Inflammatory Bowel Disease (IBD): an Overview
U.S. residents with Indian ethnicity have greater risk for IBD.
Inflammatory Bowel Disease (IBD) is an umbrella term which represents a group of digestive diseases highlighted by prolonged inflammation. The digestive tract comprises the mouth, esophagus, stomach, small intestine, large intestine (colon) and rectum. This tract is responsible for the digestion of the food (breaking down and extracting the nutrients) and removing any unusable material and waste products. Inflammation along this digestive tract can disrupt digestive process which may result in a multitude of miserable digestive symptoms which include severe stomach pains, bleeding, and malnutrition. At times, it can be even be life-threatening.
The two most common IBD conditions are ulcerative colitis (UC) and Crohn’s disease (CD). The latter can cause inflammation in any part of the digestive tract from mouth to anus. Ulcerative colitis is limited to the colon. The other less common entity is called microscopic colitis and as the name implies it is diagnosed only with microscopic examination and it is confined to the colon.
Cause: The precise cause of IBD is still unknown but genetics and malfunctioning immune system have been implicated. A person who has a sibling or parent with the disease is more likely to develop IBD; this implies that IBD may have a genetic component in susceptible people. The immune system defends the body from pathogens which cause infections. A bacterial or viral infection of the digestive tract can trigger an immune response to fight against these invaders, leaving the digestive tract inflamed. When the infection subsides, the inflammation usually disappears. In susceptible people, immune system attacks the body’s own digestive tract cells, leading to chronic inflammation resulting in IBD. This phenomenon is known as an autoimmune response and this can occur even in the absence of any overt infection.
Prevalence: Certain ethnic groups such as Caucasians and Jews have a high risk of developing IBD. There is rising incidence and prevalence of IBD in India, and there appears to be a North-South divide with more UC in north and more CD in south India. Recent research suggests that people with ancestry in the Indian subcontinent living in United States have the greatest risk for all types of inflammatory bowel disease compared with other ethnicities in the US. Physicians who attend to patients of Indian origin should be aware of their potentially higher risk for IBD.
People who live in industrialized countries and those with white collar jobs are more likely to develop IBD. This can be partially explained by lifestyle choices and diet such as high fat content and processed food. IBD is more common among people living in northern climates, with cold climate.
IBD may affect individuals at any age, but in most cases, it starts before the age of 35. UC is more common among men, while CD is more common among women.
We will review the management of IBD in the March issue.
This month’s guest columnist, Indran Indrakrishnan, MD (right), is a Gastroenterologist practicing in Lawrenceville, GA and an adjunct Clinical Professor of Medicine at Emory University School of Medicine.
[Gulshan Harjee, M.D., is a board certified internist in private practice with an emphasis on prevention. Please email your health and medical questions for consideration in this column to: firstname.lastname@example.org. The material in this column is of a general nature, and must not be construed as specific medical advice. This column rotates monthly along with the Fitness Lifestyle column by Aarti Patel.]
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