INFLAMMATORY BOWEL DISEASE

INTRODUCTION

  • Ulcerative colitis and Crohn’s disease are chronic inflammatory bowel diseases which pursue a protracted relapsing and remitting course, usually extending over years.

  • The diseases have many similarities and it is sometimes impossible to differentiate between them.

  • A crucial distinction is that ulcerative colitis only involves the colon ,while Crohn’s disease can involve any part of the gastrointestinal tract from mouth to anus.

  • Ulcerative colitis This condition causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.

  • Crohn's disease This type of IBD is characterized by inflammation of the lining of your digestive tract, which often spreads deep into affected tissues.

CAUSE

  • Genetic Predisposition

  1. CARD15 mutation-CD

  2. MDR1 gene mutation causes UC

  3. Other genes IL23R,IL128,STAT3,JAK2,LRRK2,CDKAL1,CCR6,PTPN22.

  • An altered dysregulated Immune response

  • An altered response to gut microorganism.

  • Environmental factors

MECHANISM

  • It is thought that IBD develops because of an abnormal host response to an environmental trigger in genetically susceptible individuals .

  • This causes inflammation of the intestine and release of inflammatory mediators, such as TNF, IL-12 and IL-23, which cause tissue damage.

  • These mediators are targets for therapeutic intervention .

  • In both diseases the intestinal wall is infiltrated with acute and chronic inflammatory cells.

ULCERATIVE COLITIS

  • Inflammation invariably involves the rectum (proctitis) but can spread to involve the sigmoid colon (proctosigmoiditis)or the whole colon (pancolitis).

  • Inflammation is confluent and is more severe distally.

  • In long-standing pancolitis the bowel can become shortened and ‘pseudopolyps’ develop which are normal or hypertrophied residual mucosa within areas of atrophy.

  • The inflammatory process is limited to the mucosa and spares the deeper layers of the bowel wall.

  • Both acute and chronic inflammatory cells infiltrate the lamina propria and the crypts (‘cryptitis’).

  • Crypt abscesses are typical.

  • Goblet cells lose their mucus and in long-standing cases glands become distorted.

  • Dysplasia, characterised by heaping of cells within the crypts, nuclear atypia and increased mitotic rate may herald the development of colon cancer.

  • CLINICAL SYMPTOMS

  • The major symptom is bloody diarrhoea. The first attack is usually the most severe and thereafter the disease is followed by relapses and remissions.

  • Emotional stress, intercurrent infection, gastroenteritis, antibiotics or NSAID therapy may all provoke a relapse.

  • Proctitis causes rectal bleeding and mucus discharge, sometimes accompanied by tenesmus.

  • Some patients pass frequent, small-volume fluid stools, while others are constipated and pass pellety stools.

  • Constitutional symptoms do not occur.

  • Proctosigmoiditis causes bloody diarrhoea with mucus.

  • Almost all patients are constitutionally well, but a small minority who have very active, limited disease develop fever, lethargy and abdominal discomfort.

  • Extensive colitis causes bloody diarrhoea with passage of mucus.

  • In severe cases anorexia, malaise, weight loss and abdominal pain occur, and the patient is toxic with fever, tachycardia and signs of peritoneal inflammation.

CROHN'S DISEASE

  • The sites most commonly involved, in order of frequency, are terminal ileum and right side of colon, colon alone,terminal ileum alone, ileum and jejunum.

  • The entire wall of the bowel is oedematous and thickened, and there are deep ulcers which often appear as linear fissures; thus the mucosa between them is described as ‘cobblestone’.

  • These may penetrate through the bowel wall to initiate abscesses or fistulas involving the bowel, bladder, uterus, vagina and skin of the perineum.

  • The mesenteric lymph nodes are enlarged and the mesentery is thickened.

  • Crohn’s disease has a patchy distribution and the inflammatory process is interrupted by islands of normal mucosa.

  • On histological examination, the bowel wall is thickened with a chronic inflammatory infiltrate throughout all layers.

  • CLINICAL FEATURES

  • The major symptoms are abdominal pain, diarrhoea and weight loss.

  • Ileal Crohn’s disease may cause subacute or even acute intestinal obstruction.

  • The pain is often associated with diarrhoea which is usually watery and does not contain blood or mucus.

