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Inflammatory Bowel Disease (IBD)

By Apollo 24|7, Published on- 19 December 2022 & Updated on -

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  • Symptoms: Diarrhoea, abdominal cramping and pain, fatigue, reduced appetite, blood in stool, sudden weight loss, lack of appetite
  • Causes: No exact causes are known, but poor diet, extreme stress, immune system malfunction, and previous family history can play a role
  • Risk factors: Age above 30, people belonging to the white race, prior family history, smoking cigarettes, consumption of nonsteroidal anti-inflammatory medicines
  • Severity: Mild to severe but not fatal
  • Which doctor to consult: Gastroenterologist

Overview

Inflammatory bowel disease, or IBD, causes inflammation of the digestive tract tissues.

There are two different kinds of IBD:

  • Crohn's Disease: When the inner lining of the digestive tract suffers inflammation, it's called Crohn's disease, another form of IBD. It not only impacts the small intestine but also the upper gastrointestinal tract and large intestine.
  • Ulcerative Colitis: This form of IBD involves sores and inflammation on the inside lining of the rectum and colon.

Both Crohn's disease or ulcerative colitis may cause rectal bleeding, diarrhoea, weight loss, abdominal pain, and fatigue. Generally, it is a mild disease, but some people may experience certain life-threatening complications.

When to Consult a Doctor?

If an individual witnesses constant changes in bowel movements or any early warning symptoms and signs of inflammatory bowel disease (IBD), it's time to see a doctor. Although this disease is not life-threatening, it can still lead to fatal complications if not treated promptly!

Diagnosis

When a patient consults a gastroenterologist for IBD, the doctor will likely run some procedures and tests to confirm the diagnosis.

  • Lab Tests: The doctor may primarily order the following two lab tests:

1. Stool Tests: The healthcare provider will check the stool sample for parasites in this test.
2.Infection or Anaemia Test: The doctor may recommend a blood test to confirm whether the patient is suffering from anaemia or to determine any other signs of infection from viruses or bacteria. 

  • Imaging Procedure: In moderate to severe cases of IBD, the doctor may order the following imaging tests for better visuals and clarity:

1. Magnetic Resonance Imaging (MRI): This test uses radio waves and magnetic fields to get a detailed image of tissues and organs. This is especially helpful in evaluating the small intestine or anal area to determine any fistula development.

2. Computerized Tomography (CT) Scan: This special x-ray scan offers more insight than a standard x-ray test. Sometimes a special CT scan, also known as CT enterography, can be done for a more precise visual.

3. X-ray: In severe cases of IBD, the healthcare provider may run a standard x-ray to rule out any complications that may arise in the abdominal area. This can help identify a perforated colon or megacolon.

  • Advanced Tests: If both the lab and imaging tests seem inconclusive, the doctor may suggest some advanced tests like:

1. Colonoscopy: In this procedure, the healthcare provider inserts a flexible thin tube with a camera attached at one end into the rectum. This offers a complete visual of the colon. A tiny tissue sample is extracted for laboratory analysis to determine whether its general inflammation or IBD.

2. Upper Endoscopy: This procedure is like colonoscopy, except the tube is inserted to study the stomach, oesophagus and duodenum (part of a small intestine). It's usually recommended if a patient suffers from upper abdominal pain, vomiting, nausea and eating troubles.

3. Flexible Sigmoidoscopy: Similar to both colonoscopy and upper endoscopy, this one examines the sigmoid and rectum, which are the end portions of the colon. If a colon suffers from severe inflammation, this test will be more effective than a colonoscopy.

4. Capsule Endoscopy: This test helps detect Crohn's disease. The provider will administer a pill containing a tiny camera which captures the images. This method is not recommended if the patient has any possible bowel obstruction.

5. Balloon-Assisted Enteroscopy: This test utilizes a scope and an overtube. It helps the technician to look deeper into the small bowel where normal endoscopes cannot reach. This technique confirms the diagnosis of abnormalities found during capsule endoscopy.

Treatment

IBD is not fatal and can be fixed with proper treatment. The following treatment methods can be employed:

Home Care: With the right shift in lifestyle and the usage of some home remedies, the symptoms of IBD can be eased, and the inflammatory flare-ups can be managed easily.

These remedies include fixing the diet by limiting dairy products, consuming small portions while eating, drinking plenty of water, taking the correct mineral supplement and multivitamin, and talking to a dietitian. Besides that, a patient should also avoid smoking and regulate stress levels via exercise, breathing techniques and biofeedback. 

