World IBD Day:  “IBD Has no Age”

Dr. MIR INTIKHAB

Inflammatory Bowel Disease (Overview)

People with inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis have chronic intestinal inflammation. Symptoms include stomach cramps, diarrhoea and gas. Medications and surgery can help manage IBD flares, putting the condition into remission.

What is inflammatory bowel disease (IBD)?

Inflammatory bowel disease (IBD) is a group of disorders that cause chronic inflammation (pain and swelling) in the intestines. IBD includes Crohn’s disease and ulcerative colitis. Both types affect the digestive system. Treatments can help manage this lifelong condition.

How common is IBD?

Up to three million Americans have some form of IBD. The condition affects all ages and genders. IBD most commonly occurs between the ages of 15 and 30.

What are the types of IBD?

Crohn’s disease and ulcerative colitis are the main types of IBD. Types include:

• Crohn’s disease causes pain and swelling in the digestive tract. It can affect any part from the mouth to the anus. It most commonly affects the small intestine and upper part of the large intestine.
• Ulcerative colitis causes swelling and sores (ulcers) in the large intestine (colon and rectum).
• Microscopic colitis causes intestinal inflammation that’s only detectable with a microscope.

• What’s the difference between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS)?
• IBD is a disease; IBSis a syndrome, or group of symptoms. The causes and treatments are different.
• IBS is a type of functional gastrointestinal disease. It affects how the bowels function, causing them to contract more (or sometimes less) often than usual. IBS is also known as spastic colon or nervous stomach.
• IBS doesn’t inflame or damage the intestines like IBD, so imaging scans can’t detect it and it doesn’t increase the risk of colon cancer. People with IBS rarely need hospitalization or surgery.

Can you have IBD and IBS?

Yes, it’s possible to have both IBD and IBS. While IBD can cause IBS symptoms, there’s no evidence that having IBS increases your risk of IBD.

What causes IBD?

Researchers are still trying to determine why some people develop IBD. Three factors appear to play a role:

• Genetics: As many as 1 in 4 people with IBD have a family history of the disease.
• Immune system response: The immune system typically fights off infections. In people with IBD, the immune system mistakes foods as foreign substances. It releases antibodies (proteins) to fight off this threat, causing IBD symptoms.
• Environmental triggers: People with a family history of IBD may develop the disease after exposure to an environmental trigger. These triggers include smoking, stress, medication use and depression.

What are IBD symptoms?

IBD symptoms can come and go. They may be mild or severe, and they may appear suddenly or come on gradually. Periods of IBD symptoms are IBD flares. When you don’t have symptoms, you’re in remission.

IBD symptoms include:

• Abdominal (belly) pain.
• Diarrhoea (sometimes alternating with constipation) or urgent need to poop (bowel urgency).
• Gas and bloating.
• Loss of appetite or unexplained weight loss.
• Mucus or blood in stool.
• Upset stomach.

Rarely, IBD may also cause:

• Fatigue.
• Fever.
• Itchy, red, painful eyes.
• Joint pain.
• Nausea and vomiting.
• Skin rashes and sores (ulcers).
• Vision problems.

What are the complications of inflammatory bowel disease (IBD)?

People with IBD have a higher risk of developing colon (colorectal) cancer. Other potential complications include:

• Anal fistula (tunnel that forms under the skin connecting an infected anal gland and the anus).
• Anal stenosis or stricture (narrowing of the anal canal where stool leaves the body).
• Anemia (low levels of red blood cells) or blood clots.
• Kidney stones.
• Liver disease, such as cirrhosis and primary sclerosing cholangitis (bile duct inflammation).
• Malabsorption and malnutrition (inability to get enough nutrients through the small intestine).
• Osteoporosis.
• Perforated bowel (hole or tear in the large intestine).
• Toxic megacolon (severe intestinal swelling).

DIAGNOSIS AND TESTS

How is IBD diagnosed?

Crohn’s disease and ulcerative colitis cause similar symptoms. No single test can diagnose either condition.

To make a diagnosis, your healthcare provider will ask about your symptoms. Your workup may start with a complete blood count (CBC) and stool test to look for signs of intestinal inflammation.

