Walk down any aisle in a drugstore, and you’ll find boxes and bottles of stomach meds lined up neatly on the shelves like little toy soldiers, ready to combat the aching stomach.
If you’re like the millions of Americans plagued with constant digestive issues, you very well could have inflammatory bowel diseases or irritable bowel syndrome. How do you differentiate?
Inflammatory bowel diseases (IBD) are autoimmune diseases that affect both the large and small intestine, and they can manifest as either Crohn’s disease or ulcerative colitis. Crohn’s disease, contingent upon the location, can take shape in various forms: it can occur in the ileum-end of the small intestine (ileitis), the ileum and colon (ileo-colitis) or the colon (Crohn’s colitis).
Symptoms of Crohn’s, if centralized in the small bowel, can include anemia, diarrhea, weight loss, pain and bleeding, while Crohn’s colitis may only involve some of these symptoms.
“If it involves the colon, the symptoms can be the same but more likely to be diarrhea and bleeding,” said Louis Korman, M.D., attending physician of the Metropolitan Gastroenterology Group.
Ulcerative colitis, on the other hand, affects only the colon and large intestine, and presence of the condition indicates inflammation of the colon. Signs of this may include diarrhea, bleeding, cramping and pain, all of which can become more severe over time.
“The cause of IBD is believed to be a genetic predisposition triggered by an environmental factor such as an infection,” stated Dr. Korman. “This theme is similar to that seen for other autoimmune diseases.”
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Differentiating from IBD is another three letter, similar acronym: IBS, or irritable bowel syndrome.
As Dr. Korman explains, patients with IBS do not display pathologic abnormalities; rather, they experience symptoms that can wax and wane such as bloating, constipation, diarrhea and a feeling of fullness.
“Their bowel does not seem to work properly and can produce a variety of symptoms that make the patient aware that their gut doesn’t seem to work,” he said. “There appears to be some relation between the nervous system of the gut and the gut immune system, but this is not well understood.”
Oftentimes, variations of IBD can be mistaken for IBS, because both have a tendency to display similar symptoms in the same demographic of young adults. So how should a gastroenterologist decipher what's what?
“When a patient presents to a doctor mild symptoms of gas, bloating, episodic cramping and abdominal pain, it is much more likely they have IBS than IBD. However, when patients have weight loss, persistent pain, anemia, persistent diarrhea, diarrhea at night [and] bloody stool, then IBD has to be considered. This is particularly true if they have a family history of IBD,” said Dr. Korman.
Methods to relieve IBS consist of an altered diet (no artificial sweeteners, for example) as well as over-the-counter medications like anti-diarrhea pills. On the other hand, treatment for IBD may include surgery or immune suppressing therapy based on severity.
Finally, if you and your doctor aren’t sure about the diagnosis, an examination of the bowel might be needed: “The gold standard for differentiating IBS from IBD is direct visualization of the bowel with a sigmoidoscopy or colonoscopy,” said Dr. Korman, “and using biopsies and the pattern of involvement of the inflammation to classify the patient.”
Figuring out what’s got your stomach tied up in knots might not be as simple as 1, 2, 3. Still, working toward a diagnosis to determine the underlying cause might just be worth the short-term stress in solving your long-term health problems.
