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inflammatory bowel disease can include diarrhea (that may contain blood or pus), abdominal pain, fatigue, fever, and, in children, failure to grow. In ulcerative colitis, or Crohn’s disease that involves the colon, the stool may be especially bloody because of bleeding ulcers in the intestine. If inflammatory bowel disease persists for years, it can cause a gradual deterioration in bowel function. If you have fistulas that prevent digested food from being absorbed, you may lose weight. If a fistula connects to your skin, the contents of your intestines may leak out of your body. Inflammatory bowel disease can also cause symptoms such as red eyes, rashes, joint pain, or liver abnormalities in areas of the body other than the intestines.

Diagnosis

If you have symptoms of inflammatory bowel disease, your doctor will perform a physical examination. He or she may perform a procedure called colonoscopy (see page 767) to examine your colon. If just the lower third of the colon is examined, the procedure is called sigmoidoscopy (see page 144). He or she may also order a barium X-ray (see page 767) of your intestines. You may also have capsule video endoscopy (see page 767), in which you swallow a small pill containing a camera that takes a video of your small intestine. Your doctor may also order blood tests and tests to look for blood, bacteria, or viruses in your stool to rule out cancer or a viral or bacterial infection. He or she will probably take samples of cells from your intestine for examination under a microscope (biopsy) to confirm the diagnosis.

Treatment

To treat Crohn’s disease, a doctor may prescribe anti-inflammatory medications such as sulfasalazine or mesalamine, corticosteroids such as prednisone or budesonide, or drugs such as azathioprine or methotrexate that suppress the body’s abnormal immune response. He or she may prescribe the corticosteroids in large doses for an initial, severe attack and then in gradually decreasing doses to prevent a recurrence. If Crohn’s disease affects the colon, a doctor will also prescribe antibiotics such as metronidazole or ciprofloxacin.

For ulcerative colitis, the usual treatment is mesalamine taken both by mouth and by enemas or rectal suppositories. In some cases, corticosteroids or more powerful immune-suppressing drugs may be necessary.

Surgical removal of part of the colon in a procedure called partial or total colectomy (see page 776) is sometimes necessary to treat Crohn’s disease that does not respond to medication or to treat complications such as fistulas or scarring. A total colectomy may be done for ulcerative colitis that has not responded to other treatments.

Irritable Bowel Syndrome

Irritable bowel syndrome (also called spastic or irritable colon) is a common disorder that can cause a number of symptoms in any organ in the gastrointestinal tract, including the esophagus, stomach, and small and large intestines. The cause of the disorder is unknown, but it may result from a dysfunction of the involuntary nerves or muscles in these organs. In irritable bowel syndrome, the waves of muscular contractions that normally move stool through the intestines become uncoordinated. The condition is twice as common in women as in men, and is more common in young adults. The symptoms can be triggered or worsened by stress or a poor diet.

Symptoms

The symptoms of irritable bowel syndrome vary from person to person and resemble the symptoms of other gastrointestinal disorders. Symptoms include abdominal discomfort anywhere in the colon, nausea, digestive noises such as rumbling and gurgling, and gas. People often have constipation, diarrhea, or a feeling that the rectum is not completely empty. Sometimes diarrhea alternates with bouts of constipation.

Diagnosis

To diagnose irritable bowel syndrome, a doctor performs a physical examination and rules out other possible disorders such as inflammatory bowel disease (see previous page) or colon cancer (see page 775) by ordering a series of tests. He or she may order blood tests and stool tests to rule out cancer