Inflammatory bowel disease (IBD) is a collection of long-term conditions characterised by persistent inflammation in the intestine. Can cause severe abdominal discomfort and diarrhoea, but some treatments can help with the symptoms. 

General information

The digestive tract includes the mouth, throat, stomach, small and large intestine. It is responsible for digestion, absorbing nutrients, and eliminating waste products in the form of faecal matter. Inflammation of the digestive tract can have a significant impact on the entire digestion process. IBD can be painful and can significantly impact the quality of life.

Types of Inflammatory bowel disease

The two main types of IBD are Crohn's and ulcerative colitis. Both of them cause inflammation of the small and large bowel, with similar symptoms.

Crohn’s disease: It impacts an estimated 6 to 8 million individuals worldwide. Can affect any part of the gut.

Crohn’s disease symptoms can be different depending on which part of the gut is affected. Symptoms may manifest gradually or come on suddenly, and can vary in intensity from mild to severe. Right lower quadrant pain, weight loss and diarrhoea without blood are suggestive symptoms of Crohn’s disease. 

Ulcerative colitis: UC affects up to 1 in 250 people in North America and Europe. Only affects the colon and rectum.Ulcerative colitis typically manifests as bloody diarrhoea accompanied or not by mucus. Patients often report a feeling of incomplete evacuation and abdominal discomfort. During the physical examination, the doctor may observe left lower or left upper quadrant abdominal pain.⁵

Causes¹⁶

The exact cause is unknown and researchers are still figuring out why some people develop inflammatory bowel disease. They think that a combination of problems may lead to IBD.

It is important to note that causes are different among individuals.

Genetics can be a cause, as 1 in 4 people (25%) with inflammatory bowel disease have someone in the family who has IBD.

Immune system response leads to the manifestation of IBD symptoms. The immune system is responsible for protecting the body against infections. In people with IBD, the food is mistakenly identified as foreign invaders, therefore, the body releases antibodies (proteins) to fight with it. This response leads to IBD symptoms.

Also, there are environmental triggers that can play an important role in the development of IBD. Smoking, stress a challenging early life event, some medications, and depression can contribute to the onset of IBD. Researchers believe that there is a connection between the brain and gut and how they work together. Their interaction can affect our body and cause inflammatory bowel disease symptoms.

Symptoms depend on the type of IBD

• Abdominal discomfort (pain)- is the most common symptom
• Bowel urgency (diarrhoea)
• Bloating and gasLoss of appetite and unexplained weight loss
• Blood in stool

On rare occasions, IBD may also result in:

• Exhaustion
• Elevated body temperature
• Nausea and vomiting
• Visual defects

Complications of IBD

People with IBD are at an increased risk of developing colon (colorectal) cancer.

• Anal fistula: a pathway that develops under the skin, connecting an infected anal gland to the anus
• Anaemia: low levels of red blood cells. Red blood cells deliver oxygen to our body
• Kidney stones: accumulations of salts and minerals that develop within either one or both kidneys
• Malnutrition: condition of being unable to obtain sufficient nutrients through the small intestine
• Osteoporosis: is a medical condition which affects the skeletal system, causing bone demineralisation, making them fragile and susceptible to fractures
• Severe intestinal swelling
• Perforated bowel: a hole in the colon

Diagnosis

The doctors will assess the patient’s medical history, perform a physical exam and do some tests to rule out other potential causes that can affect their digestive system. Questions about diet, family history and daily routine are included in the assessment

A complete blood count test and stool laboratory test are performed in order to diagnose health conditions and provide information about the immune system. While these tests may not reveal the exact root cause of the inflammation, they can suggest the need of further additional tests to identify what is causing the inflammation.⁶

Other tests used are:

• Colonoscopy: is an examination of the large intestine, using an endoscope, a flexible tube with a camera on the end. The colonoscope is inserted into the body through the anus and rectum into the colon, providing images from the inside
• Ultrasound: is a non-invasive diagnostic imaging test that uses high-intensity sound waves to visualise internal organs or other soft tissues within the body
• Imaging scans such as CT scans and MRIs: provide realistic images of the internal organs

Treatment

The initial step in the management of IBD is to reduce inflammation through the administration of some specific inflammatory drugs and some lifestyle changes. Certain medications are used in the short term, while others are prescribed for long-term to prevent symptoms from coming back

Surgery is also used as a treatment for inflammatory bowel disease. It is used when medication is no longer effective in providing relief from symptoms. The surgery involves bowel resection.¹

How to keep a healthy digestive system and how to manage IBD? 

IBD will require ongoing management throughout a lifetime. These conditions cannot be reversed or cured, however, there are some ways to manage them and keep a healthy digestive system:

• Include fibre into your daily diet: can be found in grains, legumes, vegetables, fruits and seeds. There are two types of fibre: soluble which can be dissolved in water (examples are lentils, beans, peas, cooked oats, and peeled fruits), and insoluble fibre which does not dissolve in water (examples of insoluble fibre include fruit with seeds, whole nuts, whole grains, brown rice, quinoa, corn, green leafy vegetables). In some people, the insoluble fibre may aggravate inflammatory bowel disease symptoms by causing more pain, gas, diarrhoea and bloating⁹
• Consume water regularly
• Maintain a well-rounded and nutritious diet
• Exercise: studies showed that regular physical activity can play a protective role in the development of inflammatory bowel disease, and improve people’s quality of life. Have the power to decrease fatigue levels among people with IBD¹⁰
• Avoid alcohol and smoking
• Manage your stress level

It is very important to avoid the triggers that can cause flare-up symptoms.

Smoking is a significant environmental factor in the development of inflammatory bowel disease. Non-smoking and formerly smoking have been associated with an increased risk of Ulcerative colitis, while smoking has been shown to develop or worsen the progression of Crohn’s disease.¹¹

It is important to note that not all people who smoke will develop Crohn’s disease. The risk of developing Chron’s in smokers may be influenced by their ethnic background, however, the precise reason behind the development of Crohn’s remains incompletely understood. Smoking could affect Crohn’s by lowering the immune system, modifying the good bacteria from our gastrointestinal tract, and altering the functionality of our genes. Stopping smoking can be challenging, however, reducing smoking may help Crohn’s. Before undergoing surgery for Crohn’s disease, the surgery team will recommend to stop smoking.¹¹

Studies showed that smokers have a lower risk of developing ulcerative colitis than non-smokers. Some people have developed ulcerative colitis once they have given up smoking. However, smoking is not recommended as a treatment for ulcerative colitis.¹²

Summary

Inflammatory Bowel Disease is a collection of long-term disorders. People affected with these conditions require ongoing management throughout their lifetime with lifestyle modifications, medications, or surgery. The symptoms of IBD can come and go.

Smoking is one of the main contributing factors to Crohn's disease. Moreover, smoking can worsen pain and other symptoms associated with this condition.

In ulcerative colitis, smoking can affect people in different ways. It can lower the risk of hospitalisation, but in the case of Crohn's disease, it could have a negative impact, increasing the risk of needing surgery and recurrence after surgical resection.

It is extremely important to report any changes or new signs or symptoms within your digestive system.