Inflammatory Bowel Disease (IBD)

Overview

Inflammatory bowel disease (IBD) refers to two conditions, Crohn's disease and ulcerative colitis, distinguished by chronic gastrointestinal (GI) tract inflammation. Prolonged inflammation causes damage to the gastrointestinal tract.

Types of IBD

There are two different kinds of IBD:

• Crohn's Disease: When the inner lining of the digestive tract suffers inflammation, it's called Crohn's disease, another form of IBD. It affects not only the small intestine but also the upper gastrointestinal tract and large intestine.

• Ulcerative Colitis: This form of IBD involves sores and inflammation on the inside lining of the rectum and colon.

Both Crohn's disease and ulcerative colitis may cause rectal bleeding, diarrhoea, weight loss, abdominal pain, and fatigue. Generally, it is a mild disease, but some people may experience certain life-threatening complications.

Symptoms of IBD:

The symptoms of inflammatory bowel disease differ depending on the severity of the inflammation and its location. Symptoms can vary from mild to severe. You are likely to experience active illness followed by periods of remission.

Crohn's disease and ulcerative colitis share the following signs and symptoms:

Diarrhea
Fatigue
Abdominal pain and cramping
Blood in your stool
Reduced appetite
Unintended weight loss

Causes of IBD:

Although the exact cause of IBD is unknown, it is thought to be caused by a compromised immune system. The following are some possible causes:

• The immune system responds incorrectly to environmental triggers such as viruses or bacteria, resulting in gastrointestinal tract inflammation.

• There also appears to be a genetic element. A family history of IBD increases the likelihood of developing this inappropriate immune response.

Risk Factors:

Specific Risk Factors for Inflammatory Bowel Disease are: 

• Smoking. Smoking and IBD have a paradoxical relationship;

• Oral contraceptive pills;

• Appendectomy;

• Diet;

• Breastfeeding;

• Antibiotics;

• Nonsteroidal Anti-Inflammatory Drugs.

Complications:

If left untreated, inflammatory bowel disease, Crohn's disease and ulcerative colitis may lead to severe complications such as:

• Skin, joint and eye inflammation: IBD can cause a flare leading to eye inflammation, skin lesions, and arthritis.

• Blood clots: The risk of blood clots in the arteries and veins increases due to IBD.

• Primary sclerosing cholangitis: This is a rare condition where the IBD inflammation leads to scarring in the bile ducts. This eventually restricts the bile flow and narrows the bile ducts, leading to liver damage.

• Medication side effects: Certain IBD medications risk side effects like infections or the development of specific types of cancer. A patient can also suffer from hypertension or osteoporosis.

• Severe dehydration: IBD can cause severe diarrhoea, sap energy levels and leave a patient dehydrated. 

• Colon cancer: In extreme cases, IBD, Crohn's disease and ulcerative colitis can lead to colon cancer. Getting oneself regularly screened after the first IBD diagnosis is essential.

• Anal fissure: The skin around the anus or the surrounding tissues may get a small tear which can cause infections. Eventually, it can lead to aching bowel movements and perianal fistula.

• Bowel obstruction: Crohn's disease causes the bowel walls to become narrow and thick, which might block the movement of digestive materials. A surgical procedure might be required to extract this diseased bowel portion.

• Fistulas: If the inflammation surpasses the intestinal wall, it can create fistula formations. It can either happen around the anus area or the walls surrounding the abdomen. This fistula might become infected and lead to an abscess or pus.

• Toxic megacolon: The colon may widen and swell rapidly due to ulcerative colitis. This is known as a toxic megacolon.

Prevention:

To lower your risk of developing IBD:

• Avoid all processed foods and additives;

• Consume a Mediterranean-style diet high in fruits and vegetables;

• Get adequate sleep;

• Limit antibiotic exposure;

• Don't smoke;

• Reduce your stress and anxiety levels;

• Breastfeeding during infancy has been shown to reduce children's risk of IBD. According to studies, regular exercise may also reduce the risk of developing IBD.
   

When to Consult a Doctor?

If an individual witnesses constant changes in bowel movements or any early warning symptoms and signs of inflammatory bowel disease (IBD), it's time to see a doctor. Although this disease is not life-threatening, it can still lead to fatal complications if not treated promptly!

Diagnosis:

When a patient consults a gastroenterologist for IBD, the doctor will likely run some procedures and tests to confirm the diagnosis.

• Lab Tests: The doctor may primarily order the following two lab tests:

1. Stool Tests: The healthcare provider will check the stool sample for parasites in this test.
2. Infection or Anaemia Test: The doctor may recommend a blood test to confirm whether the patient is suffering from anaemia or to determine any other signs of infection from viruses or bacteria. 

• Imaging Procedure: In moderate to severe cases of IBD, the doctor may order the following imaging tests for better visuals and clarity:

1. Magnetic Resonance Imaging (MRI): This test uses radio waves and magnetic fields to get a detailed image of tissues and organs. This is especially helpful in evaluating the small intestine or anal area to determine any fistula development.

2. Computerized Tomography (CT) Scan: This special x-ray scan offers more insight than a standard x-ray test. Sometimes a special CT scan, also known as CT enterography, can be done for a more precise visual.

3. X-ray: In severe cases of IBD, the healthcare provider may run a standard x-ray to rule out any complications that may arise in the abdominal area. This can help identify a perforated colon or megacolon.

• Advanced Tests: If both the lab and imaging tests seem inconclusive, the doctor may suggest some advanced tests like:

1. Colonoscopy: In this procedure, the healthcare provider inserts a flexible, thin tube with a camera attached at one end into the rectum. This offers a complete visual of the colon. A tiny tissue sample is extracted for laboratory analysis to determine whether it is general inflammation or IBD.