You may also get one or more of these diagnostic tests:

• Colonoscopy to examine the large and small intestines.
• EUS (endoscopic ultrasound) to check the digestive tract for swelling and ulcers.
• Flexible sigmoidoscopy to examine the inside of the rectum and anus.
• Imaging scan, such as a CT scan or MRI, to check for signs of inflammation or an abscess.
• Upper endoscopy to examine the digestive tract from the mouth to the start of the small intestine.
• Capsule endoscopy using a small camera device that you swallow. The camera captures images as it travels through the digestive tract.

What are nonsurgical inflammatory bowel disease (IBD) treatments?

IBD treatments vary depending on the particular type and symptoms. Medications can help control inflammation so you don’t have symptoms (remission). Medications to treat IBD include:

• Aminosalicylates (an anti-inflammatory medicine like sulfasalazine, mesalamine or balsalazide) minimize irritation to the intestines.
• Antibiotics treat infections and abscesses.
• Biologics interrupt signals from the immune system that cause inflammation.
• Corticosteroids, such as prednisone, keep the immune system in check and manage flares.
• Immunomodulators calm an overactive immune system.

You may also benefit from these over-the-counter IBD treatments:

• Antidiarrheal medication.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Vitamins and supplements like probiotics.

What are surgical treatments for Crohn’s disease?

As many as 7 in 10 people with Crohn’s disease eventually need surgery when medications no longer provide symptom relief. During a bowel resection, a surgeon:

• Removes the diseased bowel segment.
• Connects the two ends of the healthy bowel together (anastomosis).

After surgery, the remaining part of the bowel adapts and functions as it did before. Approximately 6 in 10 people who undergo surgery for Crohn’s disease will have a recurrence within 10 years. Another bowel resection may be a good option for you.

What are surgical treatments for ulcerative colitis?

After 30+ years of living with ulcerative colitis, about 1 in 3 people need surgery.

A surgeon:

• Removes the colon (colectomy) or the colon and rectum (proctocolectomy).
• Connects the small intestine and anus.
• Creates an ileal pouch that collects stool, which then exits through the anus.

Rarely, you may need an ileostomy instead of an ileal pouch. An ileostomy bag attaches outside of the belly to collect stool.

A proctocolectomy is curative. Symptoms won’t return after surgery to remove the colon and rectum. However, you may have problems with the ileostomy or ileal pouch, such as pouchitis (inflammation and infection).

How can I prevent inflammatory bowel disease (IBD)?

While there isn’t anything you can do to prevent IBD, certain dietary and lifestyle changes may control the symptoms. You can:

• Eat smaller meals every two to four hours.
• Find healthy ways to manage stress, such as meditation, movement like tai chi, listening to music or going for a walk.
• Get plenty of sleep and stay physically active.
• Keep a food diary to identify foods that trigger IBD flares. You may find you have a food intolerance, such as lactose intolerance. If so, your body has a harder time digesting certain foods, which causes stomach upset.
• Reduce foods that irritate the intestines, such as those that are fibrous, spicy, greasy or made with milk. During flares, choose soft, bland foods that are less inflammatory.
• Cut back on beverages containing caffeine, carbonation and alcohol. Drink more water to prevent dehydration.
• Quit smoking.

OUTLOOK / PROGNOSIS

What is the prognosis (outlook) for people who have inflammatory bowel disease (IBD)?

IBD is a lifelong condition, but it shouldn’t shorten your life expectancy. With proper treatment, you can prevent flares and have long periods of remission.

Managing a lifelong condition like IBD can be challenging. It’s not unusual for people with IBD to become anxious or depressed. Seeing a mental health counselor can help.

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Excess weight loss.
• Extreme abdominal pain or diarrhea.
• Fever or signs of infection.
• IBD flare.
• Signs of dehydration.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What type of IBD do I have?
• What’s the best treatment for me?
• What foods or drinks should I avoid?
• What lifestyle changes should I make?
• Am I at risk for other problems?
• Should I look out for signs of complications?

Take away note from my end…

Most people with inflammatory bowel disease (IBD) enjoy active lives. Still, symptoms of Crohn’s disease and ulcerative colitis can be life-disrupting. Some people go into remission (no symptoms) after taking medications. Some people need surgery to deal with severe symptom flare-ups. Your IBD Specialist/healthcare provider can suggest dietary and lifestyle changes to manage IBD.

(The Author is MD DNB Gastroenterology, Cygnus Hospital Nowgam, Sgr. Email: [email protected])