Irritable Bowel Syndrome vs. Inflammatory Bowel Disease
It is easy to confuse IBS (irritable bowels syndrome) with IBD (inflammatory bowel disease) since the names are so similar and the initials even more so. And, make no mistake, both are distressing illnesses to those who suffer from them.
The differences, however, are significant. While they both affect the gastrointestinal (GI) tract, there are distinct factors that differentiate these conditions.
Diagram of the Digestive System
Irritable Bowel Syndrome - IBS
IBS affects more people than does inflammatory bowel disease. Some estimates claim that 20 percent of Americans are bothered by irritable bowel syndrome. Because many people who have symptoms of the disease don't seek medical care, the exact number is hard to pinpoint.
Irritable bowel syndrome is characterized by abdominal gas, pain or cramping, diarrhea (without blood) and/or constipation. On exam with colonoscopy, there are no structural changes in the bowel. Since there are not distinctive findings, other diagnoses must be ruled out. Your doctor will make sure you don't have food allergies or enzyme problems (like a lactose intolerance), inflammatory bowel disease, infectious processes, celiac disease and so on.
IBS is sometimes called spastic colon due to the finding that the colon is more active with stronger and more frequent contractions in people with active IBS.
Treatments for Irritable Bowel Syndrome
Treatments for IBS are aimed at eliminating triggers and slowing the contractions of the intestines.
Because psychological factors such as stress and fatigue can be triggers for attacks, behavioral therapy or modification can be helpful. Relaxation techniques, exercise and learning new methods of stress management are great ways to start getting this condition under control.
Medications can be effective for a large number of patients. Medical therapy is aimed at relieving the most prevalent symptoms. Anti-diarrheals, anti-spasmodics, anti-anxiety medicines, pain medicines, laxatives, anti-depressants and others have been used in various patients.
Inflammatory Bowel Disease - IBD
Inflammatory bowel disease is actually a term used to refer to ulcerative colitis (UC) and Crohn's disease (CD), collectively. Both of these entities cause ulcers in the lining of the digestive tract leading to abdominal pain and bloody diarrhea with mucous. In severe cases, bleeding can cause anemia and other complications can occasionally lead to death. Severe cases can be life-threatening on an ongoing basis, from the disease or medications used to treat it.
Both UC and CD are considered to be autoimmune diseases. That means that for some reason, the body's immune system mistakes the lining of the digestive tract as a foreign substance and tries to attack and eliminate it. No one knows why some people get autoimmune diseases like those of IBD. Most likely, it is a complicated interaction involving genetic and environmental factors. For example, it is possible that someone has a gene that makes them vulnerable to the disease, and then an outside factor like a virus or toxin activates the immune system. The immune system forms antibodies against the digestive system. Unfortunately, the immune system has memory and once the antibodies are formed, they can be activated continuously or repeatedly.
Treatments for Inflammatory Bowel Disease
Both ulcerative colitis and Crohn's diseases have variable presentations. In other words, either can be very mild and infrequent or quite severe, debilitating, life-threatening and constant.
The first medicines used are often those with the least side effects. It makes sense to try less toxic medications first.
Sulfasalazine and mesalamine are used to try to decrease the inflammation in the bowel.
Corticosteroids are used to suppress inflammation as well. They also inhibit normal function of the immune system. It is best to use steroids for short-term control of symptoms only since they have significant side effects when used in the long-term. Unfortunately, many people with severe disease end up on steroids (such as prednisone) as a maintenance medicine.
Immunosuppressants and immunomodulators are reserved for patients who don't respond to other medicines. Some of these medicines are the same ones given to organ transplant patients to suppress the immune system, so are quite potent. Others such as Remicade and Humira are newer medicines that also interfere with immune function and require very close monitoring by a doctor while they are being used.
Surgery can be used for severe ulcerative colitis. Removing the colon and rectum can 'cure' the disease (although manifestations such as joint pain and other associated symptoms may still occur). Either an ileostomy is placed (and usually is, at least temporarily), or the small intestine is connected to the anus after the colon and rectum are surgically excised. Bowel movements will be frequent, soft and often urgent, but should be very improved compared to before surgery.
Because the large AND small intestines are affected in Crohn's, there is no curative surgery. If part of the intestine is removed, the Crohn's may just reappear in a remaining section.
Summary of IBS and IBD
Irritable Bowel Syndrome
Inflammatory Bowel Disease- Ulcerative Colitis
Inflammatory Bowel Disease- Crohn's Disease
gas, abdominal pain, urgency, diarrhea and/or constipation, food sensitivities
Bloody diarrhea, mucous in stool, abdominal pain, urgency, fatigue, fever,
Bloody diarrhea, mucous in stool, abdominal pain, fatigue, fever, urgency
Affected Part of GI System
colon, maybe small intestine
large and small intestine, as well as other parts of the digestive system sometimes
Tests for Diagnosis
rule out other conditions, no specific test
colonoscopy with biopsy, specialized blood tests
colonoscopy with biopsy, specialized blood tests
Unknown- may be a combo of inherent and environmental factors
autoimmune/genetic and likely environmental trigger
autoimmune/genetic and likely environmental triggers
Behavioral and dietary modifications, some medications to relax the spastic intestine
Dietary changes of benefit in some people to alleviate symptoms, medication, surgery to remove colon
Dietary change of benefit to some people, medications, surgery only in emergencies or as last resort