Inflammatory bowel disease (IBD) refers to many long-term disorders that include digestive tract inflammation, or intestines.
According to the Centers for Disease Control and Prevention (CDC), IBD now occurs in up to 3 million people in the USA. Most people with IBD are diagnosed before they hit age thirty.
This article discusses the various forms of IBD and how irritable bowel syndrome (IBS) is related to treatment. It also addresses the effects, causes, and strategies for treating IBD.
Types of IBD
Ulcerative colitis and Crohn’s disease are the two main cases of IBD. This will be addressed in more detail in the Parts below.
The disease is responsible for inflammation of the large intestine, or colon. Based on position and severity there are many distinct types of ulcerative colitis. Those are as follows:
- Ulcerative proctitis: This type occurs when inflammation stays within the rectum. It tends to be the mildest form of ulcerative colitis.
- Universal colitis, or pancolitis: This type occurs when inflammation spreads across the entire colon.
- Proctosigmoiditis: The type occurs when the rectum and lower end of the colon experience inflammation.
- Distal colitis: This type occurs when inflammation extends from the rectum and up the left colon.
- Acute severe ulcerative colitis: This is a rare type that causes inflammation across the entire colon, leading to severe symptoms and pain.
Crohn’s disease may affect any portion of the mouth-anus digestive tract. It occurs most frequently in the last segment of the small intestine and colon, however.
Over time this form of IBD has become more prevalent. In reality, according to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), about 500,000 people in the United States now have it.
They also say Crohn’s disease is more likely to occur when a person is 20–29 years of age.
When a doctor is unable to differentiate between the two major forms of IBD, they may identify a person’s condition as “indeterminate colitis.”
Lymphocytic colitis and collagenous colitis are several other forms of IBD.
Comparing IBD and IBS
IBS and IBD also have some parallels. For example, both of these may lead to changes in bowel habits and abdominal pain. All of these effects often appear to flare-up for brief periods, and then go into remission.
None is a remedy that can fix the disease entirely.
Therefore people also equate IBD with IBS for these reasons. The two conditions differ in the following ways though:
- IBD is a more severe condition that may lead to a number of complications, including malnutrition and damage to the bowel.
- IBD occurs due to an overactive immune system, which leads to inflammation throughout the gut and gastrointestinal tract. IBS usually develops due to digestive problems or an oversensitive gut.
- Treating IBD involves medications that reduce inflammation. People with IBS can reduce their symptoms by making changes to their diet or lifestyle.
Causes and risk factors
There are several factors that can contribute to IBD’s growth. This may happen, for example, because the immune system has an abnormal reaction to bacteria, viruses, or particles in food. This can cause an inflammatory bowel reaction.
In addition, research has related Escherichia coli to Crohn’s disease.
Although there is currently no single confirmed cause of IBD, there are many possible factors that can increase the risk of a person experiencing each of the conditions within IBD.
This will be addressed in more detail in the Parts below.
Risk factors for ulcerative colitis
- Age: Most people receive a diagnosis at around 15–30 years of age or after 60 years of age.
- Ethnicity: People of Jewish descent seem to have a high risk of ulcerative colitis than other ethnic groups.
- Genetics: People with a close relative who has ulcerative colitis have a higher risk of developing it themselves.
Risk factors for Crohn’s disease
Health care practitioners do not understand entirely what causes Crohn’s disease. They have however established several factors that can increase the risk of a individual developing it, including:
- Genetics: People who have a parent or sibling with Crohn’s disease are more likely to develop it themselves.
- Medications: The use of certain medications — including nonsteroidal anti-inflammatory medications (NSAIDs), birth control, and antibiotics — may increase the risk of Crohn’s disease.
- Smoking: This habit can increase the risk of Crohn’s by double.
- Diet: A diet that contains high levels of fat can also increase the risk of Crohn’s disease.
IBD symptoms can differ by form, place, severity, etc.
People can experience periods of worsening (flares) symptoms, and periods of little to no symptoms (remission). Flares can differ in scale, intensity, and duration.
The following symptoms are specific to both main forms of IBD, according to the CDC:
The Office on Women’s Health (OWH) suggest that IBD may also lead to symptoms outside the digestive system, including:
- joint pain
- skin conditions
The OWH also indicates that IBD may make menstrual effects more severe, and that IBD symptoms can also get worse during menstrual periods. IBD also raises the risk of iron deficiency anaemia for a child.
Health care practitioners have linked IBD to a variety of complications. Others may be life-threatening.
Other potential symptoms of Crohn’s disease, according to the NIDDK, include:
- bowel obstruction
- colon cancer
- fistulas, which are abnormal tunnels in the gut
- small tears in the anus, or anal fissures
- ulcers in the mouth, intestines, anus, or perineum, which is the area between the genitals and anus
They also suggest that ulcerative colitis can cause the following complications:
- rectal bleeding, which may lead to iron deficiency anemia
- poor absorption of nutrients
- reduced bone density, possibly leading to osteopenia or osteoporosis
A 2018 review also linked IBD to the development of kidney stones.
