Conditions

Inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn's disease.

Summary

  • Inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn's disease.
  • Ulcerative colitis usually causes inflammation in all or part of the large intestine. In Crohn's disease, inflammation may occur anywhere along the digestive tract, although it most commonly affects the small intestine.
  • The exact cause of IBD remains unknown, but there is a long-held hypothesis that IBD is an auto-immune disease.
  • Symptoms of IBD include d iarrhoea, abdominal pain, weight loss, fatigue, nausea, vomiting, and growth failure in children.
  • Many tests are used to diagnose IBD. These include endoscopy, blood tests, testing of stool samples and X-rays.
  • Because there is no known cause for IBD, there is no definite cure. The aim of treatment is to control symptoms and prevent complications.

Alternative names
Inflammatory bowel disease - Crohn's disease; regional enteritis; ileitis; granulomatous ileocolitis, ulcerative colitis; colitis, distal colitis, pancolitis, ulcerative proctitis

What is IBD?
Inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn's disease.

Ulcerative colitis usually causes chronic inflammation in all or part of the large intestine. In Crohn's disease, the inflammation may occur anywhere along the digestive tract, although it most commonly affects the small intestine.

IBD most frequently affects young people between the ages of 15 and 30, and occurs equally in both sexes. However, Caucasians seem to be at greater risk than non-Caucasians, and people with a Jewish background also have a higher risk of getting IBD.

IBD, which shouldn't be confused with irritable bowel syndrome (IBS), is a life-long condition for which there is no cure.

What causes it?
The exact cause of IBD remains unknown, but there is a long-held hypothesis that it is an auto-immune disease. This implies that the body’s immune system, for reasons unknown, becomes overactive and starts to manufacture antibodies that are self-directed, in this instance against the lining of the bowel. The antibodies attack the intestinal cells, which eventually leads to chronic inflammation.

Researchers have identified a number of factors that may trigger this auto-immune reaction:

  • Genetics,
  • Cigarette smoking (particularly in the case of Crohn's disease), and
  • Repeated antibiotic treatment.

It has also been suggested that an unknown 'irritant' (viral, bacterial or autoimmune) could be involved.

Symptoms

Symptoms of both ulcerative colitis and Crohn's disease include:

  • Diarrhoea,
  • Abdominal pain,
  • Weight loss,
  • Fatigue,
  • Nausea and vomiting ,
  • Swelling, redness and possible bleeding of the tissue that lines the mouth, and
  • Growth failure in children

Symptoms of ulcerative colitis may also include:

  • Rectal bleeding , and
  • Haematochezia (bright red blood in the stool).

Symptoms of Crohn's disease may also include:

  • Tender, bruise-like swelling of the shins,
  • Ulcers on the skin, especially on the legs,
  • Fever ,
  • Anal abscess, and
  • Arthritis.

Diagnosis

Many tests are used to diagnose IBD. These include:

  • Endoscopy, particularly colonoscopy or sigmoidoscopy. This is the most accurate method for making an IBD diagnosis. Both colonoscopy and sigmoidoscopy involve the insertion of a small, flexible tube (which contains a light and camera) into the anus. However, sigmoidoscopy differs from colonoscopy in that it only allows the physician to examine the rectum and sigmoid colon, whereas colonoscopy allows for the examination of the entire colon.
  • Barium X-ray, which involves the coating of organs with barium (either by drinking it or administering the barium through an enema). This allows for the organs to show up clearly on X-rays, which makes it possible for the physician to identify abnormalities.
  • Blood tests may be done to check for anaemia, which could indicate bleeding in the colon/rectum. These tests may also uncover a high white blood cell count - a sign of inflammation somewhere in the body.
  • A stool sample may reveal white blood cells, which could point to inflammatory disease. In addition, a stool sample will allow your doctor to detect bleeding or infection in the colon/rectum caused by bacteria, a virus or parasites.
  • Other radiology tests may be used to detect blockages in the gastrointestinal (GI) tract.

Early diagnosis is particularly important in children, as IBD can adversely affect growth.

Treatment
Because there is no known cause for IBD, there is no definite cure. The aim of treatment is to control symptoms and prevent complications by controlling the level of inflammation.

1. Medical treatment
The most effective treatment options include:

  • corticosteroids,
  • anti-inflammatory agents (aminosalicylates),
  • immunosuppressant agents (cyclosporine, azathioprine, mercaptopurine), and
  • antibiotics (metronidazole).

2. Nutritional management
Nutritional management, which must be done under the strict supervision of a qualified dietician, may focus on the prevention of nutrient deficiencies and may involve the removal of foods that trigger flare-ups.

In severe cases, parenteral nutrition ( intravenous ) or enteral nutrition ( tube feeding via the GI tract) may be called for.

3. Surgery
About 25 to 40 percent of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon, or risk of cancer.

Prognosis
IBD is a lifelong condition for which there is no cure. While it is impossible to predict the course of Crohn’s disease, ulcerative colitis is generally characterised by remissions (periods when the symptoms go away) and relapses (when symptoms return).

People with IBD have a higher risk of intestinal cancer and osteoporosis. For this reason, it is paramount to go for regular cancer screening tests at a gastroenterologist and bone-density tests at an endocrinologist.

When to call your doctor
Consult your doctor if any of the symptoms mentioned above linger, become a daily annoyance, or become more frequent or severe.

Possible questions to ask your doctor include:

  • I have observed blood in my stools. Could I have IBD?
  • What will you need to do to find out if I definitely have IBD?
  • If it's not IBD, what else could be causing the symptoms?
  • If I have IBD, what will the treatment involve?
  • Which medication will I have to take and should I be aware of any side effects?
  • How long will I have to take the medication?
  • Should I change my diet and possibly consult a dietician?
  • What lifestyle changes would you recommend?

How can IBD be prevented?
Research shows that the following actions could play a protective role:

  • Breastfeeding. It has been shown that adults who were breastfed during infancy for longer than three months have a 30-40 percent lower incidence of IBD.
  • Increased vegetable intake. In research studies, vegetables (particularly from home gardens) reduced the incidence of bowel disease by 30-40 percent.

While it is impossible to change your genetic makeup and difficult to control the number of antibiotic treatments you receive, it is possible to cut your risk of IBD by quitting smoking (or never starting).

Further publications on the topic