August 31st, 2011
07:26 AM ET

Could I have inflammatory bowel disease?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Question asked by BH from Milwaukee:

I am a 30-year-old male. I am having episodes of abdominal pain and bloody diarrhea. The doctor says she suspects ulcerative colitis or Crohn's disease and wants to do a colonoscopy. What are these diseases? What else could this be and is it appropriate to do a colonoscopy?

Expert answer:

Dear BH:

There are two major types of inflammatory bowel disease, or IBD: ulcerative colitis and Crohn's disease. It is estimated that inflammatory bowel disease affects about 500,000 Americans. Most IBD is diagnosed between ages 15 and 40 although some is diagnosed as late as age 80

The course of IBD typically consists of intermittent flare-ups of the disease alternating with sometimes long periods without symptoms.

Ulcerative colitis involves inflammation of a part of the colon and rectum. Patients can have episodes of abdominal pain, gaslike pains, bloody diarrhea, even fever during a flare, which can last for weeks or months. In its more severe form patients with UC can also have arthritis, liver problems (sclerosing cholangitis), certain skin rashes and eye problems (uveitis)

The abdominal complaints of mild ulcerative colitis are often confused with gluten allergy (celiac sprue). Other things that can be confused with IBD include amoebic, parasitic and bacterial bowel infections. Of these, Salmonella and Clostridium Difficile are most common. Salmonella can be caught from eating poorly stored or undercooked meats. Clostridium Difficile is a disease that is getting more common. It is caused by use of antibiotics. Most amoebic and parasitic infections are due to drinking contaminated water.

Crohn's disease is an inflammation that can occur anywhere in the GI tract from the mouth to the anus. When in the colon, symptoms can be similar to ulcerative colitis. Crohn's disease can cause fibrosis or scarring of the GI tract, leading to bowel obstruction or blockage, pain and fistulae. A fistula is a hole in the bowel through which bowel fluid and gas can leak. A fistula can track to other organs. Some patients with severe Crohn's can have a fistula track from the rectum to the bladder or rectum to vagina.

Crohn's disease can skip parts of bowel and a patient can have episodes of inflammation in several areas at one time. Most patients do have some small bowel involvement and about a third have disease only in the small bowel. This is often referred to as Crohn's ileitis.

Both diseases are most commonly diagnosed when a physician suspects the disease and a scoping procedure of the GI tract is performed with a fiber-optic scope. Upper endoscopy is done to investigate disease of the esophagus, stomach and small intestine. Colonoscopy is done to assess the colon, and on occasion, the distal ileum, which is the end of the small bowel. The physician can see areas of inflammation or scarring and may do a culture to diagnose infection as well as a biopsy of abnormal areas through the scope. A pathologist can confirm the diagnosis of Crohn's or ulcerative colitis with microscopic examination of the biopsy.

The causes of these diseases are unknown. Both are more common in Jews compared with non-Jews and in white Europeans compared with all other groups. The diseases do tend to run in families. In some studies, 10% to 25% of IBD patients have a first-degree relative with one of the diseases. It is not uncommon for a patient with Crohn's to have a relative with ulcerative colitis or vice versa.

For unknown reasons, there are higher rates of UC in developed countries versus developing countries. Rates are higher in the northern latitudes versus the equatorial climates.

No one knows the cause of the inflammatory bowel diseases. Older literature suggested there was a psychiatric component to these diseases. Today, it is known that stress or getting upset can cause an exacerbation of the disease, but a psychiatric illness is not believed associated with an underlying of the disease.

Interestingly, smoking appears to decrease the risk of UC and increase the risk of Crohn's disease.

While many have tried to link elements in diet as a cause of IBD, data are by no means definite. Most believe that a Western diet of processed, fried and sugary food does increase risk of IBD. It is possible that IBD is an immunologic response to foods. There is some speculation that hypersensitivity to cow's milk in infancy may cause IBD. This has been fueled by some studies to show that IBD patients were less likely to be breast fed as babies.

Patients with IBD are prone to malnutrition due to malabsorption. Children with the disease can have stunted growth.

Treatment includes attention to nutrition. There are medical therapies for the inflammatory bowel diseases and some patients with severe disease will have to have bowel resections. Patients with IBD, and especially ulcerative colitis, affecting the colon and rectum are at higher than normal risk of cancer of the colon or rectum. It is customary that UC patients get regular colonoscopy to detect malignancy. There are gastroenterologists who specialize in the treatment of this disease.

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soundoff (90 Responses)
  1. V Kelly

    It should be inflammatory bowel disease (IBD), ibs, irritable bowel is a who different story

    August 31, 2011 at 07:53 | Report abuse | Reply
  2. pat

    My "IBD" went away when I had an appendectomy.

