What is Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease or IBD is a collective term given to a group of conditions that involve chronic inflammation of the gastrointestinal tract. The two most common types of IBD are Crohn's disease and ulcerative colitis. While these two conditions share some common symptoms, they affect the body in different ways and in different parts of the GI tract.

IBD causes symptoms such as abdominal pain, persistent diarrhoea, fatigue, blood in the stool and unintended weight loss. These symptoms can come and go and one may have periods of remission followed by flare-ups or episodes when the disease is active. 

Two main types of irritable bowel disease

Crohn's disease:

This condition involves inflammation along the lining of your gastrointestinal tract, which includes the area between your mouth and the anus. While it can affect any part of the GI tract, it mostly involves inflammation in some parts of the small intestine. In Crohn’s disease, inflammation is not limited to the lining of the GI tract and it may spread to other layers. Inflammation and damage usually happen in patches and you can see normal, healthy tissue in between the affected areas. 

Ulcerative colitis:

This condition involves inflammation in the lining of your colon (large intestine) and the rectum. Inflammation in ulcerative colitis is usually present only in the innermost layer that lines the colon or rectum, causing it to become red, inflamed and swollen. In most cases, ulcerative colitis does not affect or damage the small intestine. But it is known to impact the ileum, the lower segment of your small intestine. Ulcerative colitis often leads to the formation of ulcers on the large intestine. These ulcers or open sores can cause pus and bleeding. Unlike Crohn's disease, the damage does not present as patches of healthy and inflamed tissue but is found as a continuous area.

What are the Symptoms of inflammatory bowel disease

Inflammatory bowel disease symptoms depend on the severity and location of the inflammation. Symptoms may also come and go. People with IBD may experience periods of remission when the symptoms are not aggressive or severe. In rare cases, patients may even find their disease becoming less severe as they age.

Some common IBD symptoms include:

1. Diarrhoea
2. Abdominal pain
3. Fatigue
4. Weight loss
5. Loss of appetite
6. Blood in stool
7. Anaemia

Some uncommon and rare IBD symptoms include:

1. Itchy and red eyes
2. Joint pain
3. Skin rashes
4. Vision problems
5. Fever

What causes inflammatory bowel disease?

The exact reason why someone may develop inflammatory bowel disease is not yet known. It was previously thought that stress and diet may have a hand, but it is now believed that a malfunctioning immune system plays a role in the development of IBD. A well-functioning immune system protects the body against all kinds of infections by attacking and destroying foreign invaders such as viruses, bacteria and fungi. But in inflammatory bowel disease, the immune system responds inappropriately to the bacteria and viruses in the gastrointestinal tract, causing inflammation in the area. Heredity may also play a role as people with a family history of IBD are more prone to developing this condition. Research shows that environment may have a strong role in “mediating risk of disease.” [1]

Risk Factors for inflammatory bowel disease

1. Family history
2. Viruses and bacteria
3. Cigarette smoking
4. Depression
5. Stress and anxiety
6. Excessive use of NSAIDs
7. Antibiotics
8. Age
9. Hormonal replacement therapy in postmenopausal women
10. Oral contraceptives

 

Health complications of IBD

It is not easy to live with inflammatory bowel disease. People suffering from any type of IBD - whether Crohn's disease or ulcerative colitis - may experience health complications and are at an increased risk of developing colon or colorectal cancer. The symptoms of Crohn’s disease and ulcerative colitis can also disrupt the quality of life.

Other health complications associated with inflammatory bowel disease include anal fistula, strictures (narrowing of the intestine caused by the formation and build-up of scarred tissue), anaemia, poor absorption of nutrients and resulting nutritional deficiencies, hole in the large intestine (called perforated bowel), and osteoporosis. One may also experience inflammation in the skin, eyes and joints causing symptoms such as skin rashes, itchy and painful eyes, and joint pain.