2. Upper Endoscopy: This procedure is like colonoscopy, except the tube is inserted to study the stomach, oesophagus and duodenum (part of a small intestine). It's usually recommended if a patient suffers from upper abdominal pain, vomiting, nausea and eating troubles.

3. Flexible Sigmoidoscopy: Similar to both colonoscopy and upper endoscopy, this one examines the sigmoid and rectum, which are the end portions of the colon. If a colon suffers from severe inflammation, this test will be more effective than a colonoscopy.

4. Capsule Endoscopy: This test helps detect Crohn's disease. The provider will administer a pill containing a tiny camera which captures the images. This method is not recommended if the patient has any possible bowel obstruction.

5. Balloon-Assisted Enteroscopy: This test utilizes a scope and an overtube. It helps the technician to look deeper into the small bowel, which normal endoscopes cannot reach. This technique confirms the diagnosis of abnormalities found during capsule endoscopy.

Treatment:

IBD is not fatal and can be fixed with proper treatment. The following treatment methods can be employed:

• Home Care: With the right shift in lifestyle and the usage of some home remedies, the symptoms of IBD can be eased, and the inflammatory flare-ups can be managed easily.

These remedies include fixing the diet by limiting dairy products, consuming small portions while eating, drinking plenty of water, taking the correct mineral supplement and multivitamin, and talking to a dietitian. Besides that, a patient should also avoid smoking and regulate stress levels via exercise, breathing techniques and biofeedback. 

• Medication: The goal of inflammatory bowel disease treatment is to alleviate the inflammation that causes your symptoms. In the best cases, this can result in not only symptom relief but also long-term remission and a lower risk of complications. IBD is usually treated with either drug therapy or surgery.

1. Anti-inflammatory medications: Anti-inflammatory drugs are frequently used as the first line of treatment for ulcerative colitis, particularly in mild to moderate cases. Anti-inflammatories include aminosalicylates like mesalamine, balsalazide, and olsalazine.

Corticosteroids are also administered in time-limited courses to induce remission. Steroids are not only anti-inflammatory, but they also suppress the immune system. The medication you take is determined by the area of your colon that has been affected.

2. Immune system suppressors: These medications work in a variety of ways to suppress the immune response, which releases chemicals that cause inflammation in the body. When these chemicals are released, they can cause damage to the digestive tract lining. Azathioprine, mercaptopurine, and methotrexate are some examples of immunosuppressive drugs.
More recently, orally administered agents known as "small molecules" have become available for the treatment of IBD. These include tofacitinib, upadacitinib, and ozanimod.
3. Biologics:
Biologics are a newer type of therapy that aims to neutralize proteins in the body that cause inflammation. Some are administered via intravenous (IV) infusions, while others are self-injections. Examples are infliximab, adalimumab, golimumab, certolizumab, vedolizumab, ustekinumab, and risankizumab.

4. Antibiotics: Antibiotics can be used in conjunction with other medications or to prevent infection, such as in perianal Crohn's disease. Ciprofloxacin and metronidazole are commonly prescribed antibiotics.

Other medications and supplements:
In addition to controlling inflammation, some medications may help relieve your symptoms, but always consult your doctor before taking any over-the-counter medications. Depending on the severity of your IBD, your doctor may suggest one or more of the following:
5. Antidiarrheal medications: A fibre supplement, such as psyllium powder or methylcellulose, can help with mild to moderate diarrhoea by bulking up your stool. Loperamide may help with more severe diarrhea.
These medications may be ineffective or harmful in some people who have strictures or certain infections. Please check with your doctor before taking these medications.

6. Pain relievers: Your doctor may recommend acetaminophen for mild pain. However, ibuprofen, naproxen sodium, and diclofenac sodium are likely to exacerbate your symptoms and potentially worsen your disease.
7. Vitamins and supplements: If you aren't getting enough nutrients, your doctor may prescribe vitamins and nutritional supplements.
 

• Surgical Treatment: If drug therapy and lifestyle changes do not positively impact the IBD symptoms and signs, the doctor may suggest surgical procedures. These include:

1. Surgery for Crohn's disease: The doctor will carve out a portion of the damaged digestive tract and combine two healthy sections. It can help close drain abscesses and fistulas. The surgical relief is only temporary since the disease is recurring.

2. Surgery for ulcerative colitis: This surgical procedure will remove The entire rectum colon. A small internal pouch will be connected to the anus to help bowel movement. Alternatively, the doctors will create a permanent opening in the abdomen for the stool to pass.

• Alternative Management: Alternative medicines such as adding more probiotics might help when patients with aggressive digestive disorders cannot find relief anywhere.

Lifestyle advise: 

Here are some tips to help you manage inflammatory bowel disease:
Begin with a low-fibre or liquid diet until the issue is resolved;
Follow a low-fiber diet;

Try a low-FODMAP diet;
Drink water to stay hydrated;
Avoid caffeinated and energy drinks.

Additional information

What is the significant difference between inflammatory bowel disease (IBD) and inflammatory bowel syndrome (IBS)?

IBD is an umbrella term for bowel diseases that cause irritation and swelling in the digestive tract. These mainly include two diseases called ulcerative colitis and Crohn's disease.

On the other hand, IBS is a medical condition wherein the digestive contents either move too slowly or too fast inside the intestines. This is usually followed up by abdominal pain.

The former is a structural disease, which means that physical damage inside the body gives rise to symptoms. The latter is more of a functional illness, so any tests or procedures will not indicate a physical reason to justify the symptoms.