    August 31, 2011 at 08:30 | Report abuse | Reply
  3. Jeff

    The headline is incorrect- it should read "Inflammatory Bowel Disease." Irritable Bowel is a condition not characterized by obviously-inflamed tissue in the gut and is often a condition of the central nervous system.

    August 31, 2011 at 08:44 | Report abuse | Reply
  4. bri

    If you suffer from any sort of digestive issue and overhaul of your diet is necessary. The Simple Carb Diet (SCD) developed by Elaine Gottchall has worked miracles for my family members as well and the Paleo diet is also a very good alternative. The diets are a lot of work but a far better option compared to cancer and chronic digestive pain/diarrhea.

    August 31, 2011 at 08:50 | Report abuse | Reply
    • Prasad

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      July 1, 2012 at 20:02 | Report abuse |
  5. sparknut

    bri – that's Specific Carbohydrate Diet

    August 31, 2011 at 09:12 | Report abuse | Reply
  6. bri

    sparknut – You are probably right. I guess we've been calling it Simple in my household for so long due to the fact that all the carbs that are allowed in the diet are not complex and the body doesn't need to break them down a bunch. Making it easier for them to be absorbed by a damaged gut. But you are correct that is the diet I am refering to.

    August 31, 2011 at 09:29 | Report abuse | Reply
  7. Broken

    The fact that the author says "gluten allergy" and then "celiac sprue" in the same sentence shows he's no GI expert and is about 10 years or more behind on terminology. Celiac's Disease and being allergic to wheat are two totally different things.

    August 31, 2011 at 10:07 | Report abuse | Reply
    • tensor

      Agreed. So many errors in this article on a range of digestive issues (IBD, IBS, Crohn's, Colitis), which Americans need more and better information about not less or incorrect. For those with mild digestive upsets or who have small kids with digestive issues, start with watching the wheat/gluten intake, as well as dairy. If those are triggers, dial back intake and let the gut have a chance to heal – which can take time. While genetics are there for some diagnosed above diseases, for others it is merely a sensitivity or allergy to something in one's diet. ID it, change it. Everybody, literally, every body, is different. Sometimes, you actually are what you eat. Gluten, however, is turning out to be a real bad guy for even those who never had any bowel problems before in their life.

      August 31, 2011 at 13:03 | Report abuse |
    • Heid Theba

      Not exactly – Celiac Disease, AKA gluten enteropathy is an immune (not autoimmune) response to gliadin, a component of the gluten found in wheat, rye etc. The author was just being generic in his use of the word "allergy", he didn't mean it in the systemic, runny nose, watery eyes, trouble breathing sense.

      August 31, 2011 at 18:19 | Report abuse |
  8. UC in CT

    I've been living with UC for about 9 years now and it has been life changing. I wish the article made reference to the frequency of movements that UC causes. It was not uncommon for me to go to the bathroom at least 30 times a day. It's amazing how this disease can completely take over your day to day functions. When it gets really severe, you can't even enjoy a simple walk around the block without the urge to have to find a restroom within minutes, because if you don't...well you know what will happen. One day your on top of the work and the next your life is flipped upside down. With the support of friends, family, a good doctor, and a healthy lifestyle you learn to manage it. I've tried the Specific Carb Diet and it didn't work for me. I recommend at least trying it because if it works, even better. For me, I had tried about 8 medications before I found one that worked. I eventually ended up spending a week in the hospital and a good heavy dose of steroids seemed to kick start putting it into remission. I've been good for a year, but as most people who have it know, it will at some point come back. You just have to live a healthy lifestyle in the mean time to be ready for the next episode.

    August 31, 2011 at 10:12 | Report abuse | Reply
    • Mamudoon

      I have ulcerative colitis as well, and everything you've said is true. Before I got treated, I was going to the bathroom up to 60 times a day. I lost so much blood that I was dizzy and weak all the time. It ultimately cost me my job, as I spent more time in the bathroom than at my desk. For a while, I actually developed agoraphobia because I was afraid to go anywhere where there wasn't a bathroom available. I know where every bathroom is within a 20-mile radius of my house. It really changes your life in ways you can't understand unless you have this terrible disease.

      I'm in remission now (thank you, Asacol!). Tried various diets, but none had any effect. I have flares now and then, but it feels good to have your life back. Sort of.

      August 31, 2011 at 16:19 | Report abuse |
  9. Gastro Girl

    Please fix the misleading headline as there is no such thing as "irritable bowel disease". You also need to fix the header in the promo under health on the main CNN home page. It should say "Inflammatory Bowel Disease (IBD)". Irritable Bowel Syndrome (IBS) is not a a disease and these are two different GI conditions. Thank you.

