FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER, DOC "A' AND DOC "B" NEED TO BE ON SAME PAGE OF PLAYBOOK!

Question: My family doctor said that the pain, cramping and diarrhea I have had is due to a problem with my colon. He sent me to see a specialist, who said I have inflammatory bowel disease. I've been back to see my family doctor, who now says that I have irritable bowel syndrome. Are these different names for the same condition? I'm confused.

Answer: You have good reason to be confused. We doctors use complicated labels to describe health problems to insurance companies and to one another. We often forget that everyone - particularly our patients - may not understand these terms. In your situation the confusion has even deeper roots since inflammatory bowel disease and irritable bowel syndrome are different illnesses that can both affect the colon.

There are two principle illnesses in the category of inflammatory bowel disease Crohn's disease and ulcerative colitis. They share the common feature of inflammation of the involved tissue. Crohn's disease, however, can act upon other parts of the digestive tract in addition to the colon. We don't understand the actual cause of either of these illnesses, but we do know why they produce their typical symptoms. Abdominal cramping, gas, bloating, diarrhea and bloody diarrhea are a consequence of the inflammation that is a part of these illnesses.

Treatment of inflammatory bowel disease is designed to reduce inflammation, just as you would expect. The medicine sulfasalazine, commonly sold as the brand name Azulfidine, is the cornerstone of treatment, although other medications may be necessary now and then. In Crohn's disease, nutritional therapy is quite important, but it is less so in ulcerative colitis. The object of treatment of both diseases is to make the individual comfortable and as close to normal as possible. There may be times when the disease isn't very severe, or "active" as we physicians say, but medical science has yet to devise a "cure" for inflammatory bowel disease.

Part of the treatment of inflammatory bowel disease is periodic examination of the colon for cancer. As many as 10 percent of those with ulcerative colitis of 20 years' duration may develop cancer, while up to 30 percent will do so after 35 years of the disease.

Irritable bowel syndrome (IBS) is quite different from inflammatory bowel disease. Individuals with this condition - which used to be called spastic colon - have abdominal pain that is constant or intermittent, but it is always improved by having a bowel movement. There is also altered stool frequency, stool form (lumpy, hard or loose, watery), altered stool passage (straining, urgency, etc.), passage of mucus, and abdominal distention and bloating.

The diagnosis of IBS is often established by history of the illness and examinations that fail to show signs of other causes of the bowel symptoms. In IBS the bowel tissue appears completely healthy when samples are removed and studied under the microscope. Colon X-rays may show spasm, but this is only "suggestive of" the condition. Despite the discomfort IBS causes, it is not associated with any life-shortening health risks like cancer. It is a problem of bowel function.

The treatment of IBS involves a high-fiber diet, adequate fluid consumption, and moderate exercise. This is effective in giving relief for most individuals. There are medications that can be useful for severe episodes of abdominal cramping or persistent diarrhea.

So, IBS and inflammatory bowel disease are definitely distinct illnesses with differing treatments and prognoses. Talk with your doctors again to be sure they are communicating with each other and with you. You all need to be on the same page in the playbook. That way, you will be sure of getting the proper diagnosis and the best care.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.