Everyone gets an upset stomach from time to time — but if you're constantly experiencing discomfort in your gastrointestinal tract, it could be a sign of something more serious.
Millions of people in the United States have one or more autoimmune digestive disorders, which are conditions that occur when the body's immune system wrongly attacks part of the gastrointestinal tract. "Most of them are relatively common, and certainly not rare phenomenons," says Rick Desi, MD, a gastroenterologist at Mercy Medical Center in Baltimore.
If you think you might have an autoimmune disorder that is digestive in nature, make an appointment with your physician as soon as possible for an evaluation. Here are some of the most common forms of these disorders.
Celiac Disease
Celiac disease, which affects about 1 person in 200, occurs when a person becomes intolerant to gluten, a protein found in wheat, rye, and barley products. In people with celiac disease, the ingestion of gluten causes the immune system to attack villi, the tiny structures lining the small intestine. This can result in digestive discomforts like diarrhea, vomiting, and abdominal pain. "It's tough to diagnose sometimes because the symptoms are so nonspecific," Dr. Desi says. Adults, in particular, may also experience other symptoms, like anemia, arthritis, and fatigue.
The only treatment for celiac disease is a special diet that eliminates gluten completely. Even if you only have mild reactions to gluten, it's still wise to avoid it, Desi says. Over time, damage to the small intestine can increase your risk of intestinal lymphoma, a type of cancer. "The risk isn't that high, but it's higher than the average population," Desi says. A 2005 study suggested that strict adherence to a gluten-free diet could protect against the development of cancer. Advice on shopping for gluten-free products can be found on the Celiac Disease Foundation Web site.
Crohn's Disease
This condition occurs when the immune system attacks parts of the digestive tract, causing inflammation, swelling, and even scarring. "It can affect every part from the mouth to the anus," Desi says. "No part of the digestive tract is spared." Symptoms of Crohn's disease include abdominal pain, diarrhea, and fatigue. Some patients may also experience rectal bleeding.
About 500,000 people in North America have Crohn's disease. It mainly affects people who are relatively young, between the ages of 15 and 35. "It's pretty equal among genders," Desi says. "Neither men nor women are more likely to get it."
Desi says scientists aren't sure what causes Crohn's disease to develop in some people, but some theorize that it may have to do with the hyper-disinfected environments of most developed countries. "Crohn's and other inflammatory bowel diseases are just about unheard of in developing countries," Desi says. Genes can also play a role; about 20 percent of people with Crohn's disease also have a relative with Crohn's or another inflammatory bowel disease.
Treatments include anti-inflammatory drugs, immune-suppressant drugs, and steroids.
Ulcerative Colitis
Desi calls ulcerative colitis the "cousin" of Crohn's disease, and explains that it happens when the immune system attacks the lining of the rectum and colon, causing ulcers. The ulcers can then bleed and produce pus. The most common symptoms of ulcerative colitis — abdominal pain and diarrhea — are similar to those of Crohn's. "It can sometimes be difficult to tell if someone's got Crohn's disease or ulcerative colitis," Desi says. People with ulcerative colitis can also experience anemia, rectal bleeding, and fatigue.
About 500,000 people in the United States have ulcerative colitis. Men and women are equally affected, and patients are usually either in their twenties or their fifties and sixties. "People in their thirties and forties are relatively spared," Desi says.
The pharmaceutical treatments for ulcerative colitis are the same as those for Crohn's disease. In severe cases of ulcerative colitis, a colectomy, the surgical removal of the colon, might be in order. "Surgery's always a last-ditch effort, though," Desi says. "Most people can be controlled with medications."
Autoimmune Hepatitis
Unlike most types of hepatitis, which are caused by viruses, autoimmune hepatitis happens when the body's immune system attacks liver cells, causing inflammation. Autoimmune hepatitis affects between 100,000 and 200,000 people in the United States. "It's not very common, but we do see it from time to time," Desi says. Type 1, the more common type in North America, is most likely to occur in young women, while Type 2 most often occurs in girls between the ages of 2 and 14.
Symptoms of autoimmune hepatitis include abdominal discomfort, fatigue, nausea, and jaundice, a yellowing of the skin. Many times, the symptoms can be minor, and the disease is only caught during routine blood testing.
Both types of autoimmune hepatitis can be treated with the drugs prednisone and Azasan or Imuran (azathioprine). Prednisone, a steroid, works by suppressing the immune system. Azathioprine is usually added to the treatment plan later, to help patients reduce their prednisone doses. "They both work well in calming down the immune system," Desi says.
If autoimmune hepatitis is left untreated, it can lead to cirrhosis, which is scarring and hardening of the liver. If cirrhosis develops, the liver will probably need to be replaced with one from a donor. "You can manage cirrhosis of the liver, but eventually, transplantations may be required," Desi says.
If you notice any of the symptoms of autoimmune digestive disorders, contact your doctor. The sooner you get a diagnosis, the sooner you can begin treatment and start feeling better — and perhaps prevent further damage to the affected organs.