    How is IBD different from Irritable Bowel Syndrome?

    From the American College of Gastroenterology:

    How is IBD different than IBS?
    IBD develops due to inflammation in the intestine which can result in bleeding, fever, elevation of the white blood cell count, as well as diarrhea and cramping abdominal pain. The abnormalities in IBD can usually be visualized by cross-sectional imaging (for instance a CT scan) or colonoscopy. Irritable Bowel Syndrome (IBS) is a set of symptoms resulting from disordered sensation or abnormal function of the small and large bowel. Irritable Bowel Syndrome is characterized by crampy abdominal pain, diarrhea, and/or constipation, but is not accompanied by fever, bleeding or an elevated white blood cell count. Examination by colonoscopy or barium x-ray reveals no abnormal findings.

    August 31, 2011 at 10:28 | Report abuse | Reply
    • Bruno

      I know that weight fattculuions can be really hard to deal with Heather. I've always had them. My weight has gone from just under 100 to almost 162 and I'm around 5'9 . A lot of patients find it easier to gain weight after a surgery. Your body is fighting less and due to that is digesting the nutrients you put in better. I'm sure that you'll find what works best for you soon. I can tell you it takes everyone some time to figure out how their body works after surgery.

      April 7, 2012 at 23:50 | Report abuse |
  10. j

    if you do, you might enjoy this site- http://www.lilcrohnsie.blogspot.com

    August 31, 2011 at 11:49 | Report abuse | Reply
  11. j

    also, this article in the Journal of Experiemental Medicine suggests breast milk, not cow's milk, can trigger UC.

    Honestly, CNN, where did this "expert" come from?? Anyone seeking solid information on IBD visit the Crohn's and Colitis Association's page at ccfa.org

    August 31, 2011 at 11:56 | Report abuse | Reply
    • UC in CT

      CCFA is a great place for anyone to learn more about the disease and what is on the forefront of medical treatment and how to get involved to support their mission.

      August 31, 2011 at 13:00 | Report abuse |
    • karo pones

      Is impossible that those so called "experts" can have a total dominance on every field of medicine, so is better if you want to be informed, to go an expert site on each particular disease.

      September 2, 2011 at 21:24 | Report abuse |
  12. SH

    Celiac Sprue is not a gluten allergy. It is an autoimmune disease.

    August 31, 2011 at 13:45 | Report abuse | Reply
    • Jim

      Celiac disease and gluten sensitive enteropathy. Ie gluten allergy usually do mean the same thing

      August 31, 2011 at 18:33 | Report abuse |
    • Fawaz

      I just had a colonoscopy at age 31 and they found ntihong, yet I am sick everyday: intestinal bloating, nausea, excessive gas, constipation, occasional diarrhea, putrified-looking stool, occasional black stool, mucous in stool, long narrow stool with severe cramping, and stool coming out like large pellets. What is wrong with me???

      April 8, 2012 at 01:57 | Report abuse |
  13. Anna

    As a Crohn's sufferer for the past twenty odd years, it pains me to read an article written by an "expert" wherein I find myself knowing more about the topic than the expert does. Why on earth would CNN print something like this? This article is a joke and will scare the bejesus out of someone. These diseases themselves are bad enough without a "respected" news source adding to the suffering!

    August 31, 2011 at 14:16 | Report abuse | Reply
  14. Dill Weed

    A big stool doesn't always mean a clogged toilet.

    Palin Bachmann 2012

    August 31, 2011 at 15:42 | Report abuse | Reply
  15. Tom Hartman

    IBS symptoms can definitely include bloody stools, that definition is not accurate.

    August 31, 2011 at 15:54 | Report abuse | Reply
    • Carol

      No, I don't think IBS is supposed to include bloody stool. That is inflammatory bowel disease.

      August 31, 2011 at 16:36 | Report abuse |
  16. Carol

    These diseases have been associated with a prior Accutane usage as well as antibiotic usage. I have UC and it is quite manageable. I never used Accutane myself. I notice flareups when I use antibiotics or high stress. I go for years sometimes without an episode. Then it can last anywhere from 4 weeks to 2 or 3 months. When I came down with it at 30, I'd have episodes lasting months. It's gotten more mild over the years. I've found probiotics and taking modified citrus pectin to help immensely and puts me into remission when I have a flareup.

    August 31, 2011 at 16:35 | Report abuse | Reply
  17. JimC

    My son has Crohn's. It was diagnosed when he was 15 after a colonoscopy). He went on to the Specific Carbohydrate Diet when he was 16 and was asymptomatic within 3 months. He is now 20 and has had no problems since going on the diet. I highly recommend trying the diet – it can't hurt. It takes some work to remove certain things from the diet, but the result is outstanding for someone who is suffering from Crohn's. Good luck.

