Inflammatory Bowel Disease (IBD)

Some people suffer from recurrent attacks of diarrhea with bloody stools, weakness, or ulcers in the mouth that do not resolve with the routine treatment and lead to severe health problems in them. They must consult a physician emphasizing the recurrence and debilitating effects of their attacks as they might be suffering from inflammatory bowel disease (IBD).

Inflammatory bowel disease is a group of disorders characterized by chronic inflammation of the gut, the two main types being Ulcerative colitis and Crohn's disease. The main cause is unknown, although a combination of genetics, immunity, environmental factors are thought to play a role. Apart from the gut, they can also affect other body parts like the eye, joints, and skin, resulting in conditions like uveitis, arthritis, skin nodules, rashes, etc.

Among many different types, the two main types are;

1. Ulcerative colitis: This type usually affects the superficial lining of your colon and rectum, which are the lower parts of your gut, and results in the formation of ulcers that may bleed, causing bloody diarrhea, abdominal pain, anemia due to blood loss.
2. Crohn’s disease: This type can affect any part of our gut, from the mouth up to the anus, and involves all the layers(deep) of the gut lining. It leaves small parts of the intestine unaffected, called the skip lesions, and can cause complications like strictures, fistulas, anal ulcers, etc.

Although the main cause is still unknown, an interplay between genetics, immunity, environmental factors, and gut microbial is hypothesized to be involved.

The disease is more found in people with a family history of the condition. In genetically susceptible people, the body’s defense mechanism overreacts to simple gut infections or the normal microbes found in the gut, resulting in the inflammation of the intestines. Smoking plays a major role in causing the cron’s disease.

Inflammatory bowel disease affects around 1-2 million people in the US, with the ratio of the new case being 70-150 thousand per 100,000 people. The disease Is found more in developed countries and cold climates. It affects males and females equally. There are two peaks of ages affected by the condition. First being 15-40 years of age, the next peak is 55-65 years of age. 

Having one or more of the following risk factors can increase your chances of having the condition;

• Family history
• Living in the west: White Americans and Jews are more affected
• Gastrointestinal infection with some bacteria like E. Coli.
• Taking a diet rich in high fats, sugars, and low fiber can cause IBD.
• Smoking
• Stress
• Use of medicines like NSAIDs

You may have mild, moderate, or severe symptoms that can come and go, which means you can have flares of condition with alternating periods of complete remission. You can have the following signs and symptoms;

• Diarrhea which may or may not be bloody
• Abdominal pain or bloating
• Passage of mucous from anus without passing stool
• Fever may be present, especially during the flares
• Mouth, anal ulcers, or fistulas may be present
• IBD may also affect eyes (uveitis), joints(arthritis), skin(nodules and rashes), bile ducts( cholangitis), etc
• Weight loss
• Malaise, fatigue
• Anemia (deficiency of hemoglobin to carry oxygen due to blood loss)

Some tests aid in the diagnosis of IBD along with history and examination. Your doctor may take a detailed history of your current symptoms, previous episodes, family history, etc. after physical examination; you may be advised on the following tests;

Blood tests: Complete blood count (CBC), Erythrocyte sedimentation rate (ESR), and C-reactive protein levels (CRP), iron studies, red blood cell folate, Vitamin B12 evaluation, ANTIBODY testing like; Perinuclear antineutrophil cytoplasmic antibodies (ANCA)

Stool studies: ova and parasite studies, Fecal calprotectin level, Clostridium difficile infection, Stool culture, bacterial pathogens culture, etc.

Imaging: X-ray abdomen, ultrasound abdomen, CT scan, and MRI abdomen and pelvis, Barium double-contrast enema

Colonoscopy: a thin, flexible tube with a lighted camera is inserted in your colon through the anus, and the interior of the colon and rectum are visualized. The doctor may also take out a small piece of tissue for biopsy.

Flexible sigmoidoscopy: a thin, flexible tube with a lighted camera is inserted in the sigmoid part of your colon only through the anus to see the lining and take the biopsy.

Upper GI Endoscopy: a thin, flexible tube with a lighted camera is inserted through your mouth to see the upper part of your gut that includes the esophagus, stomach, the duodenum.

Capsule endoscopy: you may be given a capsule with a camera to eat that will travel along the gut, and the images are recorded throughout. 

Many other conditions affecting the gut can look similar to that of IBD.

• Celiac disease
• Irritable bowel syndrome 
• Infectious colitis
• Amebic dysentery
• Lactose intolerance
• Behcet disease
• Ischemic colitis
• Intestinal tuberculosis
• Giardiasis

A multidisciplinary approach has to be used to treat IBD. It’s a chronic illness with no cure. The treatment goals are to keep the disease in the remission period, prevent the flares, halt the progression, prevent the complications, control the symptoms, improve the overall quality of life for the patients. The treatment includes the use of medicines, surgeries, lifestyle modifications.

Following modalities are used:

1. Medicines: Medicines are used to control the symptoms, heal the inflammation. The most commonly used medicines are anti-inflammatory.

• ASA drugs (aminosalicylates): balsalazide (Colazal), mesalamine (Apriso, Pentasa), sulfasalazine (Azulfidine)
•  Corticosteroids: budesonide (Uceris), prednisone (Prednisone Intensol), methylprednisolone (Medrol)
• Immunomodulators: methotrexate (Trexall), azathioprine (Imuran), mercaptopurine (Purixan)
• Biologics: adalimumab (Humira), golimumab (Simponi), infliximab (Remicade), natalizumab (Tysabri)
• Antibiotics are more useful in Crohn's Disease.
• Antidiarrheal medicines and laxatives can also be used.

2. Surgery: Surgery is useful more for Ulcerative Collitis type as it is usually limited to the colon. Removal of the part or whole of your colon and rectum is done called colectomy.

For Crohn's Disease, surgery is done for the complications like fistulas, sinuses, abscesses, etc. 

The course and outcome of IBD are variable. Some people with Ulcerative Collitis can have no exacerbations, while others can have persistent symptoms. 50% of Ulcerative Collitis patients with the limited disease to the sigmoid colon can have extensive disease in 10 years. After 10 years of diagnosis, the risk of colorectal cancer increases 0.5-1% every year. Crohn’s disease is characterized by periodic remissions and exacerbations. The course depends upon the severity and the anatomic location of the gut. Development of fistulas and sinuses are dealt with local surgeries. Some people get complications due to the medicines used in the treatment, like steroids. The general condition of the patients is lower than normal people, and they are at increased risk of malignancy.

Since IBD is a chronic, incurable illness, having a major contribution of environmental factors in its etiology, controlling those factors can be very beneficial in the overall outcome of the disease. You may make the following changes in your lifestyle to cope with the illness;

• Diet management: avoid a diet rich in fats, sugars, processed food, dairy products and replace them with healthy, nutrient, and fiber-rich foods.
• Avoid smoking
• Manage stress with relaxation techniques and breathing exercises
• Avoid unnecessary use of NSAIDs
• Take good care of food hygiene ( washed and cooked well) to avoid enteric infections.
• Adopt a healthy habit of regular exercise.
• Stay hydrated with optimum intake of fluids.
• Join support groups
• Try to be around your loved ones to prevent developing depression or anxiety.
• Learn about your disease as much as possible.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 07, 2023.

References

https://www.sciencedirect.com/science/article/abs/pii/S0016508520355074