Inflammatory Bowel Disease (IBD)
What is Inflammatory Bowel Disease (IBD)?
Inflammatory Bowel Disease (IBD) is a chronic condition characterised by intermittent inflammation of your digestive tract. There are 2 main types of IBD: Crohn’s disease (CD) and Ulcerative Colitis (UC). In CD, inflammation may occur in any part of the digestive tract, between the mouth and anus.In UC, inflammation is usually restricted to the large intestine only.
In both cases, it is recommended to seek professional advice from an IBD specialist.
IBD should not be confused with Irritable Bowel Syndrome (IBS). IBS symptoms are driven by the bowel being over-sensitive whereas IBD involves the presence of active inflammation within the digestive tract.
Common symptoms of both Crohn’s Disease and Ulcerative Colitis include:
- Blood in stool
- Abdominal pain
- Weight loss
Patients with IBD may occasionally have other extraintestinal manifestations. These extraintestinal manifestations include:
- Mouth ulcers
- Eye involvement
- Joint pain
- Jaundice (body turning yellow) from liver involvement
You should see an IBD doctor or an IBD specialist if your symptoms are not improving, or are recurring. Early diagnosis and pharmacological therapy can enhance treatment outcomes and reduce the need for surgical interventions.
IBD is an immune mediated disease of the digestive tract. While the immune system is needed to ward off infections in the body, this defence mechanism is weak in patients with IBD.Instead, it attacks the intestine resulting in intermittent inflammation. Exact cause is not known. While the immune system is needed to ward off infections in the body, this defence mechanism is weak in patients with IBD.
People with certain risk factors may carry a higher risk of developing Inflammatory Bowel Disease. Some of the main risk factors are:
- Positive family history: Certain genes may increase the risk of a person having Inflammatory Bowel Disease. However, most patients do not have a positive family history.
- Race and ethnicity: Caucasians especially Jewish people have a higher risk of developing IBD than their non-Caucasian counterparts.
- Smoking: Smoking is associated with an increased risk of Crohn’s disease but not ulcerative colitis. It is also associated with an increased risk of recurrent flares, severity and need for surgery.
The diagnosis of IBD is made after retrieving a complete clinical history of the patient, visual assessment of the digestive tract via endoscopy, and examining the biopsy results.
Your IBD doctor may need to do some blood tests, stool tests, endoscopy and occasionally scans. This allows your doctor to confirm the diagnosis of Inflammatory Bowel Disease; exclude other conditions that may mimic the appearance of Inflammatory Bowel Disease (such as irritable bowel syndrome, infection, cancer, etc); as well as to stage the extent and severity of your disease.
Treatment of IBD includes:
Medications used for IBD aim to heal the inflammation and maintain the disease in remission. The choice of medication often depends on the extent and the severity of the disease.
Steroids are effective in reducing inflammation rapidly. They are ideal quick treatment for ulcerativce colitis and crohn’s disease. However, due to the risk of side effects, this medication is usually used only as short-term medication.
This is usually the first-line treatment for ulcerative colitis, and less commonly, in a small subset of Crohn’s disease treatment with mild disease.
Immunomodulators can be used as a monotherapy or as a combination therapy when IBD does not respond to mesalazine or require repeated courses of steroids.
Biologic is generally reserved for patients with more severe diseases who do not respond to conventional treatment.
Surgery to remove part of the bowel is recommended when the disease is unresponsive to medication or if the disease results in complications such as narrowing, perforation, or cancer.