Inflammatory bowel disease (IBD) is a term used to describe two main diseases: ulcerative colitis and Crohn’s disease, which cause inflammation of the bowel. This inflammation is thought to be due to an imbalance of the immune system, and is not due to an infection.
Ulcerative colitis causes inflammation of only the inner lining of the colon (large bowel), and rectum. When only the rectum is involved it is sometimes called ulcerative proctitis or just proctitis. When the entire colon is involved it is sometimes called pan-colitis.
Crohn’s disease causes inflammation of the full thickness of the bowel wall and may involve any part of the digestive tract from the mouth to the anus. Most often the ileum, which is the last part of the small bowel, or the colon, or both are involved. These patterns of disease location are referred to as ileitis, colitis and ileo-colitis respectively.
Sometimes people get confused between IBD and Irritable Bowel Syndrome (IBS).
The two conditions are quite different and so are their treatments. IBD involves inflammation or damage to the bowel, whereas IBS is characterized by multiple symptoms related to the bowel including abdominal pain, diarrhoea, constipation, or bloating; but there is no inflammation and blood tests and stool tests are normal as are endoscopy, colonoscopy and imaging. IBS is thought to be due to gut hypersensitivity, hence the use of the word irritable. The two conditions IBD and IBS can, however, occur in the same person. A fact sheet on IBS is available on the GESA website.
Despite a great deal of research, the precise causes of ulcerative colitis and Crohn’s disease are unknown. There is evidence, however, that genetic, environmental, immunological and microbiology factors are all involved to a degree, and it may be their interaction in susceptible people that causes IBD to develop. Ulcerative colitis and Crohn’s disease are not contagious diseases. Relatives of people with IBD have a slightly greater risk of developing either disease, but even if both parents have IBD a child will still have a greater than 60% chance of NOT having it. Stress and/or diet alone are not thought to cause IBD, although attention to both these factors improves quality of life with IBD. Smoking can increase the chance of developing Crohn’s disease and disease activity. Both diseases are more common in the Western world, although their incidence is also rising in developing countries
People with either ulcerative colitis or Crohn’s disease can develop pain in the abdomen, diarrhoea (usually with blood and mucous when you have ulcerative colitis), tiredness and weight loss (especially with Crohn’s disease). Some people may also experience fever, mouth ulcers or nausea and vomiting. People with Crohn’s disease may also get pain or swelling around the anus, with or without a discharge. A few people have disease affecting other parts of the body and may experience swollen joints, inflamed eyes, skin lumps or rashes.
Symptoms vary from person to person based on where the disease is in the body and how severe the inflammation is. It can flare up or improve over time. When you experience worsening symptoms, you should see a doctor promptly to assess the disease activity. Many people will experience periods of remission when they are completely free of symptoms.
The goal of medical therapy is to prolong these periods of remission, and prevent repeated flares of disease activity. With current medical treatment, life expectancy is normal.
The diagnosis of Crohn’s disease or ulcerative colitis is often delayed as the symptoms can be nonspecific. When symptoms and signs are severe, the diagnosis is usually made promptly, but in milder cases delays in diagnosis are common. Gastroenterological Society of Australia.
In general, unless symptoms have been ongoing for more than 8 weeks, it is usually necessary to exclude bowel infections or gastroenteritis (which may occur from contaminated food or after a prolonged course of antibiotics). In mild cases, without rectal bleeding or weight loss, IBS is often first suspected, as it is far more common than IBD. Any abnormal test results, however, should guide the diagnosis away from IBS.
Tests which help point towards a diagnosis of IBD include blood tests which may show a low red blood cell count, raised white cell or platelet count and elevation in CRP or ESR, which are markers of inflammation in the body. Blood tests are also useful to look for complications of IBD, such as iron deficiency or other vitamin or mineral deficiencies. A faecal (bowel motion) specimen may need to be examined to exclude infection and/or to assess the severity of inflammation.
Most people require an examination of part of the bowel, either by direct inspection via a flexible tube inserted through the anus (colonoscopy or sigmoidoscopy) or the mouth (gastroscopy), or by radiology imaging, which may include CT or MRI. There is no one test that can reliably diagnose all cases of IBD, and many people require several tests.
Depending on the severity of your symptoms, it is common for it to take 6-18 months from the first onset of symptoms until a positive diagnosis of IBD is made. In most cases this delay does not lead to any additional problems. How is IBD treated? The goals of treatments are to 1) control inflammation 2) ease symptoms and 3) correct nutrition deficiencies, if required, in order to heal the gut. Treatment options involve medications, surgery, nutritional supplements or a combination of therapies depending on the location and severity of the disease.
The goals of treatments are to 1) control inflammation 2) ease symptoms and 3) correct nutrition deficiencies, if required, in order to heal the gut. Treatment options involve medications, surgery, nutritional supplements or a combination of therapies depending on the location and severity of the disease.
Medications are important to achieve and maintain remission (no symptoms and gut healing). The response to each medication may differ between individuals and many need combination of drugs.
Medications need to be taken regularly for the longterm to control inflammation. If you don’t take medications regularly, even though you may feel well briefly, it can result in significant flares of your symptoms and complications affecting quality of life in the long-term. However, some patients can be weaned off medications, or have their dose reduced, if disease is under good control, the bowel is healed, and after consultation with your treating specialist. If you feel unwell while taking medications, rather than just stopping the medication, talk to your specialist about ways to reduce side effects.
Most medications are safe to take during pregnancy and breastfeeding, but discuss this with your specialist.
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