Table of Content

• What is Inflammatory Bowel Disease (IBD)?

• Types of IBD (Inflammatory Bowel Disease)

• Symptoms of IBD (inflammatory bowel disease)

• Causes of IBD (inflammatory bowel disease)

• Treatment of IBD (inflammatory bowel disease)

• Complications of IBD (inflammatory bowel disease)

• How is IBD diagnosed?

• Take-Home Points

• FAQ on inflammatory bowel disease (IBD)

What is Inflammatory Bowel Disease (IBD)?

Inflammatory Bowel Disease (IBD) is a chronic, long-term condition that affects the digestive system. The digestive system includes the parts of the human body that help in food consumption, digestion, and excretion, i.e., the mouth, food pipe (esophagus), and intestines (small and large). IBD is characterized by inflammation of the gastrointestinal tract, which can cause various symptoms, including abdominal pain, diarrhea, weight loss, and fatigue. To properly diagnose and manage the condition, it is essential to understand what Inflammatory Bowel Disease is. By understanding the causes and symptoms of Inflammatory Bowel Disease, patients can take steps to minimize their risk for flare-ups and manage their symptoms.

Types of IBD (Inflammatory Bowel Disease)

There are two main types of inflammatory bowel disease (IBD): Crohn's disease and ulcerative colitis. Both types of IBD can cause severe discomfort and other complications such as malnutrition, anemia, liver disease, and even cancer if left untreated for too long.

Inflammatory bowel disease (IBD) is a complex condition that requires careful management and treatment to minimize the risk of long-term complications of IBD. Understanding the different types of IBD is essential to properly diagnose and treat the condition.

• Crohn’s disease is a form of IBD that usually affects the small intestine but can also affect any part of the digestive system from the mouth to the anus.

• Ulcerative colitis, on the other hand, only affects the large intestine, colon, and rectum.

Symptoms of IBD (inflammatory bowel disease)

Inflammatory Bowel Disease (IBD) is a chronic condition that affects the digestive system. It can cause various symptoms, including 

• abdominal pain

• Diarrhea

• Fatigue

• weight loss. 

Inflammatory bowel disease (IBD) can also lead to complications such as malnutrition and anemia. It is essential to be aware of the inflammatory bowel disease symptoms so that you can seek medical help if needed. 

Common symptoms of IBD include 

• abdominal pain

• cramping 

• bloating

• diarrhea or constipation 

• blood in the stool

• fatigue,

• weight loss. 

Other less common symptoms may consist of 

• Fever

• joint pain,

• skin rashes. 

If you experience these symptoms for more than two weeks, you must see your doctor for diagnosis and treatment. Consult your Gastroenterologist now

Causes of IBD (inflammatory bowel disease)

The exact cause of IBD is unknown, but several factors may contribute to its development. These include genetic predisposition, environmental triggers such as diet and stress, and abnormal immune response.

1. Family history and genetics

People with a family history of IBD are at a much higher risk of developing it themselves. A study in 2016 noted that IBD might have a genetic component.

2. Age

In most cases, IBD starts before age 35, even though it can happen at any age.

3. Gender

IBD can affect men and women equally.

According to a 2018 study, UC is more common among men over 45 than women of the same age range.

However, Crohn’s disease is more common among girls and women over 14.

4. Smoking

Smoking is a major risk factor for developing Crohn’s disease. Smoking also aggravates the pain and other symptoms associated with Crohn’s disease. It increases the risk of complications of inflammatory bowel disease.

Yet, UC mainly affects former smokers and nonsmokers.

5. The immune system

The immune system usually guards the body against pathogens, which are organisms that cause diseases and infections.

A bacterial or viral infection of the digestive tract could trigger an immune response. The digestive tract becomes inflamed as the body tries to create an immune response against the infectious agent.

Generally, In a healthy immune response, the inflammation goes away when the infection is gone.

However, digestive tract inflammation can occur even with no infection as an autoimmune response in people with IBD, where the immune system instead attacks the body’s cells. IBD can also occur when the inflammation doesn’t disappear after the infection is cured. The inflammation may last for months or even years.

6. Ethnicity

IBD is present in all populations. However, research shows that certain ethnic groups, such as Ashkenazi Jews and white people, have a higher risk of developing the condition.

7. Environmental factors

A 2019 research shows that people living in urban areas and industrialized countries have a higher risk of developing IBD.

A diet rich in fat and processed food is connected to the development of IBD.  IBD is also more common among people living in northern climates, which are often cold.

