Overview and Definition

Inflammatory Bowel Disease, known as IBD, is a class of digestive system disorders characterized by chronic inflammation and swelling in either the small or large intestines (bowels). IBD encompasses two common gastrointestinal disorders: Ulcerative colitis and Crohn’s disease, which share very similar symptoms. However, ulcerative colitis mainly involves the colon (large intestine), while the Crohn’s disease can affect any part of the digestive system, starting from the mouth down to the anus.

Symptoms of IBD

The detailed symptoms of Inflammatory Bowel Disease usually depend on the area of the gastrointestinal tract that is inflamed. The general symptoms, however, are usually non-specific and may include the following:

• Abdominal pain or cramping (usually in Crohn’s disease)
• Recurring diarrhea
• Bloody, soft stools
• Extreme tiredness
• Irregular bowel habits
• Passage of mucus during defecation
• Unexplained or sudden weight loss
• Malaise or fatigue
• Fever, usually low-grade
• Reduced appetite (due to abdominal pain)
• Perianal disease such as abscess or fistula (usually in Crohn’s disease)
• Constipation due to bowel obstruction

As mentioned, the symptoms of IBD can range from mild to severe. The symptoms can also come and go, over a span of months or even years. Symptoms may appear one time, heal on their own, and then relapse after a certain time period.

Types of IBD

As described earlier, Inflammatory Bowel Disease can come in two common forms: ulcerative colitis and Crohn’s disease. Because symptoms are usually similar, it is often difficult to figure out the type of IBD a patient has. Ulcerative colitis affects only the colon and may be classified further depending on the location and severity of the inflammation:

• Ulcerative proctitis - Inflammation occurs near the rectum, causing rectal bleeding

• Proctosigmoiditis - Inflammation is confined in the sigmoid colon (lower end of the bowel) and rectum

• Left-sided colitis - Inflammation involves the rectum, the sigmoid and the descending colon, usually causing abdominal cramping on the left side

• Pancolitis - The whole colon is affected by the inflammation causing severe symptoms

• Acute severe ulcerative colitis - Also known as fulminant colitis, this rare form also affects the entire colon and causes unbearable symptoms

Crohn’s disease (CD), on the other hand, affects different parts of the digestive tract. Most patients with CD have inflamed ileum (the ends of the small intestine) or the colon. Symptoms of Crohn’s disease may come in different forms. Inflammation can be limited only to the bowel wall leading to fibrestenosis or may cause narrowing or blockage in the colon.

Causes of Inflammatory Bowel Disease

Despite the advances in the treatment of IBD, the exact cause of this condition is still unknown. Research studies have established certain factors that lead to Inflammatory Bowel Disease. Some of which are as follows:

• Genetic or hereditary factors
• Immune system abnormality wherein disruption to the immune system can cause it to attack its own healthy gastrointestinal tissues causing inflammation
• Smoking: there are more incidences of bowel diseases in smokers than in non-smokers
• Environmental factors: IBD seems to be more common in Westernized countries suggesting that sanitation and diet can play a part in the development or severity of the condition.

When to See a Doctor

If you experience persistent symptoms and gastrointestinal problems that disrupt your daily normal activities, it is important to see a doctor immediately. Although Inflammatory Bowel Disease is usually not life-threatening and highly treatable, allowing the condition to aggravate can cause debilitating effects. If left untreated, IBD can interfere with digestion, making the body unable to fully absorb nutrients from food. Moreover, IBD can cause certain problems outside the digestive system, which can include blood loss (leading to anemia), arthritis, gallstones, kidney stone or weakening of the bones.

When you talk to your doctor regarding IBD, your GP will first ask you about your health history. A physical exam, as well as tests, will be conducted to confirm whether you have IBD. Depending on the severity of your condition, the doctor may refer you to a gastroenterologist or a gastrointestinal specialist. Some tests being used to confirm IBD include:

• Blood tests to determine signs of inflammation
• Analysis of the stool sample to determine the presence of infection or blood in the stool
• Colonoscopy or sigmoidoscopy to take images of the linings of the large intestine and the ileum (a sample of tissue may be extracted for further analysis)
• Colon x-ray to rule out other bowel conditions
• Axial Tomography or CT scan to look for signs of ulcerative colitis
• Capsule endoscopy to examine the status of the small intestine

Treatment of Inflammatory Bowel Disease

Once your doctor determines that you have IBD, appropriate treatment for the symptoms will be suggested. Treatments for Inflammatory Bowel Disease can come in many different forms, depending on the symptoms. However, these solutions are not definitive cure as they are designed to relieve symptoms and prevent recurrence.

Medications for IBD can include the following:

• Aminosalicylates - These medications are given for mild cases of IBD and can effectively reduce inflammation.

• Corticosteroids and Immunomodulators - These medications are given to manage inflammation and treat IBD flare-ups. They may be given as pills, through an enema (suppository) or injected.

• Biologic therapies - Involves the introduction of proteins that block substances in the body that cause inflammation (anti-TNF-alpha therapies like certolizumab and adalimumab).

• Antibiotics - Antibiotic medications are usually given to patients with Crohn’s Disease to reduce bacterial growth caused by fistulas or obstruction; antibiotics may also help suppress the immune system function to lessen inflammation.

In addition to inflammation-control medications, some drugs may also be recommended to help relieve signs and symptoms. This can include anti-diarrheal medications, fiber supplements, pain relievers, as well as nutritional supplements (iron, vitamin B12, calcium and vitamin D).

In serious cases of Inflammation Bowel Disease or in cases where medication doesn't help, surgery may be recommended. Surgical intervention for IBD involves the removal of the large intestine to completely cure ulcerative colitis. This is usually performed along with another operation to allow the body to still excrete food waste. Bowel resection surgery or strictureplasty to remove a part of the small intestine may be performed for Crohn’s disease to correct obstruction, bleeding or fistulae.

Aside from medical interventions, proper diet and exercise, a healthy lifestyle, and regular relaxation are known to improve and alleviate symptoms of Inflammation Bowel Disease.

References:

• American Gastroenterological Association. “Inflammatory Bowel Disease” Available: http://www.gastro.org/patient-center/digestive-conditions/inflammatory-bowel-disease
• Rowe, W. and Lichtenstein, G. (nd) “Inflammatory Bowel Disease” Available: http://emedicine.medscape.com/article/179037-overview
• Wolf, J. (2005) “Inflammatory Bowel Disease” Available: http://www.womenshealth.gov/publications/our-publications/fact-sheet/inflammatory-bowel-disease.pdf