To diagnose IBD, before requesting one or more diagnostic tests, a health care professional will take a complete medical history. Some assessments they are required to use include:
- stool samples
- blood tests, to check for anemia or infection
- X-rays, if they suspect a serious complication
- CT or MRI scans, to detect fistulas in the small intestine or anal region
A health care provider can also inquire for endoscopic procedures. They will insert a flexible probe with a camera fastened through the anus during these.
These procedures help show any bowel damage and enable the health care professional to take a small tissue sample for analysis.
Some types of endoscopic procedure that a health care practitioner might use to diagnose IBD include:
- Colonoscopy: They use this to examine the entire colon.
- Flexible sigmoidoscopy: This examination helps them check the final section of the colon.
- Upper endoscopy: This procedure allows them to examine the esophagus, the stomach, and the first part of the small intestine.
The option is an endoscopy of the capsules. This treatment allows a person to swallow a capsule containing a camera so that a health care professional can view the small intestine.
There is no cure for IBD at this time. Treatment goal will be to reduce the symptoms, attain and maintain remission, and prevent complications.
The most popular IBD therapies are medications and surgery which will be addressed in more detail in the sections below.
Doctors may prescribe certain medicines for the treatment of IBD, starting with milder ones and working later on to more severe treatments. Those medicines may include:
- Anti-inflammatory drugs: 5-ASA medications are typically the first line of defense against IBD symptoms. They reduce inflammation in the gut and may help a person achieve and maintain remission.
- Corticosteroids: A doctor may prescribe fast-acting anti-inflammatory steroids if a milder class of anti-inflammatories is not effective. People should only use these drugs short-term to treat flares. Long-term use of NSAIDs may make IBD symptoms worse.
- Immune suppressors: These work by preventing the immune system from attacking the bowel cells, leading to reduced inflammation. However, they can take around 3 months to take effect, and they may cause a number of side effects, such as an increased risk of infection.
- Biologic therapies: These are antibodies that target certain substances that cause inflammation in the body.
Some other medications that can reduce IBD symptoms include:
- antidiarrheal drugs
- vitamin and mineral supplements, for cases of nutritional deficiency due to IBD
In certain cases, IBD or its complications may need to be treated with surgery. For example, a doctor may recommend surgery to expand a narrow intestine or to remove any fistulas.
Individuals with ulcerative colitis can need surgery to remove the colon and the rectum. People with Crohn’s disease may need a procedure to remove certain parts of the intestine.
Some factors in diet and lifestyle may make the symptoms of IBD worse. Positive improvements to these behaviors, however, can help a person control his or her symptoms, rising flares and even sustain remission.
Some dietary measures that may benefit people with IBD include:
- keeping a food diary to track whether or not certain symptoms occur after eating certain foods
- limiting the intake of dairy products
- restricting the intake of high fat foods
- avoiding or limiting the intake of spicy foods, caffeine, and alcohol
- limiting the intake of high fiber foods, particularly if the bowel has narrowed
- eating frequent small meals, rather than several large ones
- drinking plenty of water
- taking vitamin and mineral supplements, to prevent deficiencies
Many people with IBD report having more serious symptoms during times of stress. Training to control stress therefore can help to reduce the frequency and intensity of these forms of flares.
Some stress management techniques include:
- breathing exercises
- progressive muscle relaxation
- engaging in hobbies and other enjoyable activities
Recent research has identified linkages between smoking and Crohn’s illness. Smoking is a contributing factor in developing the disease, and may exacerbate the symptoms.
Many work has indicated that those with ulcerative colitis may potentially benefit from smoking. However, the same researchers have found smoking-related health risks far outweigh any benefits.
IBD can have a major emotional effect, particularly on those with serious symptoms. For this reason, it is necessary to have a strong support network among family and friends.
Individuals with IBD may also consider attending a support group or taking part in therapy sessions that may be helpful to them.
It is not yet clear what exactly triggers IBD. It is difficult for that reason to know how best to prevent it.
Genetic factors linked to IBD are beyond the control of a individual. However, eating a balanced diet, stopping smoking and regular exercise can reduce a person’s risk.
While there is currently no remedy for IBD, medical treatments and improvements in lifestyle may be able to treat the disease.
According to the Crohn’s & Colitis Foundation, with successful care, about 50% of people with Crohn’s disease will be in remission, or will have only moderate symptoms over the next 5 years.
Even, in the coming year about 45 percent of those in remission won’t suffer a relapse.
48 percent of people with ulcerative colitis are in remission in any given year and 30 per cent have moderate symptoms. The longer someone remains in remission, the less likely they will experience a flare the next year.
Death resulting from IBD or its complications is rare. People with Crohn’s disease have an average mortality rate only marginally higher than people without it. Those suffering from mild to moderate ulcerative colitis have no higher mortality rates than those without IBD.
If a person has any persistent changes in bowel habit or has any other IBD symptoms, they should seek advice from their doctor.