A sedentary lifestyle increases the risk of IBD.

Treatment of IBD (inflammatory bowel disease)

IBD treatments include medications, lifestyle changes, and dietary modifications. Medications such as corticosteroids and immunosuppressants reduce inflammation in the intestines. Lifestyle changes such as stress management and exercise can help reduce symptoms of IBD. An IBD diet or inflammatory bowel disease diet can also help manage symptoms by avoiding certain foods that may trigger inflammation or worsen symptoms.

1. Medications

They help decrease inflammation of the digestive tract. However, they have many side effects. The common medications for IBD include

2. Corticosteroids

They are available as injections, oral tablets, and rectal foams. They include

• Prednisone

• Prednisolone

• Methylprednisolone

• Budesonide

3. Aminosalicylates (5-ASA drugs)

They decrease inflammation, especially in the last part of the small intestine and in the colon. They include

• Balsalazide

• Mesalamine

• Olsalazine

• Sulfasalazine.

For adults with extensive mild to moderate UC, AGA guidelines recommend

• standard-dose oral mesalamine

• balsalazide and olsalazine (diazo-bonded 5-ASA drugs).

The AGA prefers these over low-dose mesalamine, sulfasalazine, or no treatment. However, the AGA also says taking sulfasalazine is acceptable as long as you know the risk of more severe side effects.

People who do not respond to standard-dose mesalamine or diazo-bonded 5-ASA drugs should try a combination of rectal mesalamine and high-dose oral mesalamine.

4. Biologics

They are genetically designed drugs for people with moderate to severe IBD.

Some biologics block tumor necrosis factor (TNF), an inflammation-triggering chemical that the immune system produces. Excess TNF in the blood is typically blocked, but higher levels of TNF can lead to more inflammation in people with IBD.

TNF-alpha inhibitors include

• Adalimumab

• Infliximab

• Golimumab.

Other biologics include:

• Vedolizumab

• Certolizumab

• Ustekinumab

• Natalizumab

Biologics are not available as generic drugs. The AGA treatment guidelines for people with moderate to severe UC recommend that people who have never tried a biologic before opt for vedolizumab or infliximab over adalimumab. Adalimumab is less effective.

However, one can self-administer adalimumab, which makes it more convenient than the other drugs. 

5. Immunomodulators

They may be effective if corticosteroids and 5-ASA drugs aren’t enough. They can prevent the immune system from attacking the bowel and inducing inflammation.

Immunomodulators include:

• Azathioprine

• Methotrexate

• Mercaptopurine

Immunomodulators are used as an off-label drugs.

Other drugs

• The UC drug tofacitinib 

• Antibiotics kill bacteria in the small intestine that may trigger or aggravate the symptoms of Crohn’s.

• Antidiarrheal medications and laxatives can help keep your bowel movements regular.

6. Lifestyle choices 

Lifestyle changes can help reduce symptoms of IBD. They include:

1. Avoiding triggers, like stressful situations and dairy products.

2. Drinking plenty of fluids.

3. Exercising and quitting smoking.

7. Surgery

Sometimes, surgery might be necessary for people with IBD, which include:

1. In people with Crohn’s disease, surgical management includes removal of affected portions of the intestines

2. Surgeries for managing fistulas

3. In severe cases of UC, the entire colon and rectum may be removed surgically.

4. Strictureplasty may be performed to widen a narrowed bowel.

8. Supplements

Both types of IBD can cause severe discomfort and other complications such as malnutrition and anemia. Mineral and Vitamin supplements can help with nutritional deficiencies. It is essential to consult your doctor before adding any new supplements to your diet.

Complications of IBD (inflammatory bowel disease)

Ulcerative colitis and Crohn's disease have some common complications and others specific to each condition. Complications found in both conditions include

1. Colon cancer

Having ulcerative colitis or Crohn's disease can increase your risk of colon cancer. Screening for cancer with a colonoscopy at regular intervals usually begins about 8 to 10 years after the diagnosis. 

2. Skin, eye, and joint inflammation

Arthritis, skin lesions, and uveitis or inflammation of the eye may occur during IBD flare-ups.

• Side effects from medicines.

Corticosteroids used to treat IBD can be associated with a risk of osteoporosis, high blood pressure, and other conditions.

• Primary sclerosing cholangitis

 An uncommon condition seen in people with IBD where inflammation causes scarring within the bile ducts. This scarring results in the narrowing of the ducts, restricting bile flow. This can eventually lead to liver damage.

