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Inflammatory Bowel Disease (IBD): symptoms, causes, treatment, and coping strategies

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 10 minutes read
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Inflammatory bowel disease (IBD) is a term that describes a group of disorders that involve chronic inflammation of tissues in the digestive tract. The two main types of IBD are ulcerative colitis (UC) and Crohn’s disease (CD). Ulcerative colitis affects the inner lining of the large intestine (colon) and rectum, while Crohn’s disease can affect any part of the digestive tract, from the mouth to the anus. IBD is different from irritable bowel syndrome (IBS), which is a common but less serious condition that causes abdominal discomfort, bloating, and changes in bowel habits.

IBD is a serious and potentially life-threatening condition that can affect the physical, mental, and social well-being of patients. According to the World Health Organization, IBD affects about 10 million people worldwide, with the highest prevalence in Europe and North America. The average age of onset is between 15 and 35 years, but it can occur at any age. IBD imposes a significant economic burden on the health care system and society, as well as a reduced quality of life for patients and their families.

The purpose of this article is to provide an overview of the causes, symptoms, management, treatments, prognosis, and prevention of IBD. By understanding more about this condition, patients can make informed decisions about their health and well-being.

Causes of IBD

The exact cause of IBD is unknown, but it is likely a result of a complex interaction between genetic, immune, and environmental factors. Some of the possible causes and risk factors of IBD are:

Genetic factors

IBD tends to run in families, and certain genes have been identified that increase the susceptibility to IBD. However, not everyone who inherits these genes develops IBD, suggesting that other factors are also involved.

Immune system malfunction

IBD is considered an autoimmune disease, which means that the body’s immune system mistakenly attacks its own tissues, causing inflammation and damage. The immune system may be triggered by an infection, a foreign substance, or a stress response, leading to an abnormal and persistent inflammatory response in the digestive tract.

Environmental factors

IBD is more common in developed countries and urban areas, suggesting that environmental factors such as diet, hygiene, pollution, and lifestyle may play a role in the development of IBD. Some of the environmental factors that may increase the risk of IBD are listed below.

Smoking

Smoking is a major risk factor for Crohn’s disease and may also worsen the symptoms and complications of IBD. Smoking can impair the blood flow to the intestines, increase the permeability of the intestinal wall, and alter the gut microbiota, which are the beneficial bacteria that live in the digestive tract.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are medications that are commonly used to treat pain, inflammation, and fever, such as aspirin, ibuprofen, and naproxen. NSAIDs can irritate the lining of the stomach and intestines and increase the risk of bleeding and ulcers. NSAIDs may also interfere with the immune system and the gut microbiota, and trigger or worsen the symptoms of IBD.

Diet

Diet may influence the risk and severity of IBD, as some foods may trigger or aggravate the inflammation in the digestive tract. Some of the foods that may be harmful for IBD patients are listed below.

High-fat and processed foods

These foods may increase intestinal permeability, alter the gut microbiota, and stimulate the immune system, leading to inflammation and damage in the digestive tract.

High-fiber foods

These foods may be beneficial for the general health of the digestive system, but they may also cause problems for some IBD patients, especially during a flare-up. High-fiber foods may increase intestinal motility, cause gas and bloating, and irritate the inflamed tissues in the digestive tract.

Dairy products

Some IBD patients may have lactose intolerance, which means that they cannot digest the sugar (lactose) found in milk and other dairy products. Lactose intolerance can cause diarrhea, abdominal pain, and cramping, which may worsen the symptoms of IBD.

Gluten

Gluten is a protein found in wheat, barley, rye, and some other grains. Some IBD patients may have celiac disease, which is an autoimmune disorder that causes the immune system to react to gluten and damage the small intestine. Celiac disease can cause symptoms similar to IBD, such as diarrhea, weight loss, and malnutrition.

It is important to note that diet and stress are not the cause of IBD, but they may affect the symptoms and severity of the disease. Therefore, IBD patients should consult their doctors and dietitians to find the best diet and lifestyle for their individual condition.

Symptoms of IBD

The symptoms of IBD may vary depending on the type, severity, and location of inflammation, and they may occur in periods of flare-up and remission. A flare-up is when the symptoms are active and severe, and remission is when the symptoms are mild or absent. Some of the common symptoms of IBD are:

  • Diarrhea is the frequent and loose passage of stool, which may contain blood, mucus, or pus. Diarrhea is caused by the inflammation and ulceration of the intestinal lining, which reduces the absorption of water and nutrients and increases the secretion of fluid and electrolytes. Diarrhea can lead to dehydration, electrolyte imbalance, and weight loss.
  • Abdominal pain and cramping are caused by the inflammation, spasms, and distension of the intestinal muscles, which may also affect the surrounding organs. The pain and cramping may be constant or intermittent and may vary in intensity and location. The pain and cramping may be relieved by passing gas or stool, or by taking medication.
  • Blood in stool is caused by the bleeding of the inflamed and ulcerated tissues in the digestive tract. Depending on the source and duration of bleeding, the blood may be bright red, dark red, or black. It may be mixed with the stool or appear as streaks or clots. Blood in the stool can lead to anemia, a condition that occurs when the red blood cells are low in number or function, causing fatigue, weakness, and shortness of breath.
  • Reduced appetite and weight loss are caused by inflammation, pain, and diarrhea, which reduce the intake and absorption of food and nutrients. Reduced appetite and weight loss can also be caused by the side effects of some medications, such as nausea & vomiting and taste changes. Reduced appetite and weight loss can lead to malnutrition, which is a condition that occurs when the body does not get enough of the essential nutrients, such as protein, vitamins, and minerals, causing growth retardation, muscle wasting, and impaired immunity.
  • Fatigue is a feeling of tiredness, exhaustion, and lack of energy, which may affect the physical, mental, and emotional functioning of the patient. Fatigue is caused by inflammation, anemia, malnutrition, dehydration, and electrolyte imbalance, which reduce the oxygen and nutrient supply to the cells and organs. Fatigue can also be caused by stress, anxiety, and depression, which are common psychological problems among IBD patients.

