Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) involves chronic inflammation of the inner tract of the intestine. In effect, IBD is related to long-lasting inflammation in the bowel that is a result of activation of an immune-mediated response. This cascade of a response results in clinical manifestation of the disease.¹Symptoms of IBD include diarrhea, reduced appetite, unintended weight loss, and blood in the stool. Blood in the stool is also a key indicator and alarm for IBD.²

Various forms of IBD exist. Crohn’s disease is probably the most wellknown form of IBD. In Crohn’s disease, particularly, this inflammatory process spreads deep into the affected tissues. Ulcerative colitis is another manifestation of IBD and is also a progressive disorder of the gastrointestinal tract inflammatory process.

In general, IBD comprises these 2 debilitating forms, Crohn’s and ulcerative colitis. As in many chronic diseases, family history is an important risk factor for developing IBD. There is an increased risk in early adulthood; however, a patient can be affected at any age. Ulcerative colitis is differentiated from Crohn’s by the fact that it solely involves the colon, whereas Crohn’s can involve the entire digestive tract and progress to include the esophageal tract.

Risk factors for IBD often include being Caucasian and receiving a diagnosed at an age younger than 30 years. The risk increases with cigarette smoking and use of nonsteroidal antiinflammatory drugs. IBD is actually diagnosed within the context of the clinical presentation, as well as via laboratory tests that are specific for inflammatory markers. Keeping in mind the clinical nature of this diagnosis may help the provider and patient be aware of the most appropriate treatment goals for the patient.

It is vital to treat IBD with a multidimensional approach of therapeutic agents and nutritional counseling. The types of therapeutic drugs include immune system suppressors, antiinflammatory drugs, antibiotics, and symptom-relief medications, such as anti-diarrheals. Nutritional counseling is important because uncontrolled and unmanaged IBD can lead to malabsorption problems, even osteoporosis. Adding a multiprofessional approach to the patient’s counseling on condition management would optimize outcomes as well. In this type of approach, including the pharmacist, provider, and other allied health professionals in the treatment plan and follow-up is key to a patient’s success.

Complications of unmanaged, poorly managed, or inappropriately diagnosed IBD include inflammation, bowel obstruction, ulcers, and fistulas. Fistulas are an important risk of untreated Crohn’s disease to be aware of because they can become infected and require surgical correction. Most of the symptoms and problems facing uncontrolled IBD are related to complications of gastrointestinal flare-up on the cellular level of the immune response.

In conclusion, one of the most important aspects of IBD is the value of timely, effective diagnosis. Discuss the risk factors and symptoms, placing emphasis on the importance of multifaceted treatment approaches for all patients. Ultimately, it is essential to diagnose IBD early and effectively for immediate results, especially when related to comorbid autoimmune disorders. Addressing the patient’s history and exam fully will lead to prompt diagnosis and management of such an important health challenge in the United States today.

Kristene Diggins, DNP, MBA, FAANP, CNE, NEA-BC, is a doctorally prepared family nurse practitioner (FNP) and has been inducted as a fellow of the American Association of Nurse Practitioners. She has worked as an FNP in direct patient care for 10 years in family practice. She currently serves as the national chair for MinuteClinic’s Shared Governance, as well as a senior clinician. Diggins writes regular columns for nursing journals and serves as adjunct faculty for Liberty University, University of Phoenix, and Kaplan University.

References

1. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences.Gastroenterology. 2004;126(6):1504-1517.
2. Dodd M, Janson S, Facione N, et al. Advancing the science of symptom management.J Adv Nurse. 2001;33(5): 668-676.