What is Inflammatory bowel disease (IBD)?

Causes of Inflammatory bowel disease (IBD)

Inflammatory bowel disease (IBD) is a complex condition and several factors can contribute to the development of this disease. However, the exact cause of IBD is unknown. It is believed to be a combination of genetic predisposition, viral, environmental, nutritional, and immunological factors.

While diet has a big role to play in the development of IBD, one possible cause is an imbalance in gut microbiota or an abnormal immune response against bacteria, viruses, or food particles. This immune system malfunction can trigger an inflammatory reaction in the gut. Additionally, stress and psychological factors may exacerbate symptoms in some individuals, although they are not direct causes.

Types of inflammatory bowel disease (IBD)

Inflammatory bowel disease comprises two main types (or conditions): ulcerative colitis and Crohn’s disease. They are characterised by persistent gastrointestinal (GI) tract inflammation.

1. Ulcerative colitis

Ulcerative colitis primarily affects the large intestine (colon) and rectum, causing inflammation and ulcers in the innermost lining of the large intestine. The ulcers even tend to bleed and form pus. Other symptoms may include diarrhoea, rectal bleeding, abdominal pain, and urgency to defecate.

2. Crohn’s disease

Crohn’s disease can affect any part of the digestive tract, from the mouth to the anus. It can cause inflammation that may spread through the various layers of the GI tract’s walls. Symptoms vary widely and may include abdominal pain, diarrhoea, weight loss, fatigue, and fistulas.

Both conditions are chronic and characterised by periods of flare-ups, impacting the quality of life for those affected.

Risk factors of inflammatory bowel disease (IBD)

Inflammatory bowel disease (IBD) encompasses Crohn’s disease and ulcerative colitis, characterised by chronic inflammation of the gastrointestinal tract. Here are several risk factors that may contribute to its development:

1. Age

Age plays a role in increasing the risk of IBP, as it is common among young adults. However, IBD can occur at any age as well.

2. Family history

IBD can run in families. You would have a higher risk of developing IBD if someone in your blood relation has suffered from this disease.

3. Smoking

Smoking is another well-established risk factor, particularly for Crohn’s disease, as it not only increases the likelihood of developing the condition but also exacerbates its symptoms.

4. Auto-immunity

In IBD, the immune system mistakenly starts targeting its own cells in the gut, causing chronic inflammation in the gastrointestinal tract and other symptoms such as diarrhea and rectal bleeding.

6. Stress

Stress is not a direct contributor to the development of IBD. However, it has been seen that stress may exacerbate symptoms and trigger flare-ups in susceptible individuals.

7. Air pollution

Air pollution has emerged as a potential environmental risk factor for IBD. A study published by Nature Portfolio found that residential exposure to SO2 and NO2 may increase the risk of the early onset of ulcerative colitis and Crohn’s disease, respectively.

8. Medications

Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, can exacerbate or trigger inflammatory bowel disease symptoms in some individuals.

9. Lack of vitamin D

Vitamin D deficiency has been associated with an increased risk of IBD, although the exact mechanisms are not fully understood.

Differences between IBD and IBS

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two different gastrointestinal disorders. IBD, encompassing Crohn’s disease and ulcerative colitis, involves chronic inflammation of the digestive tract, leading to damage and complications such as ulcers and rectal bleeding.

On the other hand, IBS is a functional gastrointestinal disorder without visible damage to the digestive tract. Its symptoms include cramping, abdominal pain, bloating, and changes in bowel habits (diarrhoea or constipation). The treatment is also different. IBD treatment often involves anti-inflammatory medications or surgery, whereas IBS is managed through dietary changes and stress management.

Key Facts of Inflammatory bowel disease (IBD)

Major Symptoms	Persistent diarrhoea Abdominal pain and cramping Urgent bowel movements Unexplained weight loss Fatigue Bloody stools Mouth sores Perianal pain and drainage Other intestinal symptoms, such as joint pain or eye inflammation
Necessary Health Tests	Medical history Physical exam Blood tests (CBC, CRD and antibody tests) Stool tests Endoscopic procedures Imaging techniques (X-ray, CT scan and MRI) Biopsy
Treatment	Medications Biologic therapies Lifestyle changes Surgery

Symptoms of Inflammatory bowel disease (IBD)

IBD includes two conditions, Crohn’s disease, and ulcerative colitis, both of which cause inflammation of the gastrointestinal tract. The symptoms of IBD vary depending on the type of IBD, location, and severity of the inflammation. Here are some common signs of IBD:

1. Persistent diarrhoea

IBD often causes chronic diarrhoea, which can be watery or bloody. This frequent and urgent need to use the bathroom disrupts daily life and can lead to dehydration and nutrient loss.

2. Abdominal pain and cramping

People with IBD frequently experience severe abdominal pain or cramping. This pain can be localised to different areas of the abdomen depending on the type of IBD—often the lower abdomen in ulcerative colitis and various locations in Crohn’s disease.

3. Urgent bowel movements

IBD can cause a sudden and intense urge to defecate, sometimes accompanied by a feeling of incomplete evacuation. This urgency can significantly impact the quality of life.