    August 31, 2011 at 16:45 | Report abuse | Reply
  18. Scott

    The SCD may work for some..But not for all, and it's not a cure. After 11 years of living with colitis and hearing well intentioned (or otherwise) people offer diets, cookbooks, supplements, teas, theories and everything else under the sun, i've found that what works best is proven science.

    Say cutting out carbs and going paleo is the answer all you want....Let's see you try it with IBD and Type I Diabetes and still get up for work the next day.

    August 31, 2011 at 20:15 | Report abuse | Reply
  19. IsNot

    For those of you asking who the "expert" is, his name is at the bottom of the article.

    August 31, 2011 at 21:54 | Report abuse | Reply
  20. Steve

    Sh1t no!

    August 31, 2011 at 22:15 | Report abuse | Reply
  21. me

    maybe all this stuff is viral

    September 1, 2011 at 08:27 | Report abuse | Reply
  22. Dr.Satinder Mullick

    Good answer to IBD.May I suggest another item that should be considered besides medicines ,nutrition that you mentioned.If you read Dr.Robyn Karlstadt article in ACG(she was past President) ,she says that WOMEN SUFFER IBD-2 times more than men.Dr.Tarun Mullick of Geneva,Illinois concurs from his experience.Stress is a factor besides physiology differences.Mistreatment is another issue.Many Gastroenterologist rush women quickly as they have another patient waiting after 15 minutes.
    A real example will illustrate my point. There is a 15 year old who was diagnosed with Chron's.Medicine helped,but his muscles were harmed and he could not return to his racing(he was part of his School Racing Team in Aurora,Illinois).Dr.Tarun Mullick treated him with encouragement,medicines and physical therapy.His muscles were restored in 6 months and this kid decided to organize http://www.foxriver5K.org every year in Batavia,Illinois.Dr.Mullick decided to sponsor it to encourage him further.Now this kid is 19/20 years old -studying in college and still organizing this RACE every year.
    Multidiscipline approach is needed to treat patients.
    Dr.Mullick has found more IBD in overweight people and he is advocating treating the underlying causes of overweight now with success.His success in treating women and others with multidiscipline approach is working.

    September 5, 2011 at 10:19 | Report abuse | Reply
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    April 30, 2012 at 16:27 | Report abuse | Reply
  24. Aubrey Santibanez

    Irritable bowel syndrome (IBS) is a functional GI disorder characterized by abdominal pain and altered bowel habits in the absence of specific and unique organic pathology. Osler coined the term mucous colitis in 1892 when he wrote of a disorder of mucorrhea and abdominal colic with a high incidence in patients with coincident psychopathology. Since that time, the syndrome has been referred to by sundry terms, incl`

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    March 14, 2013 at 09:54 | Report abuse | Reply
  25. Sundar

    My son who is 20 year old is undergoing treatment for IBD for the last 4 years. We have done colonoscopy last year august till last march he was under remission. suddenly for the last one month he is having frequent motions with mucous coming out as layers and some traces of blood in the stools. He is taking Pentasa 1 g 3 times a day, Mesacol suppository 2 times a day, Folic acid, rockbon D, VSL3 3 times a day and still it continues.

    Bssically i would like to know why this is happening and we are under the treatment of the India's No 1 Gastro entrologist. Kindly let me know what are latest developments in the medication of IBD and is there any medicine for permanent cure of this IBD. I will be grateful if i get a reply soon.

    June 3, 2013 at 06:09 | Report abuse | Reply
  26. Eliana Ur

    The iris is made up of muscular fibers that control the amount of light entering the pupil so that you can see clearly. The iris accomplishes this task by making the pupil smaller in bright light and larger in dim light.:-:'

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    June 23, 2013 at 09:02 | Report abuse | Reply
  27. Geri Allegrucci

    Several conditions may present themselves as IBS, including coeliac disease, fructose malabsorption,[5] mild infections, parasitic infections like giardiasis,several inflammatory bowel diseases, bile acid malabsorption, functional chronic constipation, small intestinal bacterial overgrowth, and chronic functional abdominal pain.-"..'

    With kind regards http://www.healthmedicinejournal.comew

    June 23, 2013 at 12:08 | Report abuse | Reply
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  30. amyonlowfodmapdiet

    I was just diagnosed with IBS and my doctor thinks it's a good idea if I went on that low FODMAP diet.

    Any suggestions or resources? Like for example this site that I found really helpful with great low FODMAP recipes https://casadesante.com/blogs/low-fodmap-meal-plans-low-fodmap-recipes I also tried following their meal plans. So far so good!

    Would love to hear others experiences here too. Thanks!

    December 18, 2018 at 10:42 | Report abuse | Reply
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