Inflammatory Bowel Disease (IBD)

What is Inflammatory Bowel Disease (IBD):

Inflammatory bowel disease describes several conditions that involve chronic inflammation of the bowel. Ulcerative colitis (UC) and Crohn’s disease (CD) form the majority (90%) of IBD, whereas Indeterminate colitis is seen in 10% of patients. UC effects the large bowel (colon and rectum) whereas CD can occur in any part of the intestine (from mouth to anus). IBD may be associated with extra-colonic manifestations such as, Liver (primary sclerosing cholangitis), Skin (pyoderma gangrenosum), Arthritis (ankylosing spondylitis) and others.

Irritable bowel syndrome (IBS) is not part of IBD. IBD is an autoimmune disorder, where the patient’s immune system attacks the gastrointestinal tract. This is a similar principal to other autoimmune conditions such as: rheumatoid arthritis, systemic lupus, or psoriasis. IBS does not cause inflammation of the bowel, but rather the bowel does not work as it should.

There is a different distribution of inflammation in Crohn’s Disease and Ulcerative Colitis. In CD there are skip lesions, where as in UC it is usually continuous.

Who is at risk:

The exact causes of IBD are not know, therefore it is difficult to predict who is at risk, however a combination of genetic, immunological and environmental factors appear to be associated with the disease. There are typically two peaks of onset, before the age of thirty and after the age of sixty. IBD is more common in patients with a family history of this condition.

What are the symptoms of IBD:

Patients with IBD typically follow cyclical periods of flare and remission. The manifestation of symptoms variable in different patients as this depends on severity of inflammation and the areas of bowel effected. Symptoms of IBD may include:

  • Abdominal pain and cramps
  • Diarrhea (which may be frequent and/or bloody)
  • Bowel urgency and potential accidents
  • Fevers and sweats (during acute flares)
  • Lethargy, weakness, loss of appetite and weight loss
  • Anaemia (due to direct blood loss or malabsorption)
  • Anal pain and infections in the anal area (Crohn’s disease)

How is IBD diagnosed:

There are a number of tests that are sometimes used to diagnose IBD. Not all tests are required for all patients, this depends on the distribution of the disease within the bowel. The potential tests include:

  • Endoscopy and biopsy (colonoscopy or flexible sigmoidoscopy)
  • Blood tests (screening for inflammation, malabsorption or anaemia)
  • Fluoroscopy of small and/or large bowel (these are Xrays performed with an oral or rectal infusion of contract to help identify areas of narrowing).
  • CT or MRI scan (these may be performed to examine the bowel, or the anal area)
  • Examination under Anaesthesia of Anus and Rectum (this is required for patients with suspected Crohn’s Disease)

What is the treatment of IBD:

IBD is best managed in a team approach by a gastroenterologist and a colorectal surgeon. Unfortunately, IBD is a chronic condition and therefore requires life long follow up. Treatment can be differentiated into:

  • Inducing remission (controlling the flare up)
  • Maintaining remission (reducing the likelihood of a future flare up)
  • Prophylactic screening of complications (performing regular tests that screen for high risk complications of IBD such as bowel cancer or malabsorption)

Management is patient specific and may require major surgery. In some cases, early surgical intervention may “reset the clock” and help achieve lifelong remission.