The digestive tract is a single tube that exists between the mouth and the anus, with many folds and convolutions. There are four main parts in this tube (such as the esophagus, stomach, small intestine, and large intestine), each with its own specific structure and function. Solid organs such as the liver and pancreas are also considered portions of the digestive system.
The hollow parts of the digestive tract are responsible for breaking down large portions of food into small molecules that can be readily absorbed into the circulation. The sterile bloodstream is separated from the mass of nutrients, toxins, and organisms in various parts of the hollow digestive tract by only a very thin layer of cells, collectively called the intestinal mucosa. This delicate and complex lining is responsible for secreting substances that aid in digestion and absorption of nutrients, and for defending the body against the toxins and other contaminants in the intestine itself (Abraham 2009).
During healthy conditions, the immune cells in the intestinal lining cope with invaders quickly and efficiently, without producing excessive amounts of localized inflammation. However, in inflammatory bowel disease, inflammation becomes uncontrolled. Cytokines released by inflammatory cells in the intestine attract additional immune cells that produce destructive chemicals and propagate inflammation (Neuman 2004). Since the inflammatory reactions taking place in the gut can promote systemic inflammation people with IBD should monitor levels of inflammatory cytokines in their blood. Cytokine testing can be used as a measure of the effectiveness of anti-inflammatory therapies, and can also help determine risk for other conditions associated with inflammation, such as atherosclerosis.
Crohn’s disease and ulcerative colitis are by far the most prevalent forms of Inflammatory Bowel Disease.
Crohn's Disease:
Crohn’s disease can attack any portion of the digestive tract, although inflammation most commonly occurs in the lower portion of the small intestine. The disease can cause ulcerations within the intestine that can erode into surrounding tissues such as the bladder, vagina, or even the surface of the skin. Inflammation in Crohn’s disease is not limited to the intestine - some people who have Crohn’s disease have inflammation of the eyes and joints as well.
The most common symptoms of the disease include severe abdominal pain, which can present with or without diarrhea. Diarrheal stool may be mixed with blood, mucus and/or pus and bowel movements are often painful. Cramping in the right lower side of the abdomen is common, especially after meals. People with Crohn’s disease often have chronic low-grade fever, poor appetite, fatigue, and weight loss. Skin rashes may also occur. People who have Crohn’s disease often have some degree of anemia, related to poor iron, folic acid, and/or vitamin B12 absorption and due to chronic blood loss. Those with mild Crohn’s can eat and function reasonably normally, while those with severe disease often fail to respond to conventional treatment and have persistent gastrointestinal symptoms, as well as fevers, and infections. Diagnosis of Crohn’s disease is usually based on a patient’s medical history and symptoms. Diagnostic tests may be used to confirm the disease and to distinguish it from ulcerative colitis. Such tests include x-rays (with contrast material such as barium), colonoscopy, and endoscopy.
No blood test can diagnose Crohn’s disease, but routine testing is usually done to detect anemia, infection, degree of inflammation, and determine liver function.
Ulcerative Colitis:
Ulcerative colitis is characterized by inflammation of the large intestine (colon) that leads to episodes of bloody diarrhea, abdominal cramping, and even fever. Unlike Crohn’s disease, ulcerative colitis usually does not affect the full thickness of the intestine and rarely affects the small intestine. The disease usually begins in the rectum or sigmoid colon and spreads partially or completely through the large intestine.
A definitive diagnosis can be made by direct examination of the colon by sigmoidoscopy or colonoscopy Both procedures can be used to take a biopsy of intestinal tissue, which can reveal important information about the degree and extent of inflammation and help rule out other causes of symptoms. Further classification of Ulcerative Colitis can be grouped as Severe (affecting the whole colon with serious blood loss), Moderate (various symptoms with minimal signs of inflammation), or Mild (the most common form, which responds well to treatment).
Conventional treatments for IBD will be greatly influenced by the disease location and severity, possible complications, and response to prior treatments. The goals of therapy are focussed to control inflammation, correct nutritional deficiencies, and relieve symptoms such as abdominal pain, diarrhea, and rectal bleeding. Therapy may include drugs, surgery, or a combination of approaches.
Drug Treatments:
- Anti-inflammatory drugs help control local inflammation of the gut and glucocorticoids or corticosteroids to reduce inflammation.
- Glucocorticoids (or corticosteriods) reduce inflammation and used for more severe cases.
- Immune system suppressors, or the cancer chemotherapy drug methotrexate, are used to treat patients with IBD who have not responded to 5-ASAs or Glucocorticoids.
People with Crohn's disease should avoid aspirin as this type of medication can increase the risk of Crohn’s disease (but not ulcerative colitis).
