Inflammatory bowel disease is a complex chronic disease characterized by an inflammation of the GI tract. Many people affected by IBD worldwide have an increased risk of developing colorectal cancer. Surgery, whether curative or not, plays a crucial role in improving the life conditions of people suffering from IBD.
Statistics and Diagnosis
Inflammatory Bowel Disease, or IBD, is a very common disease in Canada. It is estimated that 260 0000 Canadiens are affected by IBD. People who are mostly diagnosed with IBD are 15-40 years old. It is possible to identify IBD through the analysis of blood tests and imagery of the small bowel using ultrasound or MRI, upper endoscopy, colonoscopy, and biopsy. A biopsy is a surgical procedure that consists of tissue sampling. When performing a biopsy for IBD, the surgeon searches for crypt abscess (immune cell accumulation in tube-resembling glands in the GI tract lining, causing inflammation), crypt atrophy (a reduction in the size of specialized glands found in the colon), mucin depletion (less intestinal mucosal epithelial cells called goblet cells or fewer lipid droplets coated by proteins or by non-ionic surfactants called mucin droplets), and inflammatory signs.
Forms of IBD
There are two types of IBD with apparent differences: Ulcerative colitis and Crohn’s disease.
Ulcerative colitis is usually characterized by inflammation of the rectal and sigmoid colon, which spreads continuously from the distal colon to the proximal colon. Common symptoms of ulcerative colitis include diarrhea, abdominal pain, rectal bleeding, weight loss, fatigue, fever, loss of appetite, and joint problems.
Crohn’s disease, on the other hand, is generally an inflammation that can affect the cecum, the ileum, the colon, the perianal parts, and the small intestine. The inflammation is usually present as skip lesions, meaning that some parts of the colon are inflamed but are often separated by healthy areas. Crohn’s disease is more common among men and affects all the layers of the colon. The symptoms are commonly the same as those of ulcerative colitis.
Causes of IBD
Sometimes, IBD is due to genetic factors that generate problems with antimicrobial peptides, autophagy, and cytokines. Environmental factors such as having an unhealthy diet, smoking, stressing, and using antibiotics excessively or wrongly can play a role in the development of IBD.
In a normal gut dendritic cells sample antigens from the mucus layer and present the antigens to activate the immune system response and prevent the pathogens from going through the epithelial layer. The immune system’s defensins, innate lymphoid cells, IgA antibodies, and macrophages participate in keeping the pathogens out of the inner system. If pathogens cross the epithelial layer, the body’s immune system is activated and can kill the pathogens with B-cells and T-cells. Some regulatory T-cells ensure that this immune response does not affect commensal microbes in the gut.
In a gut affected by IBD, the immune response to pathogens is abnormal. Research is still ongoing on IBD, and a lot is unknown about the pathogenesis of IBD. This is a general overview of it: Patients with IBD can have an impaired barrier function (for genetic or environmental reasons), which will let more microbes through the epithelial layer and trigger an increased immune response. This immune response will create chronic inflammation in IBD, resulting in a loss of integrity in the epithelial barrier and in a disruption of the gut homeostasis. Patients with IBD are found to have more TNF alfa cytokines and other proinflammatory cytokines than a healthy person.
Surgery
Ulcerative Colitis:
Surgery is usually performed if the medication does not work very well, if cancer is developing, or if precancerous changes are occurring. There are two options of surgery which are curative in the case of ulcerative colitis:
- Surgeons can remove the colon and most of the rectum; however, they keep the rectal and anal sphincter muscles. They then connect the anal canal to the small bowel to create a reservoir for stool. This is a total colectomy.
- Surgeons can remove the colon and rectum and attach the small intestine end to the abdominal wall, forming a stoma of ileostomy. An external bag is connected to the stoma to collect stool, which must be emptied several times daily. This is a proctocolectomy.
Crohn’s Disease
Surgery is usually performed if the patient has intestinal blockage, intestinal rupture, abscess, infection, bleeding, or if precancerous or cancerous developments are found. There are again two options of surgery which are not curative in the case of Crohn’s disease (but they reduce the risk of cancer):
- Surgeons can section the very affected and damaged parts of the colon and remove them. Then, healthy areas are joined together with sutures. This is called Intestinal Resection.
- In case of blockage, surgeons can perform a lengthwise incision to widen the obstructed section. This is called Stricturoplasty.
Works Cited
Anusia Thourani. “Chron’s and Colitis: What exactly is the distinction?” Revive research institute. Inc, July 6 2022, https://www.reviveresearch.org/blog/crohns-and-colitis-what-exactly-is-the-distinction/.
Canadian Digestive Health foundation. “IBD: Ulcerative Colitis.” Bowel concerns,
https://cdhf.ca/en/digestive-conditions/ibd-ulcerative-colitis/.
Dr.Ho, Vincent. “Inflammatory Bowel Disease (IBD) | The GutDr Explains (3D Gut Animation).” YouTube,
uploaded by the Gut Doctor, 8 December 2021, https://www.youtube.com/watch?v=9ldn_q48oOQ&t=189s.
Diem-Phuong D. Dao; Patrick H. Le. “Histology, Goblet Cells.” National Library of medicine, March 15, 2023. Bookshelf ID: NBK553208, PMID: 31985989.
Guilherme Piovezani Ramos, MD, and Konstantinos A. Papadakis, MD. ” Mechanisms of Disease: Inflammatory Bowel Diseases. ” Thematic Review Series on Gastroenterological Disease, Volume 94, Issue 1, January 2019, 155-165. Mayo clinic proceedings, https://doi.org/10.1016/j.mayocp.2018.09.013.
Hasudungan, Armando. “Inflammatory Bowel Disease – Crohns and Ulcerative Colitits.” YouTube, 15 February 2016, https://www.youtube.com/watch?v=iefghc2g91M.
Hasudungan, Armando. “Inflammatory Bowel Disease – Pathophysiology and Complications.” YouTube,
29 February 2016, https://www.youtube.com/watch?v=chSyQPKsNk4&t=524s.
Imedex, LLC and Mechanisms in Medicine Inc.”Surgery and IBD.” You and IBD,
https://www.youandibd.com/en-ibd/view/m301-s9-what-is-an-ileostomy-slide-show.
Mehmet Coskun. “Intestinal epithelium in inflammatory bowel disease.” Perspective Article Frontiers,
Volume 1, 25 August 2014, https://doi.org/10.3389/fmed.2014.00024.
Public health agency of Canada. Inflammatory Bowel disease, Government of Canada, 2021-07-06,
https://www.canada.ca/en/public-health/services/chronic-diseases/inflammatory-bowel-disease.html.
Unknown. “Crypt Abscess.” Pathology for patients, My pathology report.ca, https://www.mypathologyreport.ca/pathology-dictionary/crypt-abscess/.
Unknown. “Small Bowel and Large Bowel Surgery.” YouTube, uploaded by Animated IBD patient, 16 October 2012, https://www.youtube.com/watch?v=1H5vuQzp4As.
Roger Feakins et al. “Definitions of Histological Abnormalities in Inflammatory Bowel Disease: an ECCO Position Paper.” Journal of Crohn’s and Colitis, Volume 18, Issue 2, February 2024, Pages 175–191, https://doi.org/10.1093/ecco-jcc/jjad142.
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