Inflammatory bowel disease (IBD) is a collective term that refers to chronic, autoimmune, inflammatory diseases of the bowel, mainly ulcerative colitis and Crohn ‘s disease, although IBD may also be referred to as colitis, enteritis, ileitis, and proctitis.
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder causing increased contractions or spasms of the colon or rectum. In people with IBS, the colon is more sensitive and contracts more readily than it does in other people. IBS is a syndrome or collection of symptoms rather than a disease.
Signs and symptoms in Inflammatory Bowel Disease
Patients with inflammatory bowel disease have symptoms of diarrhea, abdominal pain, fever, abdominal pain, usually on the right side of the lower abdomen, feeling of a mass or fullness in the lower, right abdomen, weight loss, and bloody stools. Perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) are seen in IBD, and inflammatory white blood cells are seen in the colon mucosa. On occasion, signs and symptoms of both ulcerative colitis and Crohn’s disease both occur in patients, causing an overlapping type of inflammatory bowel disease.
Ulcerative colitis primarily involves the mucosal lining of the colon. The disease typically affects the rectum and spreads to the proximal colon. The entire colon is affected in some people. In others, disease is restricted to the lower areas of the bowel. Like most autoimmune disorders, periods of symptoms tend to alternate with periods of remission. Ulcerative colitis is associated with an increased risk of colon cancer particular in patients with extensive colitis of long duration.
Crohn’s disease may involve any part of the intestine, including the colon. Often, the entire bowel wall is involved. Unlike ulcerative colitis some parts of the intestine are affected with adjacent areas unscathed. Lesions in Crohn’s disease involve the presence of strictures, abscesses, and fistulas.
Signs and symptoms in Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a condition of spastic colon. It is not an inflammatory disorder. Symptoms of IBS include chronic abdominal pain, discomfort, diarrhea, and constipation. Symptoms of IBS often occur in people with systemic lupus erythematosus, fibromyalgia, and other disorders. In these conditions, symptoms of IBS are often linked to stress, inadequate fluids, poor nutrition, and poor eating habits, such as eating too fast or not relaxing after a meal. An examination of the colon shows no changes in patients with IBS. IBS is diagnosed in people having symptoms for at least 12 weeks in the preceding 12 months. Two of the following features must be present for a diagnosis of IBS:
- Relief upon defection
- Onset associated with a change in frequency of stool
- Onset associated with a change in form of stool.
Imaging tests and blood tests are used to rule out the presence of other disorders that may mimic IBS.
Incidence of Inflammatory Bowel Disease and Irritable Bowel Syndrome
Both IBD and IBS primarily emerge in young people between 10-20 years or people in their early 30’s. Up to 600,000 Americans are reported to have irritable bowel disease. About 15 percent of the American population is reported to have irritable bowel syndrome, with two-thirds of all cases occurring in women.
Coexistence of IBS and IBD
Although the topic is still controversial, many physicians think that symptoms of IBS can occur in patients with IBD. It’s also known that patients with IBD often complain of having symptoms of IBS for several years before being diagnosed with IBD. Studies show that people with IBS do not have a higher risk of developing IBD than other people. However, people diagnosed later in life with IBD tend to have a history of IBS symptoms prior to diagnosis.
Depression in IBD and IBS
A recent study conducted at Boston University showed that up to 40 percent of patients with IBS suffer from depression related to changes in serotonin levels. Low serotonin levels in IBS stem from gastrointestinal influences affecting serotonin production and release. According to researchers up to 95 percent of the body’s supply of serotonin is found in the colon.
Similar studies have shown an increased rate of depression in patients with IBD. In a large study conducted in Italy, researchers showed that the overall severity of psychological symptoms was not statistically different between patients suffering from IBD versus IBS.
Resources:
T Burgman, I Clara, L Graf, et al., The Manitoba Inflammatory Bowel Disease Cohort Study: Prolonged symptoms before diagnosis—how much is irritable bowel syndrome? Clin Gastroenterol Hepatol, 2006 May; 4(5) 614-620.
Norma Gaetani, IBS and IBD: Two Very Different Disorders, Crohn’s & Colitis Foundation of America, accessed March 1, 2007.
David Keren and James Goeken, Autoimmune Reactivity in Inflammatory Bowel Diseases, Progress and Controversies in Autoimmune Disease Testing, Clinics in Laboratory Medicine, Philadelphia: W.B. Saunders Company, Sept 1997 :465-481.
F. Pace, P Molteni, S Bollani, et al, Dept of Gastroenterology, Milan, Italy, Inflammatory bowel disease versus irritable bowel syndrome: a hospital-based, case-control study of disease impact on quality of life, Scand J Gastroenterol, 2003 Oct; 38(10): 1031-1038.
S. Jones, Beat the IBS Blues, Natural Health, April, 2007: 18.
