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BACKGROUND


INFLAMMATORY BOWEL DISEASE


Both CD and UC are marked by an abnormal response by the body’s immune system. Normally, the immune system protects the body from infection. In people with IBD, however, it reacts inappropriately. For unknown reasons, the immune system mistakes microbes, such as bacteria that are normally found in the intestines, as foreign or invading substances, and launches an attack. In the process, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation. These cells then generate harmful products that ultimately lead to ulcerations and bowel injury. When this happens, the patient experiences the symptoms of IBD.


Currently, there is no cure for CD; therapies focus on maintaining remission (freedom from symptoms) and achieving a normal quality of life. The approach is similar with UC, although UC technically can be ‘cured’ by surgical removal of the large intestine (although this option is reserved until medical therapy fails).


Although CD most commonly affects the lower end of the small intestine (the ileum) and the beginning of the large intestine (the colon), it may involve any part of the gastrointestinal (GI) tract. In UC, the GI involvement is limited to the colon (or, to a lesser extent, the stomach). In CD, all layers of the intestine may be affected; this can result in deep ulcers that go through the wall of the bowel completely. These ulcers can cause complications such as abscesses in the abdomen or can lead to the development of connections between the bowel and other organs (fistulas) -- for example, there can be connections between the small bowel and bladder (leading to recurrent urinary tract infections). CD is often discontinuous, with normal healthy bowel in between patches of diseased bowel. In contrast, UC affects only the superficial layers (the mucosa) of the colon in a more even and continuous distribution, which starts at the level of the anus. Differences between UC and CD are summarized in Table 1.1


Patients experience symptoms such as abdominal pain, rectal bleeding, fatigue, vomiting, diarrhea, itchiness or irritation around the anus, flatulence, and bloating. Weight loss and anemia also pose significant problems. Additionally, the complications associated with IBD can affect a patient’s bones (leading to osteoporosis), liver, skin, eyes, height and weight, and mental health (leading to depression or anxiety).


IBD is a lifelong disease, usually starting in early adulthood and increasingly diagnosed in childhood in otherwise healthy, active individuals. IBD can significantly impact the quality of life of the patient, their caregiver/s and family, workplace, and community. It can impact career choices, lead to reduced work hours, impact family planning decisions, and lead to income disparity and depression. There are also concerns involving ongoing drug treatment, recurrent hospitalizations and surgeries. IBD can also complicate travel, life and working arrangements due to the need for bathroom access.


People with IBD can lead generally normal lives most of the time, but with ongoing medication needs and occasional flares that may require hospitalization with surgery. The unpredictability of symptoms and the prospect of eventual surgery burden daily life. Finally, due to the intimate nature of the symptoms, there may be a stigma attached to the disease from family, friends and workplace colleagues.


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 17


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