Complications of IBD

Some of the possible complications of IBD are:

  • Bowel obstruction - Bowel obstruction is a blockage of the normal passage of stool through the digestive tract, which may be caused by the inflammation, swelling, scarring, or narrowing of the intestinal wall, or by the formation of masses, such as tumors, polyps, or abscesses. Bowel obstruction can cause severe abdominal pain, vomiting, constipation, and distension, and may require emergency surgery to remove the obstruction and restore the bowel function.
  • Perforation - Perforation is a hole or tear in the wall of the digestive tract, which may be caused by the severe inflammation, ulceration, or trauma of the tissues. Perforation can allow the contents of the digestive tract, such as bacteria, food, and stool, to leak into the abdominal cavity, causing infection, inflammation, and peritonitis, which is a life-threatening condition that requires immediate medical attention and surgery to repair the perforation and treat the infection.
  • Ulcers - Ulcers are open sores or wounds in the lining of the digestive tract, which may be caused by the inflammation, erosion, or infection of the tissues. Ulcers can bleed, cause pain, and impair the function of the affected organ. Ulcers can also affect other parts of the body, such as the mouth, skin, eyes, and joints, because of the systemic inflammation and immune response of IBD.
  • Fistulas - Fistulas are abnormal connections or tunnels between two organs or tissues, which may be caused by the inflammation, infection, or surgery of the digestive tract. Fistulas can allow the contents of one organ to pass into another, causing infection, inflammation, and leakage. Fistulas can affect the intestines, bladder, vagina, skin, and anus, and may require surgery to close the fistula and treat the infection.
  • Abscesses - Abscesses are collections of pus or infected fluid in the tissues, which may be caused by the inflammation, infection, or perforation of the digestive tract. Abscesses can cause pain, swelling, fever, and drainage, and may require drainage and antibiotics to treat the infection.
  • Malnutrition - Malnutrition is a condition that occurs when the body does not get enough of the essential nutrients, such as protein.

When to see your doctor?

Inflammatory bowel disease (IBD) encompasses a group of chronic conditions that cause inflammation in the digestive tract. If you experience symptoms suggestive of IBD, it's essential to seek medical attention promptly. Common signs and symptoms of IBD include persistent diarrhea, abdominal pain, rectal bleeding, unintended weight loss, fatigue, and fever. Additionally, individuals with a family history of IBD or those with autoimmune conditions may be at higher risk and should be vigilant for any changes in bowel habits or digestive health.

What will your doctor do?

When you visit your doctor with concerns about inflammatory bowel disease, they will conduct a thorough evaluation to determine the cause of your symptoms and provide appropriate management. Here's what to expect during your doctor's appointment:

Medical History Review

Your doctor will begin by asking detailed questions about your symptoms, including their onset, duration, severity, and any factors that worsen or alleviate them. They will also inquire about your medical history, including any previous gastrointestinal issues, family history of IBD, autoimmune disorders, or other relevant conditions.

Physical Examination

A comprehensive physical examination will be performed to assess your overall health and identify any signs of inflammation or abdominal tenderness. Your doctor may gently palpate your abdomen to check for areas of tenderness, swelling, or masses, which can provide valuable clues about the underlying cause of your symptoms.

Diagnostic Tests

Depending on your symptoms and physical examination findings, your doctor may recommend several diagnostic tests to confirm or rule out inflammatory bowel disease and assess its severity. These tests may include:

  • Blood Tests - Complete Blood Count (CBC) tests can detect signs of inflammation, anemia (low red blood cell count), and nutritional deficiencies associated with IBD.
  • Stool Tests - Stool samples may be analyzed for the presence of blood, infectious pathogens, or markers of inflammation.
  • Colonoscopy - A colonoscopy allows your doctor to examine the lining of your colon and rectum using a flexible tube with a camera attached (colonoscope). During the procedure, your doctor may collect tissue samples (biopsies) for further analysis.
  • Endoscopy - Upper endoscopy or flexible sigmoidoscopy may be performed to evaluate the upper gastrointestinal tract or the lower part of the colon and rectum, respectively.
  • Imaging Studies - Imaging tests such as X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) may be recommended to visualize the gastrointestinal tract and assess for complications of IBD, such as strictures, fistulas, or abscesses.

Treatment Plan

Based on the results of your evaluation, your doctor will develop a tailored treatment plan to manage your inflammatory bowel disease effectively. Treatment may include medications to reduce inflammation, control symptoms, and prevent complications, such as corticosteroids, immunomodulators, biologic therapies, or salicylates. In some cases, dietary modifications, nutritional supplementation, and lifestyle changes may also be recommended to support your overall health and well-being.

Follow-Up Care

Your doctor will schedule regular follow-up appointments to monitor your condition, assess treatment response, and make any necessary adjustments to your management plan. It's essential to attend these appointments and communicate any changes in your symptoms or concerns to your healthcare provider promptly.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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