What is Inflammatory Bowel Disease?
Inflammatory bowel disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract. There are two main forms of IBD: Ulcerative colitis (UC) and Crohn’s disease (CD).
The exact cause of IBD remains unknown. However, genetics and immune system malfunction have been associated with IBD. When your immune system tries to fight off an invading bacteria or virus, an abnormal immune response causes the immune system to attack the cells in your own digestive tract, too.
Ulcerative colitis is an IBD that causes long-lasting inflammation and ulcers in the innermost lining of the large intestine (colon) and rectum.
Crohn’s can affect any part of the gut – from the mouth to the anus, though the most common area affected is the end of the ileum (the last part of the small intestine), or the colon. The areas of inflammation are often patchy with sections of normal gut in between, and it often spreads deep into affected tissues. Complications in the gut may include strictures, bowel obstruction, perforations and fistulas.
Who gets it?
IBD usually starts before the age of 40. It affects men and women equally. People with a family history of IBD are at least 10 times more likely to develop the condition than those with no history. Caucasians and people of Jewish descent have a higher risk. Certain medications, especially NSAIDs (non steroidal anti inflammatory drugs – often used as pain killers) may increase the risk of developing IBD or worsen disease in people who have IBD. Smoking is one of the main risk factors for developing Crohn’s disease. People who live in urban areas and industrialized countries have a higher risk of getting IBD, in which the high fat diet or refined foods, may play a role here. Nowadays, we are starting to see increasing number of new cases of IBD in Asia. The incidence and prevalence rates of IBD are reported as low in Malaysia but the incidence appears to be increasing with marked racial differences (Ida Hilmi et al. 2015).
How does IBD present?
Symptoms of IBD vary depending on the location and severity of inflammation. Its symptoms will vary from person to person. They range from mild to severe and may also change over time. In general, both usually present with chronic diarrhea, tummy pain, easy tiredness and weight loss.
IBD is a chronic illness. It is ongoing and life-long, although you may have periods of good health (remission), as well as times when symptoms are more active (relapses or flare-ups).
How is IBD diagnosed?
To diagnose IBD, the doctor needs to gather information about your family’s medical history and your bowel habits, together with a thorough physical exam, followed by investigation especially colonoscopy. Colonoscopy is an investigation that allows the doctor to look at the inner lining of the large intestine. It helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding. Few small samples of the bowel wall are often to be taken for microscopic examination (biopsy). Sometimes, radiological studies such as barium study or CT scan is required for further assessment.
Is IBD = IBS?
IBD is sometimes confused with IBS, which stands for irritable bowel syndrome. As a gastroenterologist, we always emphasize that IBD is not IBS. IBS is a set of symptoms resulting from abnormal function of the small and large bowel. IBS is characterized by crampy tummy pain, diarrhea, with/without constipation, but is not accompanied by fever, bleeding or an elevated white blood cell count. Examination by colonoscopy or barium study reveals no abnormal findings.
Is there a link between IBD and bowel cancer?
It’s important to stress that IBD is not a form of cancer. However, if one has had extensive or total colitis (inflammation of the large intestine) for many years, he or she has a greater risk than normal of developing bowel cancer. Patients with IBD are often unaware that they have bowel cancer as the initial symptoms are similar to IBD, such as passing bloody motion, diarrhoea and abdominal pain. Because of this, you will probably be advised to have a colonoscopy every few years as surveillance.
How to fight IBD?
IBD can often be managed by drug treatment, but surgery can be necessary if symptoms are very bad, or there are complications. Nowadays, gastroenterologists use one of two approaches to treatment: “step-up,” which starts with milder drugs first (anti-inflammatory drugs as the first line of treatment in UC), versus “top-down,” which gives patients stronger drugs earlier in the treatment process (tumor necrosis factor (TNF)-alpha inhibitors, or “biologics” for CD).
Surgery can often eliminate UC, but that usually means removing the entire colon and rectum. While in CD, up to one-half of the patients will require at least one surgery. However, surgery does not cure CD.
You may find during flare-ups that certain foods affect your symptoms, such as raw vegetables, high-fibre foods, spicy foods, beans, dairy products, alcohol and caffeine. You should eat a nutritious and balanced diet to maintain your weight and strength. You may need to take a calcium supplement with added vitamin D as IBD is associated with osteoporosis, especially if you are treated with steroid.
Living with IBD can have both an emotional and practical impact on your life. Flare-ups can be disruptive to relationships and work. Learning stress management techniques may help you handle the illness better.
Can patients with IBD have children?
If the IBD is well controlled, most women with IBD can expect to have a normal pregnancy and a healthy baby. Also, for most women, having a baby does not make their IBD worse.
If you have active IBD, especially CD, you may have a slightly lower chance of conceiving. Most of the drugs prescribed for IBD do not affect fertility, except sulphasalazine, a 5-ASA medication, which is known to reduce fertility in men.
IBD may be a lifelong condition, but there are ways to keep it in check. Through medications, lifestyle changes, and stress management, many patients with IBD can still enjoy their life. IBD is largely a hidden disease, and one that causes stigma, fear and isolation – it’s thought that a lot of people with the presentation go undiagnosed and suffer in silence. The awareness among general public, or health care professional should be raised.
Dr Chieng is a medical lecturer and Consultant Gastroenterologist & Hepatologist at the Medical Department of Universiti Putra Malaysia.
References
Hilmi I, Jaya F, Chua A, Heng WC, Singh H, Goh KL. A first study on the incidence and prevalence of IBD in Malaysia–results from the Kinta Valley IBD Epidemiology Study. J Crohns Colitis. 2015 May;9(5):404-9.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]