Inflammatory Bowel Disease Essay

nflammatory bowel disease (IBD) encompasses two illnesses - Crohn’s disease (CD) and ulcerative colitis (UC) - that are characterized by chronic intestinal inflammation. The disease progression of IBD is heterogeneous, as is the response of individual patients to different treatments. Typically IBD and the resultant inflammation cause a combination of abdominal pain, diarrhea, intestinal bleeding, weight loss, malabsorption and nutritional deficiencies. The onset of IBD is greatest in early adulthood, with peak incidence among those aged 18 to 35 [1]. Diagnosis at this stage of life has a significant impact on employment and psychosocial functioning of the affected. Up to 25% of cases of IBD are diagnosed during childhood [2]. There are approximately 1.4 million Americans living with IBD, with a prevalence of 201 and 238 per 100,000 for CD and UC respectively [3]. Medical costs for each IBD patient in the United States is estimated to be over $18 000 per year [4].
There is a concern in patients with IBD that their disease can predispose them to an increased risk of neoplasia of the bowel. This increased risk was first noted by Crohn and Rosberg in 1925 [5] and further explored in the 1930s in patients undergoing an at-the-time popular procedure for IBD, bypass of the diseased segment. Those who had a section of diseased small bowel left in
This may be due to the heterogeneity of disease phenotype, and specifically the degree of colonic involvement. That is, in those CD subjects with extensive colitis, there appears to be somewhat of an increased risk, while those with disease limited to the small bowel appear to be at a baseline risk [19-21]. When all phenotypes of Crohn’s disease are included, some studies place the relative risk of CRC between 2 and 3 [22-24], whereas others do not demonstrate any increased risk