Inflammatory bowel diseases: what to know
Inflammatory bowel diseases (IBDs) affect the gastrointestinal (GI) tract, causing symptoms such as chronic inflammation and abnormal bowel movements. In this article, a consultant gastroenterologist, Dr Bel Kok, explains the symptoms of IBDs, how they are diagnosed, and the treatment options for patients.
What are inflammatory bowel diseases?
IBDs are chronic conditions, which means they cannot be cured, although there are methods to manage the symptoms. Symptoms typically aren’t constant, but come and go in waves, known as ‘flare-ups’. IBDs can develop at any age, but they commonly manifest at a young age, and most diagnoses occur in patients ranging from 15 to 30 years.
There are two main types of IBDs:
- Crohn’s disease can affect any part of the GI tract but is most common at the end of the small intestine and the start of the colon (large intestine).
- Ulcerative colitis is similar to Crohn’s disease but tends to be milder and only affects the colon.
Though both conditions are distinct, they have some shared symptoms, such as abdominal pain, diarrhoea that can have blood or pus), weight loss, fatigue, rectal bleeding, fever, weight loss and smaller appetites, and ulcers. There is no known singular cause for either condition, but it is thought that they occur due to a combination of genetics, autoimmune dysfunction, and gut bacteria imbalances.
How are IBDs diagnosed?
Diagnosis is important to determine which type of IBD is affecting the patient. Typical tests and scans used in the diagnostic process include X-rays, CT scans, and ultrasounds to find the exact location and the extent of damage from the inflammation and rule out other types of GI issues. However, for further analysis and for extracting tissue samples, then an endoscopic procedure will likely be performed, such as a sigmoidoscopy to look at the end of the bowel, a colonoscopy to look at the entire bowel, or a capsule endoscopy to look at the small intestine.
How are IBDs treated?
Treatment for both types of IBD focuses on managing symptoms to alleviate pain and discomfort for the patient. With success, flare-ups can become very mild and infrequent, in what is called ‘remission’ – it is more common for ulcerative colitis patients, however.
There are medicinal and surgical approaches to treating an IBD. Medications include anti-inflammatories like steroids and amino-salicylates, or immunosuppressants to stifle the immune system’s inflammatory mechanisms if it is thought that an autoimmune response is contributing to the IBD.
Surgical treatment methods are typically considered if medicinal approaches have not been effective or if the patients are suffering severely from their IBD, typically for patients of Crohn’s disease. Procedures include small bowel resection, where portions that are affected by the disease, typically for patients of Crohn’s, are removed and the ends of healthy tissue are rejoined. If there is not enough tissue to reconnect, then the patient will undergo an ileostomy which will replace the colon, sending waste directly to a pouch called a stoma bag that is connected to a hole that is made through the abdomen
Patients will be encouraged to make lifestyle changes to better accommodate their condition and prevent flare-ups. This will include stress management, regular physical activity, improving their diet to avoid inflammatory foods, and to quit smoking.