  • Medication: Certain anti-inflammatory drugs, immunosuppressants, antibiotics, and supplements can help manage IBD. A doctor may recommend the following:

1. Aminosalicylates like olsalazine, balsalazide, and mesalamine
2. Time-limited corticosteroids
3. Azathioprine, methotrexate, mercaptopurine
4. Cipro and flagyl
5. Anti-diarrhoeal medications
6. Pain relievers such as tylenol or acetaminophen
7. Vitamin supplements

Surgical Treatment: If drug therapy and lifestyle changes do not positively impact the IBD symptoms and signs, the doctor may suggest surgical procedures. These include:

1. Surgery for Crohn's disease: The doctor will carve out a portion of the damaged digestive tract and combine two healthy sections. It can help close drain abscesses and fistulas. The surgical relief is only temporary since the disease is recurring.

2. Surgery for ulcerative colitis: The entire rectum colon will be removed in this surgical procedure. A small internal pouch will be connected to the anus to help bowel movement. Alternatively, the doctors will create a permanent opening in the abdomen for the stool to pass.

  • Alternative Management: Alternative medicines such as adding more probiotics might help when patients with aggressive digestive disorders cannot find relief anywhere.

Risks and Complications if Left Untreated

If left untreated, inflammatory bowel disease, Crohn's disease and ulcerative colitis may lead to severe complications such as:

  • Skin, joint and eye inflammation: IBD can cause a flare leading to eye inflammation, skin lesions, and arthritis.
  • Blood clots: The risk of blood clots in the arteries and veins increases due to IBD.
  • Primary sclerosing cholangitis: This is a rare condition where the IBD inflammation leads to scarring in the bile ducts. This eventually restricts the bile flow and narrows the bile ducts, leading to liver damage.
  • Medication side effects: Certain IBD medications risk side effects like infections or the development of specific types of cancer. A patient can also suffer from hypertension or osteoporosis.
  • Severe dehydration: IBD can cause severe diarrhoea, sap energy levels and leave a patient dehydrated. 
  • Colon cancer: In extreme cases, IBD, Crohn's disease and ulcerative colitis can lead to colon cancer. Getting oneself regularly screened after the first IBD diagnosis is essential.
  • Anal fissure: The skin around the anus or the surrounding tissues may get a small tear which can cause infections. Eventually, it can lead to aching bowel movements and perianal fistula.
  • Bowel obstruction: Crohn's disease causes the bowel walls to become narrow and thick, which might block the movement of digestive materials. A surgical procedure might be required to extract this diseased bowel portion.
  • Fistulas: If the inflammation surpasses the intestinal wall, it can create fistula formations. It can either happen around the anus area or the walls surrounding the abdomen. This fistula might get infected and lead to abscess or pus. 
  • Toxic megacolon: The colon may widen and swell rapidly due to ulcerative colitis. This is known as toxic megacolon.

Additional information

What is the significant difference between inflammatory bowel disease (IBD) and inflammatory bowel syndrome (IBS)?

IBD is an umbrella term for bowel diseases that cause irritation and swelling in the digestive tract. These mainly include two diseases called ulcerative colitis and Crohn's disease.

On the other hand, IBS is a medical condition wherein the digestive contents either move too slowly or too fast inside the intestines. This is usually followed up by abdominal pain.

The former is a structural disease, which means that physical damage inside the body gives rise to symptoms. The latter is more of a functional illness, so any tests or procedures will not indicate a physical reason to justify the symptoms. 
 

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Frequently Asked Questions

No, there is no known cure for IBD which can completely fix the disease. Remission periods will often come when the condition is inactive and proper medications can increase the length and number of such remissions while also reducing inflammation. The patient will be needed to manage the symptoms of the disease through lifestyle changes and medicines because there's no exact cure for this.

With time, the patient may identify certain food items triggering the flare-ups caused by IBD, ulcerative colitis or Crohn's. If not, a patient must still steer clear of the following foods and beverages: Fried, greasy, and fatty foods Spicy and hot food items High-fibre fruits ad raw vegetables Sugary or caffeinated beverages Beans, seeds, and nuts Alcoholic drinks

Many clinical trials and experimental procedures have indicated that stress might cause the development or relapse of inflammatory bowel disease.