Most people have experienced problems with their bowels at some point in their lives. The most common issues that people face are usually diarrhoea or constipation. And whilst they can be distressing, there are many lifestyle changes and medications available to treat them. 

There are some bowel disorders that are more complicated and can last for a very long time. An example of one such disease is inflammatory bowel disease (IBD). IBD consists of two main types: Crohn's disease and ulcerative colitis.

At times, interferon therapy can be useful in the treatment of IBD. Interferons are proteins that are a part of your immune system. They help to trigger an immune response in your body. Interferons are often used as a treatment for various disorders. There are even some artificial versions that can be used to treat various cancers. 

Understanding inflammatory bowel disease 

IBD consists of two main types: Crohn's disease (CD) and ulcerative colitis (UC). It forms in people who are genetically susceptible to it.  There is no exact known cause and it can run in families. IBD causes long-term inflammation of the tissues of the bowel. This is triggered by an immune response to a normal stimulus which normally would not trigger such a response.¹ The trigger can be normal everyday food or any intestinal bacteria. IBD is relapsing and remitting which means that its symptoms can come and go. Usually, the intestinal lining, which is known as the mucosa, also acts as a protective barrier. It prevents bacteria and viruses from entering the intestines. In IBD, this barrier is damaged which can cause further inflammation and damage to the lining of the intestines. This allows organisms to invade the intestines.

In ulcerative colitis (UC), there is inflammation of the mucosa of the gut. It starts at the lower end of the gut, near the rectum. This inflammation then often progresses steadily upwards, in an uninterrupted fashion towards the colon. But sometimes, it remains confined to the rectum area. 

In contrast, Crohn's disease (CD) can begin from anywhere in the gut and there are alternating areas of normal and inflamed gut wall. CD normally affects the colon and a part of the small intestine which is known as the ileum. Additionally, it involves all layers of the gut, not just the mucosa. Strictures and fistulas are also more common in CD than in UC.

Symptoms of IBD

Both UC and CD exhibit similar symptoms which include:² 

• Abdominal pain 
• Diarrhoea (sometimes there may even be blood)
• Bleeding from the rectum
• Faecal incontinence (this means you might have faecal leakage or not be able to reach the toilet in time)
• Faecal urgency (a sudden need to evacuate your bowels)
• Fever 
• Weight loss
• Anaemia 
• Malnutrition and poor growth in children 

At times, some symptoms of inflammation can occur in areas outside the gut. Affected areas can include the eyes, mouth, liver, skin or kidneys. This inflammation can cause symptoms specific to the organ that it affects. 

Role of interferon therapy in IBD

Interferon therapy in IBD

Interferons are proteins which are made by the white blood cells in our body's defence system (immune system). These proteins help to protect our bodies from various diseases and infections. Interferons can act as an “alarm” for the body whenever there is an invading bacteria or virus. They can then stimulate the immune system to attack the invading organism. 

Interferons are also used in cancer treatments because they can help to attack and destroy cancer cells. There are three main types of interferons; alpha interferon, beta interferon and gamma interferon. Some interferons are also manufactured, meaning they have been artificially created in a laboratory. 

Due to their ability to evoke an immune response and modulate inflammation, interferons were assessed as a potential treatment for IBD. While some studies showed interferon therapy to have a significant positive effect on patients with IBD, other studies did not.³ Therefore, it is difficult to predict if interferon therapy has potential as a future treatment option for IBD.

