increasingly effective treatments. Environmental Triggers Immune System Disturbance E i Genetic Predisposition IBD Figure 2. 6 As the lining of the intestine becomes inflamed and ulcerated, it loses its ability to adequately process food and waste or absorb water, resulting in loose stools (diarrhea), and in severe cases weight loss. Most people with Crohn’s disease or ulcerative colitis experience an urgency to have a bowel movement and have crampy abdominal pain. Inflammation can cause small sores (ulcers) to form in the colon and rectum. These can join together and become large ulcers that bleed, resulting in bloody stools. Blood loss can eventually lead to anemia if unchecked. The symptoms of IBD vary from person to person, may change over time, and can range from mild to severe. People with IBD often go through periods when the disease is quiet with few or no symptoms (remission), alternating with times when the disease is active and causing symptoms (flares). Disease Progression Over Time Once IBD has been diagnosed, the symptoms can often be effectively managed. However, Crohn’s disease and ulcerative colitis are chronic illnesses, and changes are likely to occur over time. Symptoms may recur at times and complications may develop. Symptom Recurrence Ulcerative colitis: In a given year: • 48% of people with ulcerative colitis are in remission • 30% have mild disease activity • 20% have moderate disease activity • 1% to 2% have severe disease1 Seventy percent of patients who have active disease in a given year will have another episode of active disease in the following year. Only 30% of those in remission in a given year will have active disease in the following year. The longer a person with ulcerative colitis remains in remission, the less likely he or she is to experience a flare-up of the disease in the following year. 48% In remission 30% Mild disease 20% Moderate disease 1% to 2% Severe disease IBD? THE SIGNS AND WHAT ARE SYMPTOMS OF Symptoms related to inflammation of the GI tract: General symptoms that may also be associated with IBD: • Diarrhea • Abdominal pain • Rectal bleeding • Urgent need to move bowels • Sensation of incomplete evacuation • Fever • Loss of appetite • Weight loss • Fatigue • Night sweats • Loss of normal menstrual cycle 7 Crohn’s disease: Because Crohn’s disease can occur in various areas of the GI tract, disease activity and severity can vary widely over time. Most patients have active disease at the time Crohn’s disease is diagnosed. With medical and/or surgical treatment: • About 50% of patients will be in remission or have mild disease over the next five years • 45% of those in remission will remain relapse-free over the next year • 35% will have one or two relapses • 11% will have chronically active disease For a Crohn’s disease patient in remission, relapse rates at one, two, five, and ten years are estimated at 20%, 40%, 67%, and 76%, respectively.2 IBD Complications In addition to the signs and symptoms of IBD described on the preceding pages, some people develop complications that may require urgent medical care. Complications of ulcerative colitis include: • Heavy, persistent diarrhea, rectal bleeding, and pain • Perforated bowel—chronic inflammation of the intestine may weaken the intestinal wall to such an extent that a hole develops • Toxic megacolon—severe inflammation that leads to rapid enlargement of the colon Complications of Crohn’s disease include: • Fistula—ulcers on the wall of the intestine that extend and cause a tunnel (fistula) to another part of the intestine, the skin or another organ. • Stricture—a narrowing of a section of intestine caused by scarring, which can lead to an intestinal blockage • Abscess—a collection of pus, which can develop in the abdomen, pelvis, or around the anal area • Perforated bowel—chronic inflammation of the intestine may weaken the wall to such an extent that a hole develops • Malabsorption and malnutrition, including deficiency of vitamins and minerals. Complications Outside the GI Tract Not all complications of IBD are confined to the GI tract. For reasons that are not entirely understood, some people develop symptoms that are related to the disease but affect other parts of the