Interestingly,  inflammatory bowel disease affects women in different ways. For example, women with this condition are more likely to experience premenstrual symptoms such as pain and headache. In fact, IBD symptoms may also be more pronounced around the time of periods. With poor absorption of iron and an increased risk of bleeding in the GI tract, women with IBD may have a higher risk of developing iron deficiency anaemia. 

In addition, IBD medications can also increase the risk of certain health conditions. For example, corticosteroids put you at increased risk of osteoporosis, high blood pressure, suppressed immunity and other health problems.

In a nutshell, complications of IBD include:

1. Bowel obstruction
2. Formations of anal fistula and strictures
3. Nutritional deficiencies
4. Iron deficiency anaemia
5. Osteoporosis
6. Joint pain
7. Skin rashes
8. Perforated colon
9. Increased risk of colon cancer
10. Poor quality of life

Can IBD be managed?

Inflammatory bowel disease inflammation and symptoms can be managed with the help of some medications such as corticosteroids, antibiotics, immunomodulators, and aminosalicylates. They are biologic medicines such as infliximab, adalimumab, and certolizumab that can significantly help in reducing the recurrence of active flares. 

But yes, most patients with IBD need to take medicine to control their symptoms, to reduce inflammation, and to reduce the frequency and severity of their flare-ups. One should avoid painkillers to treat the pain associated with IBD. Narcotics only treat the symptoms and make the inflammation worse. In fact, people with IBD who take narcotics are more likely to develop severe abdominal infections, strictures and intestinal obstruction.

In severe cases, where chronic inflammation has caused extensive damage and when medications are not able to provide any relief in symptoms, your physician may recommend surgery to remove the damaged sections of the gastrointestinal tract. It is followed by anastomosis, where the two ends of healthy bowel are connected. This procedure, called bowel resection, is particularly useful in Crohn's disease. 

Prolonged use of corticosteroids like prednisone has many side effects such as bone loss, fluid retention, weight gain, diabetes, fungal infections, mood swings, cataracts, and weakened immune system. What's more, long term use of prednisone makes the body resistant to its effect. The best way one can ease inflammatory bowel disease symptoms and to prevent future flare-ups is to take maintenance medicine.

How can you manage IBD symptoms?

It is important to understand that inflammatory bowel disease is not caused by your diet. However, some foods such as dairy products, foods with high fibre content, spicy food and caffeine can aggravate IBD symptoms. Similarly, certain foods may reduce inflammation and promote healing of your gastrointestinal tract. Steps like limiting consumption of dairy products, avoiding spicy foods, drinking plenty of water, getting plenty of sleep, and eating smaller meals can be very useful in managing symptoms and flare-ups in IBD. Identifying foods that may irritate your digestive tract, cause inflammation, and trigger flare-ups can also help people with IBD to plan their diet.

Foods that trigger IBD

1. Processed food
2. Foods loaded with refined sugar
3. Fried and fatty foods
4. Hot and spicy foods
5. Caffeinated beverages
6. Alcohol
7. Dairy products
8. Nuts and seeds
9. Gluten
10. High fibre foods

Stress and lack of sleep can also exacerbate the symptoms and trigger flare-ups in some people. Cigarette smoking is another serious environmental risk factor in the development of IBD, especially in the Crohn's disease. It also increases the severity of the disease and makes the symptoms worse. According to Crohn's & Colitis UK, active smokers with Crohn's disease are more likely to have severe symptoms and to develop health complications such as strictures (and resulting intestinal blockages) and fistulas. They are also more likely to require surgery.

IBD and nutritional deficiencies

Since inflammatory bowel disease also manifests into nutritional deficiencies [2], it is important to take care of your diet and to eat healthy. Poor absorption of nutrients, restricted diet, and diarrhoea are some of the obvious reasons why people with Crohn's disease may result in a shortage of some micronutrients such as iron, zinc, calcium, vitamin B6, vitamin B12, vitamin D, magnesium and folate.

Taking a multivitamin may also help ward off nutritional deficiencies and prevent the risk of health conditions such as osteoporosis, nerve damage and iron deficiency anaemia.