Conventional treatments for IBD

Treatment for IBD depends largely on the severity of the disease and the extent to which it has spread. Some of the more conventional methods  used to treat this condition are listed below:⁴

• Anti-inflammatory agents such as aminosalicylates are often used for mild IBD
• Corticosteroids can also be administered for short periods of time. This is done to induce remission of the disorder. Corticosteroids have the double benefit of being anti-inflammatory as well as immunosuppressing. This can greatly assist in making IBD go into remission
• Drugs that suppress the immune system can also be used to treat IBD. Examples are  azathioprine and mercaptopurine 
• A new class of drugs known as biologics are also now being used to treat IBD. Biologics can neutralise the proteins in the body that are causing the inflammation. These drugs are taken as self-administered injections.
• Other medications can be used to treat the general symptoms of IBD.  These include antibiotics for any infections, pain relievers or anti-diarrheal medication. Nutritional support via supplements are also encouraged. This is to make up for any vitamins or minerals that are not being absorbed due to the inflammation of the gut. 

For extreme and severe cases of IBD, surgery might be needed. During the surgery, your surgeon will remove any damaged part of your gut and reconnect the healthy ends of your gut to each other. At times, your gut might need to be connected to your abdominal wall through a stoma (small hole) with a colostomy bag attached to it. 

Safety and adverse effects of interferon therapy

As with any therapy, there are some side effects to be expected with interferon therapy in general. However, many of the side effects are mild and short-lived. Some general side effects you may experience are:⁵ 

• Some soreness or redness at the injection site 
• Flu-like symptoms which might include a mild fever, chills and muscle aches. These symptoms usually occur a few hours after the injection is administered and last less than a day.q
• Fatigue is also a common side effect of interferon therapy. Therefore, it is recommended that you avoid strenuous activity after a dose of interferon therapy
• Some intestinal symptoms such as nausea, vomiting or diarrhoea might also occur. These can be treated with the use of anti-nausea and antidiarrheal medication. 

These symptoms are mild and are not expected to last very long. However, if you are worried, you can discuss them with your healthcare provider. 

Rarely, some serious side effects may occur such as:⁵ 

• Heart problems 
• Reduced number of blood cells
• Depression 
• An overactive or underactive thyroid 

It is important to seek urgent medical help if you begin to experience any of these symptoms. Furthermore, you might have to discontinue interferon therapy. 

Patient selection and monitoring 

Keeping in mind the side effects and risks which are present with the use of interferon therapy, patients need to be carefully selected for this type of therapy. Moreover, continuous monitoring might be needed. Before starting interferon therapy, your doctor will conduct a series of blood tests to assess your kidney and liver functions. These blood tests will be conducted at regular intervals to ensure the patient’s wellbeing. In addition to repeated blood tests, you should also keep an eye on any new symptoms you may develop. If any new symptoms occur, please report them to your healthcare provider immediately. 

Interferon therapy is not suitable for some people, such as:⁵

• People with pre-existing kidney or liver diseases 
• People with a previous history of autoimmune disease
• People with a previous history of immunosuppressive treatments 
• People with a previous history of organ transplantation
• People with uncontrolled thyroid disorder
• People with  severe psychological disorders

Summary 

Problems with the bowel are quite common and most people will experience them at some point in their lives. They can be simple conditions such as diarrhoea and constipation. On occasion, they can be more long-term and complicated conditions such as inflammatory bowel disease (IBD). 

IBD is a chronic, inflammatory condition which consists of ulcerative colitis (UC) and Crohn’s disease (CD). They both exhibit similar symptoms. These can consist of abdominal pain, diarrhoea, bleeding from the rectum, fever, anaemia and weight loss. However, there are some differences between these two conditions which are explained in this article. 

Our immune system is responsible for protecting us against invading organisms. Interferons are proteins which are a part of our immune system. They are released in response to a virus or bacteria and trigger an appropriate immune response. In addition, interferons also possess anti-inflammatory properties which makes them ideal in the treatment of IBD. 

There are some minor side effects which you should expect after taking interferons. These minor side effects include mild flu-like symptoms, body pains and pain at the injection site. These symptoms are expected to go away eventually. On rare occasions, more serious side effects can occur. These include depression and heart problems. There are some people who cannot take interferons safely. You will be assessed closely by your healthcare provider to determine if this is the right treatment for you. 

Interferons have exhibited mixed results when used on patients with IBD in clinical trials.