NURS 6501: Advanced Pathophysiology
Lorie Valentin RN, BSN
Gastrointestinal symptoms such as pain, bloating, nausea, vomiting, and diarrhea, are a common manifestation of many different etiologies. Medication side effects, viral illness or stress are just a few. Sometimes though, these symptoms can indicate a bigger problem and a more chronic illness that needs to be addressed. Two of these chronic illnesses are inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Because of the similarities in their presentation it can sometimes be hard to tell the difference between the two, but it is important to accurately identify which is the causative factor, because pathophysiology and treatment are very different (Huether & McCance, 2017).
IBD is one of several disease that cause inflammation of the mucosa of the intestines. Ulcerative colitis (UC) and Crohn disease are two of the inflammatory diseases. Both are autoimmune disease that cause ulceration of the mucosa, resulting in thickening in the lining causing narrowing of the lumen (Huether & McCance, 2017). Crohn’s additional can cause ulceration through the full thickness of the intestinal wall and often has additional inflammatory manifestation concurrently (Hammer & McPhee, 2019). Both have a high risk of infection and malignancy due to remodeling of the tissue. The most common symptoms are pain, bloating, diarrhea and blood in the stool ((Huether & McCance, 2017).
IBS is similar in presentation to IBD, but lacks the autosomal component. IBS is thought to be the result of environmental factors (Huether & McCance, 2017). IBS is diagnosed based on symptom presentation without a detectable disease process (Huether & McCance, 2017). Symptoms of IBS are pain, bloating, diarrhea or constipation, or alternating diarrhea and constipation, nausea, and gas. Treatment is usually based on lifestyle changes and avoiding triggers (Huether & McCance, 2017).
The treatment for mild to moderate IBD is most often aminosalicylates, such as sulfasalazine or mesalamine (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). During acute exacerbations often corticosteroids are added, but if symptoms continue or for severe cases immunosuppressant medications might be needed to return to a remission state (Arcangelo et al., 2017). The treatment for IBS is behavioral changes to include reducing stress and dietary changes to reduce triggers and improve gut flora (Huether & McCance, 2017). Similar changes in diet are recommended for those with both IBD and IBS, reduction in inflammatory items such as gluten and increasing anti-inflammatory nutrients like omega 3 fatty acids and probiotics to improve gut flora (Arcangelo et al., 2017; Huether & McCance, 2017).
Genetics is considered one possible influencing factor for an individual developing IBD, though this risk appears to be relatively low at about 20-30 percent (Hammer & McPhee, 2019). Multiple genes have been recently identified that play a role in the development of IBD (Hammer & McPhee, 2019). However, like IBS, genetics is most certainly not the only factor that contributes to the development of IBD. Environmental causes such as stress, diet, behaviors, and infection are thought to be triggers for developing either disorder (Hammer & McPhee, 2019). Therefore, knowing that a close relative has IBD or IBS is most significant in determining the type of testing that might be considered.
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