The role of vitamin D in inflammatory bowel disease

People suffering from inflammatory bowel disease should take nutritional supplements to prevent nutritional deficiencies arising from the symptoms and complications associated with this chronic condition. People with active disease may be more vulnerable to developing vitamin D deficiency and this could largely be due to reduced physical activity and poor absorption of vitamin D. While it’s not very clear if vitamin D deficiency may play a role in the development of IBD, there is growing evidence that suggests low vitamin D levels may increase the risk of flareups and vitamin D supplementation may reduce the frequency of relapses. Vitamin D deficiency will increase the severity of the disease.

Vitamin D not only boosts natural immunity but also regulates adaptive immunity, reducing the risk of autoimmune conditions and allergies. Vitamin D reduces inflammation and preserves gut health through various mechanisms. It's effect on adaptive immunity may play a particularly important role in controlling the gut inflammation in patients with IBD. Research suggests that vitamin D supplementation may help prevent relapse.

Experts say that people with IBD, including children, should be tested for vitamin D deficiency and those with insufficient levels should take Vitamin D supplements. A study found that taking a daily dose of at least 2000 IU of vitamin D improved vitamin D levels and reduced disease activity ulcerative colitis patients with vitamin D deficiency. [3]

Is IBD the Same as Irritable Bowel Syndrome (IBS)?

Most people confuse IBD with IBS. And it’s easy to get mixed up because these two conditions have many symptoms in common. But they are two different conditions. IBD is a general term used for chronic inflammation in any or all parts along your GI tract, whereas irritable bowel syndrome (IBS) is a condition where the normal functioning of your bowels is disturbed, causing changes in the bowel movement. People with IBS can have a wide range of symptoms from mild to severe, that can severely affect their quality of life. They are also prone to developing other health problems such as fibromyalgia and chronic fatigue syndrome. It is possible for a person to have both IBD and IBS.

Some typical irritable bowel syndrome symptoms include chronic pain in the abdomen, gas, bloating, nausea, swelling in the abdomen, constipation, diarrhoea or even constipation alternating with diarrhoea. It is also common for people with IBS to have mucus in their stool and to have the urge to move their bowels without being able to do so. The symptoms can be chronic, or they may come and go.

What causes IBS?

While the exact cause of this chronic condition is not yet clear, food poisoning and a hyperactive immune system could be some possible causes. In addition, women are more likely to develop IBS than men. Stress and anxiety can also trigger symptoms.

You can manage mild and minor symptoms of IBS with changes in diet and lifestyle. Dietary and lifestyle modifications are useful in easing IBD symptoms, such as eating smaller meals, avoiding spicy food, engaging in regular exercise, cutting down on sugar, alcohol and processed food, and managing stress levels. However, those suffering from chronic and debilitating symptoms of IBS, such chronic pain in the abdomen, may need to see a doctor. Severe cases may need antibiotics, medication to manage pain and constipation, and counselling to help manage their symptoms. 

Worried you may have inflammatory bowel disease?

If you experience any of the above-mentioned signs and symptoms or there is a sudden change in your bowel habits, it is best to consult a doctor to rule out the possibility of having IBD.  It is usually diagnosed with the combination of various procedures such as blood tests, endoscopy, colonoscopy, CT scan and MRI.  Signs such as rectal bleeding and persistent pain in the abdomen could mean something more serious and should not be ignored.

References:

1. Ashwin N. Ananthakrishnan. Environmental Triggers for Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2013.
2. Yong Eun Park et al. Incidence and risk factors of micronutrient deficiency in patients with IBD and intestinal Behçet’s disease: folate, vitamin B12, 25-OH-vitamin D, and ferritin. BMC Gastroenterology. 2021.
3. Karimi et al. The effects of two vitamin D regimens on ulcerative colitis activity index, quality of life and oxidant/anti-oxidant status. Nutrition Journal. 2019

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