Surgery:
In severe cases of Crohn’s disease, abscesses can develop in chronically inflamed tissues. These abscesses can grow and tunnel through tissue barriers to produce fistulas, or channels between organs. Almost half of patients who have Crohn’s disease develop perianal disease involving anal fissures, perianal abscesses, and fistulas. These symptoms seldom respond well to conventional therapies (Braunwald 2001; McNamara 2004). Surgery may be required in a high percentage of these patients (Danelli 2003). Unfortunately, complications are a frequent consequence.
If portions of the intestinal tract are severely inflamed ,surgery may also be recommended to remove the specific section. The goal of surgery is to preserve as much of the intestine as possible and normally involves working on the colon or small intestine. Occasionally, the end of the intestine that has been left in place will need to be brought to the skin's surface to allow waste excretion.
Lifestyle changes and nutritional supplementation synergize to promote healthy digestion and absorption while simultaneously reducing the inflammation and damage associated with inflammatory bowel disease (IBD).
The following suggestions may help patients with Crohn’s disease to first reduce their symptoms and then begin long-term repair of the damage caused by their disease:
- Avoid troublesome foods. Remove all foods that precipitate symptoms, and trial a diet consisting of just organic meat, spelt, butter and organic teas. Through trying different diet styles and inclusions / exclusions you will be able to identify which foods do not accommodate with your body.
- Following a diet based upon blood IgG antibody testing for food sensitivities has been shown to reduce stool frequency in Crohn’s patients.
- Supplement to correct potential nutritional insufficiencies. The diets of most patients who have IBD are deficient in one or more vitamins or minerals as the digestive tracts ability to absord consumed nutrients is impaired. Vitamin D and vitamin K deficiencies are frequently found in those with Crohn’s disease, as well as deficiencies in iron, vitamin B6, carotene, vitamin B12, and albumin (protein).
- Balance intestinal microbiota. studies have shown that a normal healthy intestine contains about 100 trillion microorganisms. In a intestine where disease reigns, these bacteria are often not present in adequate amounts and/or have been replaced by pathogenic organisms. By taking the right mixture of probiotics the patient can promote continued repopulation with these beneficial bacteria.
- In children and adolescents who have Crohn’s disease, a semi-elemental diet has been shown to be as effective as glucocortocoids in maintaining remissions.
Inflamed intestines may not absorb nutrients properly, therefor people with IBD are prone to malnutrition and vitamin deficiencies and will benefit from the following therapies.
Probiotics: Clinical trials of probiotic use in IBD populations have indicated beneficial effects by stimulating growth of helpful gut flora.
Omega-3 fatty acids: Omega-3 fatty acids are powerful immunoregulatory agents that reduce circulating inflammatory cytokines and decrease the cytotoxicity of natural killer cells.
Vitamin D: a powerful immunomodulator. Experimental models have shown that T-cells express a vitamin D receptor, and that lack of vitamin D signaling causes T-cells to produce higher levels of inflammatory cytokines. Moreover, vitamin D is required for development of subsets of Treg cells that are important in suppressing inflammation specifically in the gut (Chambers 2011; Ooi 2012). Antioxidants. Normal digestion produces a host of reactive oxygen and free radicals against which the intestinal mucosa maintains an extensive defense system of antioxidants.
Curcumin: The efficacy of the turmeric extract curcumin as an anti-inflammatory agent in a variety of settings is well-documented.
Selenium: Selenium is a trace element that is essential for the function of a number of selenium-dependent enzymes. Supplementation helps alleviate this problem, based both on increases in serum selenium and improved glutathione peroxidase function.
Butyrate: in various clinical trials, oral butyrate has provided relief in both Crohn’s and ulcerative colitis. The amino acid carnitine is necessary for proper cellular metabolism, and insufficient carnitine levels particularly affect cells that require a great deal of energy, such as those of the immune system.
Glutamine: Oral glutamine supplementation can stabilize intestinal permeability and mucosal integrity.
Melatonin: Numerous in vitro and animal studies have suggested that melatonin can reduce inflammation in IBD. Dehydroepiandrosterone (DHEA) plays an important role in preventing chronic inflammation and to maintain healthy immune function.
Vitamin K: this nutrient is used by the body to regulate blood clotting. A deficiency in vitamin K can result in bruising or bleeding and patients with IBD are frequently deficient in vitamin K.
Fiber: Greater intake of dietary fiber is linked with lower incidence of Crohn’s disease, while higher sugar consumption is associated with increased risk. A diet low in refined sugar and high in dietary fiber has been shown to have a favorable effect on the course of Crohn's disease and does not lead to intestinal obstruction compared to a normal diet.
