you might avoid items such as carbonated and alcoholic beverages, caffeine, raw fruit, and certain vegetables, such as cabbage, broccoli and cauliflower.
• Gluten. Research shows that some people with IBS report improvement in diarrhea symptoms if they stop eating gluten (wheat, barley and rye) even if they don't have celiac disease.
• FODMAPs. Some people are sensitive to certain carbohydrates such as fructose, fructans, lactose and others, known as FODMAPs — fermentable oligo-, di-, and monosaccharides and polyols. FODMAPs are found in certain grains, vegetables, fruits and dairy products. Your IBS symptoms might ease if you follow a strict low-FODMAP diet and then reintroduce foods one at a time

• Alosetron (Lotronex). Alosetron is designed to relax the colon and slow the movement of waste through the lower bowel. Alosetron can be prescribed only by doctors enrolled in a special program, is intended for severe cases of diarrhea-predominant IBS in women who haven't responded to other treatments, and isn't approved for use by men. It has been linked to rare but important side effects, so it should only be considered when other treatments aren't successful.
• Eluxadoline (Viberzi). Eluxadoline can ease diarrhea by reducing muscle contractions and fluid secretion in the intestine, and increasing muscle tone in the rectum. Side effects can include nausea, abdominal pain and mild constipation. Eluxadoline has also been associated with pancreatitis, which can be serious and more common in certain individuals.
• Rifaximin (Xifaxan). This antibiotic can decrease bacterial overgrowth and diarrhea.
• Lubiprostone (Amitiza). Lubiprostone can increase fluid secretion in your small intestine to help with the passage of stool. It's approved for women who have IBS with constipation, and is generally prescribed only for women with severe symptoms that haven't responded to other treatments

2) COLITIS

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than sudden.

SYMPTOMS

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:

• Diarrhea, often with blood or pus
• Abdominal pain and cramping
• Rectal pain
• Rectal bleeding — passing small amount of blood with stool
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever
• In children, failure to grow

Causes

The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don't cause ulcerative colitis.

One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.

Heredity also seems to play a role in that ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don't have this family history.

Risk factors

Ulcerative colitis affects about the same number of women and men. Risk factors may include:

• Age. Ulcerative colitis usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until after age 60.
• Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. If you're of Ashkenazi Jewish descent, your risk is even higher.
• Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.

Treatment

Ulcerative colitis treatment usually involves either drug therapy or surgery.

Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition and location. The drugs that work well for some people may not work for others, so it may take time to find a medication that helps you.

5-aminosalicylic acid (5-ASA)

5-aminosalicylic acid (5-ASA) is often the first step in the treatment of ulcerative colitis. Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Which one you take, and whether it is taken by mouth or as an enema or suppository, depends on the area of your colon that's affected.

Corticosteroids

These drugs, which include prednisone and budesonide (Uceris), are generally reserved for moderate to severe ulcerative colitis. Due to the side effects, they are not usually given long term.

Immunomodulator drugs

These drugs also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. Examples include:

• Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). Taking these medications requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver.
• Cyclosporine (Gengraf, Neoral, Sandimmune). This drug may be used for people who haven't responded well to other medications and is not for long-term use.
• Tofacitinib (Xeljanz). This drug has recently been approved for treatment of conditions such as ulcerative colitis, rheumatoid arthritis or psoriatic arthritis.

Biologics

Types of biologics used to treat ulcerative colitis include:

• Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These drugs are called tumor necrosis factor (TNF) inhibitors and work by neutralizing a protein produced by your immune system.
• Vedolizumab (Entyvio). This gut-specific medication works by blocking inflammatory cells from getting to the site of inflammation.

Surgery

Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy)

3) CROHNS DISEASE

Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.

n some people with Crohn's disease, only the last segment of the small intestine (ileum) is affected. In others, the disease is confined to the colon (part of the large intestine). The most common areas affected by Crohn's disease are the last part of the small intestine and the colon.

• Diarrhea
• Fever
• Fatigue
• Abdominal pain and cramping
• Blood in your stool
• Mouth sores
• Reduced appetite and weight loss
• Pain or drainage near or around the a-nus due to inflammation from a tunnel into the skin (fistula)

Other signs and symptoms

People with severe Crohn's disease also may experience:

• Inflammation of skin, eyes and joints
• Inflammation of the liver or bile ducts
• Delayed growth or sexual development, in children

CAUSES

• Immune system. It's possible that a virus or bacterium may trigger Crohn's disease. When your immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.
• Heredity. Crohn's is more common in people who have family members with the disease, so genes may play a role in making people more susceptible. However, most people with Crohn's disease don't have a family history of the disease

TREATMENT

Anti-inflammatory drugs

Corticosteroids

Oral 5-aminosalicylates

Immune system suppressors

Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan

Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia)

Methotrexate (Trexall)

Antibiotics

Anti-diarrheal

pain relievers