• Blood clots

IBD raises the risk of blood clots in veins and arteries.

• Severe dehydration

 Excessive diarrhea can cause dehydration.

3. Complications of Crohn's disease may include:

• Bowel obstruction.

Over time, Crohn's disease affects parts of the bowel that can thicken and narrow, blocking the flow of digestive contents. 

• Malnutrition

Diarrhea, abdominal pain, and cramping can make it difficult to eat and absorb enough nutrients to keep you nourished. 

• Fistulas

Fistulas are atypical connections between different body parts. Fistulas near or around the perianal are the most common kind. In some cases, a fistula may become infected and form an abscess.

• Anal fissure

They are small tears in the tissue that lines the anus or in the skin around the anus where infections occur. It's frequently associated with painful bowel movements and can lead to a perianal fistula.

4. Complications of ulcerative colitis include

• Toxic megacolon. 

Ulcerative colitis can cause the colon to widen rapidly and swell, a severe condition known as toxic megacolon.

• Perforated colon

 A perforated colon is most commonly caused by toxic megacolon, but it can also occur on its own.

How is IBD diagnosed?

Diagnosing IBD can be complex as the symptoms are similar to other conditions. To accurately diagnose IBD, doctors use a combination of tests and procedures to rule out other possible causes. These tests may include blood tests, imaging scans, endoscopy, and biopsy. By using these methods, doctors can determine if IBD is present and what type it is.

1. Blood and stool laboratory tests

To diagnose IBD, doctors often use blood and stool tests to detect inflammation in the body. These tests can help identify the presence of IBD and determine its severity. 

Blood tests measure levels of certain proteins, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which are indicators of inflammation in the body. Stool tests look for signs of infection or bleeding in the intestines, which IBD can cause. By combining these two tests, doctors can accurately diagnose IBD and develop effective treatments for IBD patients.

2. Endoscopy

Endoscopy is a medical procedure used to diagnose and treat Inflammatory Bowel Disease (IBD). It involves inserting a thin, flexible tube with a camera attached to the patient's digestive tract. Endoscopy allows the doctor to view the inside of the patient's intestines and stomach, allowing them to identify any abnormalities or signs of IBD. Endoscopy tests are often combined with other tests, such as blood tests and imaging scans, to diagnose IBD. The endoscopy test can also be used to monitor the progress of IBD treatments and detect any complications of IBD. Endoscopy is an essential tool for diagnosing and treating IBD, and it can help patients get back on track toward better health.

Endoscopies used in IBD testing include

• Colonoscopy, allowing doctors to examine the colon or large intestine.

• Upper GI endoscopyallows doctors to see the GI tract from the top.

• Sigmoidoscopy allows doctors to examine the left side of the colon or rectum.

• Video capsule endoscopy helps to take pictures of your small intestine and bowel as it travels through your GI tract for 8 to 12 hours. 

• Chromoendoscopy involves spraying a blue liquid dye into the colon to highlight and detect minute changes in the lining of your intestine, such as polyps.

• Biopsy of your colon or other areas of your GI tract is done while performing a colonoscopy or endoscopy. During the biopsy, a small piece of tissue is removed from the inside of the intestine.

3. Diagnostic imaging and radiology scan

To diagnose IBD, doctors often use radiology scans or diagnostic imaging tests. These tests help to identify any abnormalities in the digestive tract and provide valuable information about the severity of the disease. Radiology scans such as X-rays, CT scans, and MRIscans detect inflammation in the intestines and other organs. They can also monitor how well IBD treatments are working or if there are any complications of inflammatory bowel disease.

Take-Home Points

• Inflammatory Bowel Disease (IBD) is a chronic condition that affects the digestive system. It is characterized by inflammation of the lining of the intestines, which can cause abdominal pain, diarrhea, and other symptoms. 

• The exact cause of IBD is not known. Various factors, including genetics, environmental triggers, and lifestyle choices, can cause IBD. 

• IBD treatments typically involve medications to reduce inflammation and improve symptoms. In some cases, surgery may be necessary to remove damaged parts of the intestine or to correct any underlying issues. 

• Understanding the symptoms, cause of IBD, and treatment options for IBD can help people manage their condition more effectively.

References

• The facts about IBD

• What is inflammatory bowel disease (IBD)? 

• Environmental Risk Factors for Inflammatory Bowel Diseases

• Genetics and pathogenesis of inflammatory bowel disease

• Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis