What is inflammatory bowel disease?

Inflammatory Bowel Disease (IBD) is described as a persistent inflammation of the intestines which arises from interactions between the host and microbial agents in an individual with genetic susceptibility. IBDs represent a cluster of autoimmune conditions distinguished by inflammation affecting both the small and large intestines, where components of the gastrointestinal (GI) tract are targeted by the immune system of the body itself. 

These inflammatory disorders consist of two primary types, specifically identified as Crohn’s disease and ulcerative colitis. Individuals suffering from these conditions typically encounter abdominal manifestations, such as diarrhoea, abdominal discomfort, bloody faeces, and nausea.¹

Alcohol consumption & gut

Consumption of substantial amounts of alcohol can lead to disruptions in the intestinal absorption of various nutrients, including several vitamins. The interference with sodium and water absorption induced by alcohol plays a role in the inclination of alcoholics towards developing diarrhoea. 

The excessive intake of alcohol, even in a singular instance, may lead to erosions and bleeding in the duodenum, as well as mucosal damage in the upper jejunum. A higher prevalence of bacterial overgrowth in the small intestine among alcoholics might be a contributing factor to both functional and morphological irregularities in this intestinal segment, along with non-specific abdominal issues.²

Understanding inflammatory bowel disease

Types of IBD

Crohn's disease and ulcerative colitis represent the primary forms of inflammatory bowel disease (IBD), varieties include:

• Crohn's disease: induces discomfort and inflammation within the GI tract, with the potential to impact any region spanning from the oral cavity to the anal opening.  It manifests in the small intestine and the proximal segment of the large intestine.
• Ulcerative colitis: leads to inflammation and the formation of lesions (ulcers) in the expansive intestine, encompassing the colon and rectum. 
• Microscopic colitis triggers inflammation in the intestines, which is solely identifiable by a microscope.³

Symptoms and complications

IBD symptoms can be moderate or severe, appear suddenly, or develop gradually. IBD flares are periods of increased symptoms. When you have no symptoms, you are in remission.

IBD symptoms include:

• Abdominal discomfort
• Diarrhoea (often alternating with constipation) or an urgent need to poop (bowel urgency)
• Gas and bloating
• Unexplained weight loss or loss of appetite
• Mucus or blood in the stool
• Upset stomach

Rare symptoms ofBD can cause:

• Fatigue
• Fever
• Itchy, red, and painful eyes
• Joint discomfort
• Nausea and vomiting
• Skin rashes and ulcers
• Visual issues³

People with IBD are more likely to develop colon (colorectal) cancer. Other potential complications are:

• Anal fistula (a tunnel that forms beneath the skin, connecting an infected anal gland to the anus)
• Anal stenosis or stricture (a constriction of the anal canal where stool exits the body)
• Anaemia (low red blood cell count) or blood clots
• Kidney stones
• Liver Cirrhosis and primary sclerosing cholangitis
• Malabsorption and malnutrition (inability to obtain sufficient nutrients through the small intestine)
• Osteoporosis
• Perforated bowel (a hole or rip in the large intestine)
• Toxic megacolon (intestinal edema)³

Causes 

The specific cause of inflammatory bowel disease is uncertain. Previously, food and stress were associated, but doctors now understand that while these factors can aggravate IBD, they are not the cause. One probable explanation is an immune system malfunction. 

When your immune system tries to fight off an invading virus or bacteria, an unusual immune response causes it to attack digestive tract cells as well. Several gene mutations have been linked to IBD. IBD is more likely in persons who have family members who have the disease, which appears to be influenced by heredity. However, the majority of persons with IBD do not have this familial history.⁴

Risk factors 

• Age:  Most persons with IBD are diagnosed before the age of thirty. However, some people do not get the condition until their fifties or sixties.
• Race or ethnicity: IBD is more common in white people, however, it can affect any colour. Cases are also growing among other races and ethnicities.
• Family history: You are more likely to have the condition if you have a close relative who has it, such as a parent, sibling, or child.
• Cigarettes: Smoking is the most significant modifiable risk factor for developing Crohn's disease. Quitting smoking can enhance the overall health of your digestive system while   also providing numerous other health benefits.
• Nonsteroidal anti-inflammatory drugs: These include ibuprofen (Advil, Motrin IB, and others), naproxen sodium (Aleve), and diclofenac sodium, among others. These drugs may raise the chance of developing IBD or exacerbate existing IBD.⁴

Effects of alcohol on digestive health

Overview of the Digestive System

The (GI) tract's functions include absorbing nutrients, eliminating waste, and the breaking down of food. Saliva starts the chemical breakdown process as food is ground by teeth in the mouth. After passing down the oesophagus and into the stomach, food is further broken down by enzymes and gastric acid. Reflux can be caused by sphincter weakness in the stomach. 

