Inflammatory bowel disease: a guide

Inflammatory bowel disease (IBD) is an “umbrella term” that comprises a group of chronic conditions which cause inflammation in the digestive tract, and sometimes in other tissues. The two main forms of IBD are Crohn’s disease and ulcerative colitis. These conditions lead to a variety of gastrointestinal symptoms, which differ in severity and presentation between individuals.
 

If you or a loved one has recently been diagnosed with IBD, it can be daunting to understand the condition and its implications. A renowned gastroenterologist, Dr James Lee, helps to clarify some aspects of IBD, how it affects the body, and what options are available for managing symptoms.

 

 

How does IBD affect the body?

The digestive tract is responsible for breaking down food and absorbing essential nutrients. In IBD, the immune system mistakenly targets healthy tissue in the digestive tract, causing inflammation, ulceration, and damage. This can prevent the intestine from performing its normal functions. 

The two primary types of IBD affect different areas of the digestive system. Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the anus, but most often involves the last part of the small intestine (‘ileum’) and/or the large intestine (‘colon’). Ulcerative colitis, however, is limited to the colon and almost always begins in the rectum. The amount of the colon that is affected differs between patients.

 

What are the common symptoms of IBD?

IBD symptoms vary depending on the individual and the severity of inflammation. Some common symptoms may include:

• Abdominal pain
• Frequent diarrhoea (sometimes with blood)
• Fatigue
• Unintended weight loss

Flare-ups, when symptoms intensify, may alternate with periods of remission when symptoms subside. Fatigue, often caused by chronic inflammation and immune activity, can significantly affect daily life. Some individuals may also experience symptoms outside the gut, such as joint pain, skin rashes, or eye inflammation.

 

Why does IBD develop?

In most people, there is not a single cause of IBD. It is generally thought that an environmental trigger sets the disease off in people who also have some degree of genetic predisposition. This results in the immune system getting its wires crossed and attacking the intestines causing damage. The environmental triggers are poorly understood and are likely to be different for different people. While diet and stress do not directly cause IBD, they can aggravate symptoms.

 

How is IBD diagnosed?

Diagnosing IBD typically involves a thorough medical history, physical examination, and additional tests. Blood tests can reveal signs of inflammation or anaemia, while stool tests rule out infections and confirm that the inflammation is coming from the digestive tract. Imaging studies, such as MRI or CT scans, and endoscopic procedures, like colonoscopy, allow doctors to visualise the digestive tract and identify abnormalities. Tissue biopsies are often used to confirm the diagnosis and distinguish between Crohn’s disease and ulcerative colitis.

 

What treatment options are available?

Although there is no cure for IBD, treatment focuses on controlling inflammation to prevent disease complications and resolve symptoms. This often involves:

• Medications: Anti-inflammatory drugs, immune modulators, and biologic therapies (e.g., anti-TNF agents) are commonly prescribed.
• Lifestyle adjustments: Lifestyle changes (e.g. diet, smoking) and stress management can help ease symptoms.
• Surgery: In severe cases, surgery may be necessary to remove damaged sections of the bowel or address complications.

 

Living with IBD

Managing IBD can be challenging, but with personalised care, a multidisciplinary team, and advances in treatment, many patients achieve improved symptom control and quality of life. Ongoing research, such as that performed by Dr Lee, continues to provide hope for better therapies and outcomes