Inflammatory bowel disease (IBD)

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What is Inflammatory Bowel Disease (IBD)?

Inflammatory Bowel Disease (IBD) includes ulcerative colitis and Crohn’s disease, which cause bowel inflammation due to immune system imbalance, not infection.

Ulcerative Colitis:

  • Affects the inner lining of the colon and rectum.
  • Can be limited to the rectum (ulcerative proctitis) or involve the entire colon (pan-colitis).

Crohn’s Disease:

  • Involves the full thickness of the bowel wall.
  • Can affect any part of the digestive tract, commonly the ileum (ileitis), colon (colitis), or both (ileo-colitis).

IBD vs. IBS:

  • IBD involves inflammation or bowel damage.
  • IBS causes symptoms like abdominal pain, diarrhea, constipation, and bloating without inflammation.
  • IBD and IBS can coexist in the same person.

 

Symptoms of IBD

Common Symptoms:

  • Abdominal pain and diarrhea (with blood and mucus in ulcerative colitis).
  • Tiredness and weight loss (especially in Crohn’s disease).
  • Fever, mouth ulcers, nausea, and vomiting.
  • Anal pain/swelling and possible discharge in Crohn’s disease.

Other Possible Symptoms:

  • Swollen joints, inflamed eyes, and skin rashes/lumps.

Symptom Variation:

  • Symptoms vary by disease location and severity.
  • Symptoms can flare up or improve over time.
  • Periods of remission are common, where symptoms are absent.

Diagnosis of IBD

Most people with IBD need a bowel examination through:

  • Direct inspection: Colonoscopy or sigmoidoscopy via the anus, or gastroscopy via the mouth.
  • Radiology imaging: CT or MRI scans.

There is no single test to reliably diagnose all IBD cases, so multiple tests are often required.

Tests to Confirm Ulcerative Colitis or Crohn’s Disease

Diagnosing Crohn’s disease or ulcerative colitis can be delayed due to non-specific symptoms. Severe cases are diagnosed more quickly, while milder cases may be mistaken for IBS or infections.

Initial Tests:

  • Blood tests: Check for low red blood cell count, high white cell or platelet count, and elevated CRP or ESR (inflammation markers). Also check for iron or vitamin deficiencies.
  • Faecal specimen: Exclude infections and assess inflammation severity.

Imaging and Direct Inspection:

  • Colonoscopy or sigmoidoscopy: Flexible tube inserted through the anus.
  • Gastroscopy: Flexible tube inserted through the mouth.
  • Radiology imaging: CT or MRI scans.

Diagnosis Timeframe:

  • It may take 6-18 months from symptom onset to diagnosis, but this delay usually doesn’t cause additional problems. Multiple tests are often needed for a reliable diagnosis.

 

Treatment of IBD

Goals of Treatment:

  1. Control inflammation
  2. Ease symptoms
  3. Correct nutritional deficiencies

Treatment Options:

  • Medications: Used to achieve and maintain remission.

    • Aminosalicylates: Control mild ulcerative colitis (e.g., mesalazine).
    • Corticosteroids: Control moderate to severe inflammation (e.g., prednisolone).
    • Immunomodulators: Dampen immune response (e.g., azathioprine).
    • Biologics: Used for moderate to severe IBD, target inflammation.
    • Other Medications: Paracetamol for pain, loperamide for severe diarrhea, antibiotics for infections.

  • Importance of Medication Compliance: Regular medication use is crucial to prevent flares and complications. Some patients can reduce or stop medication if the disease is well-controlled.

  • Surgery: For ulcerative colitis, removing the entire large bowel can be curative. For Crohn’s disease, surgery can ease symptoms but is not a cure.

  • Nutritional Therapy and Diet:

    • Exclusive Enteral Nutrition (EEN): Important for active Crohn’s disease.
    • Balanced Diet: Most people with IBD can eat a normal diet, but some foods might trigger symptoms.
    • Nutritional Supplements: May be needed for vitamin and mineral deficiencies.

Lifestyle Recommendations:

  • Good nutrition and regular check-ups with a specialist are essential.
  • Consult with a dietician for personalized dietary advice.

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