In general, inflammation is a defensive reaction of an organism. An inflammatory reaction is triggered by our immune system as a sign of its proper function while protecting us against the unwanted actions of foreign organisms or other harmful agents. However, a problem develops when the intensity of the reaction crosses a certain line. At that point the reaction stops fulfilling its role and causes more trouble than benefit. An inflammation can arise anywhere in the body. Some organs of the human body are more susceptible to harm than others or their damage has more serious consequences for the organism. That is the case with the digestive tract. Bowel inflammation can be categorized according to the cause as infectious inflammation, inflammation from other extrinsic or intrinsic causes and idiopathic inflammation.
Infectious Bowel Inflammaiton
Infectious inflammation is the most common type of bowel inflammation. It can affect adults, children and newborns, men just as often as women. The causes can differ geographically depending on the distribution of individual causative agents. This is linked to the severity of the disease and its treatment. Viruses, bacteria, chlamydia and even parasites can play a role in the causation of a bowel inflammation. The disease usually presents with elevated temperature and diarrhea. Diarrhea is especially dangerous for children and the elderly as it can quickly lead to dehydration, which can lead all the way to death. Infectious inflammation is, among others:
- Viral gastroenteritis is caused by rotaviruses, adenoviruses or coronaviruses. Clinically it presents with watery diarrhea and vomiting.
- Bacterial enterocolitis is caused by a wide range of bacteria, which is why it can present with manifold signs and symptoms. The most common agents are Vibrio cholerae, Escherichia Coli, staphylococci and some salmonellas. All of them cause increased secretion of liquid into the bowel and therefore persistent watery diarrhea endangering the patient with dehydration. Dysentery belongs into this group. It is a disease caused by bacteria of the Shigella genus. These bacteria affect mostly the large bowel, which is then covered with a whitish layer underneath which ulcers can arise. The ulcers can be a source of bleeding.
- Pseudomembranous enterocolitis is caused by a bacterium called Clostridium difficile. This type of inflammation occurs in individuals treated long-term with wide-spectrum antibiotics. The wide-spectrum antibiotics kill bacteria commonly present in the bowel so nothing stands in the way of multiplication of harmful bacteria. Symptoms include stomach pain, fever, nausea, vomiting, diarrhea and dehydration.
- Typhoid fever is a severe disease only rarely occurring in our part of the world. The causative agent is a bacterium of the Salmonella genus. It causes frequent bloody liquid stools with a risk of dehydration.
Bowel Inflammation from Other Extrinsic or Intrinsic Causes
Chemically induced colitis is one of bowel inflammations from extrinsic or intrinsic causes. It is caused by administration of certain medicaments, such as non-steroidal anti-inflammatory drugs. We can also encounter radiation colitis, which can be nowadays most commonly seen in women after pelvic irradiation, usually radiotherapy-treated patients with gynecological tumors. Immature newborns or newborns with low birth-weight may present with necrotizing colitis caused by immaturity of their immune system.
Idiopathic Bowel Inflammation
Idiopathic inflammation is an inflammation without a known cause. This means the diseases tend to be chronic, incurable and with numerous complications. Two severe disease count among idiopathic bowel inflammations - Crohn’s disease and ulcerative colitis.
Crohn’s disease is a chronic inflammatory disease initially affecting the small bowel. However, the disease can spread to practically the entire digestive tract. It occurs more commonly in young people, it is said that 4-9 new cases per 100,000 inhabitants appear in the Czech Republic every year. The initial cause of the disease is not known but an error in the immune system of the patient is assumed.
- Crohn’s disease symptoms are numerous, the most important being cramping abdominal pain, diarrhea, increased temperature, weight loss, fatigue and possibly appearance of blood in the stool. The disease can show symptoms outside of the digestive tract, such as skin rash, joint inflammation or eye inflammation.
- Diagnosing Crohn’s disease is very difficult as the above-mentioned symptoms can appear in various other diseases. The diagnosis is based on blood work where we can detect anemia or increased rate of sedimentation. An important diagnostic tool is colonoscopy. It is an endoscopic examination where a probe with a recorder is inserted through rectum to the large bowel and gradually to the terminal part of the small bowel where first signs of the disease tend to appear. If this examination is not successful we can further try an X-ray examination with contrast or CT - computer tomography. That is an examination utilizing X-rays in order to create a detailed visualization of tissues of the human body.
- Crohn’s disease treatment is difficult and the disease cannot be completely cured so far. The treatment therefore concentrates on reducing symptoms and keeping them at as low a level as possible. The most commonly used drugs are aminosalicylates, then corticosteroids or immunosuppressives - drugs suppressing one’s own immune system. In complicated cases where the patient does not react to treatment with drugs surgical treatment is utilized.
- Crohn’s disease complications are life threatening conditions that need to be always kept in mind. The small bowel may become obstructed, perforated with a consequent development of inflammation within the abdominal cavity. Other complications are bleeding, establishment of communication between the bowel and other organs - so called fistulas, or even the development of a malignant tumor.
Ulcerative colitis is a chronic ulcerating inflammation of the anus and adjacent parts of the large bowel. The small bowel is rarely affected. In the Czech Republic, 45 people per 100,000 inhabitants are affected by this disease. First symptoms of the disease appear at the age of 30-40, women are affected more often than men. The initial cause is not known but it is speculated that the entire immune system of the patient is affected.
- Ulcerative colitis symptoms are numerous. Among others cramping abdominal pains, diarrhea, rectal bleeding, anorexia, fever, nausea. Symptoms outside of the digestive tract are also usually present, such as inflammation of joints or eyes, affections of the biliary tract or skin rashes.
- Diagnosing ulcerative colitis isn’t easy and consists of collecting a stool sample, colonoscopy and other imaging techniques such as X-rays or CT.
- Ulcerative colitis treatment takes place in the comfort of one’s own home. The treatment is the same as with Crohn’s disease, aminosalicylates, corticosteroids and immunosuppressives can be used, in case of complications also antibiotics. Surgical treatment centers on removing the entire large bowel.
Prevention of Bowel Inflammation
Prevention of bowel inflammation depends on the initial cause. In the case of infectious bowel inflammation the principal measure is adhering to the principles of good personal hygiene, including regular hand washing. When we are suffering from such a disease we should avoid coming in contact with foodstuffs completely. In the case of idiopathic bowel inflammation a certain preventive measure is diet. There are also bowel inflammations that arise as a complication of other treatment and can therefore practically not be avoided. Among those belong for example radiation colitis that develops after irradiation of pelvis because of a tumor in that region.