4. Unexplained weight loss

Due to reduced appetite, malabsorption, and nutrient loss from diarrhoea, weight loss is a common symptom. This unintentional weight loss can be significant and affect overall health.

5. Fatigue

Chronic inflammation and frequent blood loss from the digestive tract can lead to anaemia, contributing to persistent fatigue and a general feeling of weakness.

6. Bloody stools

Especially in ulcerative colitis, blood in the stool is a frequent symptom. This can be alarming and indicates inflammation and ulceration of the colon’s lining.

7. Mouth sores

Crohn’s disease can cause sores in the mouth, increasing the discomfort caused by the disease.

8. Perianal pain and drainage

In Crohn’s disease, inflammation can affect the perianal area, leading to pain, swelling, and drainage from fistulas or abscesses.

9. Other intestinal symptoms

IBD can also manifest outside the digestive tract, known as extraintestinal manifestations (EIMs) of IBD. It can cause joint pain, eye inflammation, skin disorders, and liver problems.

When to see a doctor?

See a doctor if you experience a persistent diarrhoea, severe abdominal pain, blood in your stool, unexplained weight loss, or ongoing fatigue. Immediate medical attention is crucial to managing these symptoms, as they may indicate inflammatory bowel disease (IBD).

Diagnosis of Inflammatory bowel disease (IBD)

To confirm the diagnosis of inflammatory bowel disease (IBD), you will need multiple tests and procedures to go through. Here’s an overview of the diagnostic process:

1. Medical history

Physicians may ask about the family history of IBD or prior gastrointestinal issues in grandparents, parents, or any other person in blood relations. Apart from the family history of IBD, the doctor may also ask you if you smoke, are on any medication, have had any illnesses in the past, or have any infections.

2. Physical exam

A physical exam follows, where the doctor checks for abdominal tenderness, masses, and signs of complications such as anaemia or malnutrition. They might also examine the patient’s mouth for sores and the skin for any unusual rashes or inflammation, which can be associated with IBD.

3. Blood tests

Blood tests are essential in the diagnosis of IBD:

• Complete blood count (CBC): Identifies anemia or elevated white blood cells, indicating inflammation or infection.
• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): These tests measure inflammation in the body, which is common in active IBD.
• Antibody tests: Specific antibodies (like ASCA and pANCA) can help differentiate between Crohn’s disease and ulcerative colitis.

4. Stool tests

Stool tests check for blood, pathogens, and inflammatory markers like calprotectin or lactoferrin. These tests help rule out infections and confirm inflammation in the intestines.

5. Endoscopic procedures

• Endoscopy and colonoscopy: In these tests, a probe is inserted via the mouth (endoscopy) or the rectum (colonoscopy) to allow direct visualisation of the gastrointestinal tract. It can identify inflammation, ulcers, and strictures.
• Capsule endoscopy: It involves swallowing a small, camera-equipped capsule that takes images throughout the digestive tract, useful for visualising areas not easily reached by traditional endoscopy.

6. Imaging techniques

• Abdominal X-ray and ultrasound: These are initial imaging tests to detect complications like blockages or structural changes.
• Computed tomography (CT scan): It provides detailed cross-sectional images of the abdomen and pelvis, identifying inflammation, abscesses, and fistulas.
• Magnetic resonance imaging (MRI): It is especially useful for pelvic imaging and assessing perianal disease in Crohn’s disease.

7. Biopsy

During endoscopic procedures, small tissue samples (biopsies) are taken from the intestinal lining. These samples are analysed to confirm the presence of chronic inflammation, granulomas (in Crohn’s disease), or ulcerative colitis.

Treatment of Inflammatory bowel disease (IBD)

While there is no specific cure for inflammatory bowel disease (IBD), its treatment aims to reduce inflammation, manage symptoms, and achieve long-term relief. The approach typically involves medications, lifestyle changes, and sometimes surgery.

1. Medications

• Aminosalicylates: Used primarily in mild to moderate ulcerative colitis, these medications reduce inflammation in the intestinal lining.
• Corticosteroids: Effective for short-term control of moderate to severe flares, corticosteroids reduce inflammation but are not suitable for long-term use due to side effects.
• Immunomodulators: Drugs like azathioprine and methotrexate suppress the immune system to reduce inflammation and maintain remission.

2. Biologic therapies

Targeted therapies such as adalimumab, certolizumab, infliximab, natalizumab, golimumab, vedolizumab, and ustekinumab are used for moderate-to-severe IBD unresponsive to conventional treatments.

3. Lifestyle changes

Dietary adjustments, such as following specific carbohydrate diets, can alleviate symptoms. Stress management techniques, including exercise, meditation, and counseling, can also be beneficial.

4. Surgery

Surgery is often required when medications fail to control symptoms or complications arise. For Crohn’s disease, surgery may involve removing diseased sections of the intestine. In ulcerative colitis, a colectomy (removal of the colon) may be necessary and can be curative.

Combinations of these treatments help manage IBD effectively, enhancing quality of life.