  • Almost all patients lose weight because they avoid food since eating provokes pain.

  • Weight loss may also be due to malabsorption, and some patients present with features of fat, protein or vitamin deficiencies.

  • Crohn’s colitis presents in an identical manner to ulcerative colitis, but rectal sparing and the presence of perianal disease are features which favour a diagnosis of Crohn’s disease.

  • Many patients present with symptoms of both small bowel and colonic disease.

  • A few have isolated perianal disease, vomiting from jejunal strictures or severe oral ulceration.

DIAGNOSIS

  • Colonoscopy

  • Biopsy

  • Stool culture

COMPLICATIONS

  • Life-threatening colonic inflammation

  • Haemorrhage

  • Fistulas

  • Cancer

  • Extraintestinal Complications.

HOMOEOPATHIC THERAPEUTICS

  • Arsenicum Album: For Ulcerative Colitis with Stool of Offensive Odour and Blood

Arsenicum Album is a natural medicine of great help for the treatment of Ulcerative Colitis. The main symptom guiding its use is stool with an offensive odour and dark-coloured blood in it. The complaints get worse at night and the patient feelsa lot of weakness. This medicine can bring about much relief when alcoholic drinks, watery fruit or cold drinks worsen the condition. Burning pain in abdomen and rectum is a constant accompanying symptom. Warm drinks generally bring relief to patients requiring medicine Arsenicum Album.

  • Phosphorus: For Ulcerative Colitis with Stool Containing Blood and Greenish Mucus

Phosphorus is a very beneficial remedy for patients of ulcerative Colitis where the stool contains blood and greenish mucus with extreme offensiveness. The condition mainly gets worse in the morning. The patients show an excessive craving for cold drinks, ice cream and juicy things.

  • Aloe Socotrina: For Crohn’s Disease with Loose Stool

Aloe Socotrina is among the top natural remedies for Crohn’s Disease. The patients requiring this medicine complain of loose stool which gets worse immediately after eating or drinking anything. The patient feels a sudden urge to pass stool and has to rush to the toilet. Aloe Socotrina also brings relief from the cutting pains in lower abdomen which get worse before and during passing stool and get better after the stool is passed out. Faintness usually follows stool. This medicine can also control diarrhea that gets worse due to the intake of beer.

  • Podophyllum Peltatum: For Crohn’s Disease with Diarrhea

Podophyllum Peltatum is a very beneficial remedy for Crohn’s Disease with diarrhea and when the stool is watery, greenish and very offensive. The diarrhea mainly gets worse in the morning but in the evening, the stool is normal. The patient can also complain of prolapse of rectum before or during stool. The patient always feels a thirst for large quantities of cold water.

  • Mercurius Corrosivus: For Blood and Mucus in Stool in Ulcerative Colitis

Mercurius Corrosivus is the top natural medicine to treat patients suffering from Ulcerative Colitis. This is the best remedy for patients in whom blood and shreds of mucus membranes are passed along with the stool. The patients requiring this medicine feel a constant urge to pass stool but only scanty, hot stool of offensive odour is passed. After passing the stool, the urge reappears and the patient gets no satisfaction. Cutting pains in the rectum accompany the passage of stool.

  • Colchicum Autumnale: For Ulcerative Colitis with Jelly-like Mucus in Stool

Colchicum Autumnale is a natural remedy used in treating those patients of Ulcerative Colitis who complain of excessive jelly-like mucus in stool. The patients experience nausea of the extreme degree and even faint from the odour of cooking food, mainly eggs and meat.

  • Cinchona Officinalis: For Crohn’s Disease with Diarrhea Worse at Night

Cinchona Officinalis is a natural medicine of great help in treating Crohn’s Disease where the diarrhea gets worse at night. The patient has excessive flatulence in the whole abdomen along with diarrhea. This remedy also works best for patients in whom diarrhea gets worse by taking milk or fruits.

  • Argentum Nitricum: For Crohn’s Disease with Watery Green Stool and Flatulence

Argentum Nitricum is thee top natural remedy for Crohn’s Disease with watery green stool accompanied by discharge of loud and noisy flatus. The diarrhoea mainly gets worse by over-eating sweets or after any emotional excitement. An unusual craving for sweets may be present in patients requiring this medicine.