What is Inflammatory Bowel Disease (IBD)?
There are two main types of IBD:
- Ulcerative Colitis (UC). In ulcerative colitis there is inflammation and ulceration along the inside lining of the large intestine (colon or bowel) including the rectum (the last part of the bowel), and
- Crohn’s Disease (CD). In Crohn’s disease there can be inflammation of the lining anywhere along the intestine – small or large. It can also involve the deeper layers of the digestive tract.
How Common is Inflammatory Bowel Disease (IBD)?
According to the BPAC, over 20,000 New Zealanders are affected by IBD – our rates are amongst the highest in the world and are increasing due to a range of reasons.
It usually starts between ages 15 and 40, but it can begin at any age. About 20 – 25 young people are diagnosed with it each year.
What Causes Inflammatory Bowel Disease?
The exact cause of these chronic conditions is unknown. For many years it was believed that they were autoimmune conditions – where the body attacks it’s own cells. But so far, this has not been proven (no antibody has ever been identified).
Sometimes a viral infection or a stomach bug (gastroenteritis) can trigger it, suggesting an alteration of the gut microbiome might have an important role.
People with IBD may have a certain genetic make-up that makes them more susceptible to these diseases, but some people with the same genetic profile never go on to develop it. One theory is that there is an interaction between specific gut bacteria and these genes, which disrupts the immune system.
Excessive use of hygiene practices during early life are thought to be a significant contributor to the risk of developing IBD and other immune-mediated conditions (the “hygiene hypothesis”). What this means is that if children are not exposed to a wide range of microorganisms, parasites and allergens when young, they may be at risk of inadequate immune development instead of the expected immune tolerance.
What are the Symptoms of Inflammatory Bowel Disease ?
Pain in the abdomen (stomach or tummy) is often what people notice, which may be caused by other problems as well (such as constipation). But diarrhoea, blood in the stool (poo), passing mucous, and urgency to have a bowel motion are indications that all is not well.
While an acute infection (such as a tummy bug) can cause these symptoms, they would normally resolve within a short period of time.
If IBD is the cause, these problems are persistent, and may be associated with losing weight, loss of appetite or nausea, and fatigue (being overly tired), low iron levels or even anaemia.
In some cases a sore bottom, sore joints, mouth ulcers and skin problems (such as rashes) can also happen when a person has one of these chronic digestive diseases.
How is Inflammatory Bowel Disease Diagnosed?
After taking a history, your doctor will examine you and order some tests. A sample of your faeces (poo) is tested to see if there are markers of inflammation (calprotectin), or blood. By testing a sample of your blood, markers for anaemia, some vitamins, and iron can help understand the problem.
Further tests may include special imaging xrays, and endoscopy (looking inside). There are two types of endoscopy: gastroscopy, which is done from the mouth end of the intestines to look at the stomach, and a colonoscopy, done from the bottom up (literally).
In both cases a flexible tube with a camera on the end is used to take pictures and to check for inflammation. Samples are taken by biopsy for examining under the microscope to help confirm the diagnosis in the laboratory.
How is Inflammatory Bowel Disease Treated?
Medical management of IBD usually involves taking anti-inflammatory medications, and often some that suppress the immune response. In severe cases, a liquid diet (containing food that does not need to be digested) can help to rest the intestines to help them heal.
Some of the commonly used medications have side effects with long-term use, such as sun sensitivity, increased risk of infection, impaired liver function, and others. If on these medications, regular blood tests are important to monitor these side effects.
In severe cases, if medicines are unsuccessful at controlling the disease, a badly affected section of the intestines may be removed surgically. Sometimes it is necessary to remove the whole large intestine. In this case a colostomy is created. This is where the end of the bowel is brought to the surface on the abdomen (tummy), and the stool empties into a bag that is stuck onto the skin.
What Other Treatment Options are there for Inflammatory Bowel Disease?
IBD is associated with a number of nutrient deficiencies, with iron and vitamin D deficiency being the most common. Other deficiencies – such as vitamin B12, folate, vitamin K or calcium – are also frequent.
The consequences of these impairments include specific deficiency syndromes and poor bone health, with growing pains, osteopaenia and osteoporosis. Because of the significance of these nutritional complications it is very important to focus on ensuring adequate nutrition to maximise growth potential and avoid long-term complications.
- Inflammatory bowel disease – a focus on Crohn’s disease and ulcerative colitits. BPAC NZ (2021)
- Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology 2017;152:313-321.e2.
- The microbiome and inflammatory bowel disease. J Allergy Clin Immunol . 2020 Jan;145(1):16-27
- Treating IBD by rebalancing the gut microbiome. IBDVisible, 2021;Aug 9
- Diet, Nutrition and Inflammatory Bowel Disease. Crohns-Colitis Foundation (2013)
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Updated 19 May 2022, by Sharon Erdrich