Nutrients are broken down by digestive enzymes in the small intestine.  Villi improves absorption. After entering the large intestine, indigestible material is compressed before being expelled. The colon, the rectum, and the cecum make up the large intestine. All things considered, the GI tract helps with waste removal, absorption, and digestion.⁵

How alcohol affects digestion

When alcohol enters the body, it first travels through the GI tract's several sections. As a result, alcohol may affect both the GI tract segments' structure and function. Alcohol, for instance, can weaken the muscles that divide the stomach and oesophagus, which makes heartburn more likely to occur. Alcohol affects the secretion of gastric acid in the stomach. 

Alcohol consumption also raises the risk of oesophageal cancer by damaging the mucosal lining of the oesophagus.  Similarly, alcohol may affect the way that muscles in the small and large intestine move, which could be a factor in the diarrhoea that is commonly seen in alcoholics.⁵

Impact of alcohol on gut microbiota

Alcohol consumption has been shown to cause alterations in the composition of the gut microbiota and metabolic processes. These changes may be linked to the development of alcoholic liver disease (ALD) and other diseases by inducing oxidative stress and intestinal hyperpermeability to luminal bacterial products. 

Moreover, changes in the intestinal microbiota have been linked to alcohol-related disorders in preclinical and clinical settings. These changes may also be linked to increased inflammation in the GI tract, intestinal leakage leading to endotoxemia, systemic inflammation, tissue damage, and organ pathologies such as ALD.

For the purpose of preventing and treating alcohol-related diseases, gut-directed therapies such as probiotic and synbiotic modification of the intestinal microbiota should be taken into consideration.⁶

Alcohol’s role as a trigger for inflammation

Alcohol-related medical issues are frequently linked to chronic inflammation. Gut microflora-derived lipopolysaccharide (LPS) is the primary and most well-understood inducer of this type of inflammation. The amount of LPS that leaves the stomach can be greatly increased by alcohol. 

Multiple organs work together to counteract the harmful effects of low-level stress exposure to LPS in healthy persons. LPS detoxification and the production of a balanced cytokine milieu are largely dependent on the liver. The neuroimmunoendocrine functions of the central nervous system aid in the modulation of anti-inflammatory responses.

Overindulgence in alcohol causes chronic inflammation of the system, which damages organs and affects not only the liver and intestines but also the interactions between various organs.⁷

Research findings on the role of alcohol in IBD

Over a 10-year period, a large, retrospective, matched-cohort study involving over 250,000 persons from Taiwan revealed that hospitalised patients for alcohol intoxication had a higher risk of IBD than their respective controls. On the other hand, following four to ten years of follow-up, a multinational questionnaire-based European study with 262,451 participants discovered no correlation between alcohol intake and the onset of IBD.

Fascinatingly, a case-control study involving 354 Chinese individuals discovered that moderate alcohol use prevented the development of UC; however, multivariate examination of risk factors did not support this protective effect. 

In the end, a meta-analysis combining epidemiologic research on this topic revealed no correlation between alcohol intake and the chance of CD with a fresh onset. While alcohol may play a role in promoting intestinal inflammation, there is currently not enough data linking alcohol use to the emergence of new IBD cases.⁸

Strategies for moderating alcohol intake

• Set a limit on how much you will drink before you start
• Spend no more than a certain amount of money on alcohol
• You may receive support from friends and family if you inform them that you're cutting back and that it's important to you
• Drinks are still enjoyable but limit your intake. Instead of pints, try bottled beer or a modest glass of wine rather than a large one
• Reduce the alcohol content by substituting high-ABV wines or beers with lower-ABV options. This information is printed on the bottle
• Before consuming alcohol, have a glass of water, and switch between alcoholic and non-alcoholic beverages⁹
• Take a few days off from alcohol per week

Summary

Crohn's disease, ulcerative colitis, and microscopic colitis are all classified as IBD, which are characterised by a persistent inflammation of the intestines. From mild discomfort in the abdomen to serious consequences such as colon cancer, symptoms might vary. 

Hereditary factors and immune system dysfunction are implicated, while the precise mechanism of the disease is still unknown. Drinking alcohol might change the gut flora and worsen digestive problems, which may make IBD symptoms worse. Making educated choices about alcohol usage is essential for people with IBD. Alcohol may worsen symptoms and increase intestinal irritation, thus, moderation is essential. 

Alcohol consumption can be controlled by being aware of one's own tolerance levels, establishing boundaries, and asking friends and family for help. A person with IBD can live a better quality of life and manage their symptoms more effectively if they are aware of how alcohol affects their digestion and general health.

FAQs

1. Does alcohol make inflammatory bowel disease worse?
2. How to calm down inflamed bowels?
3. What is the life expectancy of someone with IBD?
4. Is it okay to drink alcohol with Crohn's disease?