Inflammatory bowel disease

Types Of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) comprises two conditions (Crohn’s disease and ulcerative colitis) characterized by persistent inflammation of the gastrointestinal (GI) tract, leading to eventual damage.

1. Ulcerative colitis 

• It primarily affects the large intestine (colon) and the rectum. 

• Only the innermost layer of the colon's lining is inflamed in ulcerative colitis. The ulcers that develop on the inner lining of the colon have a tendency to bleed and form pus.

• Damaged areas in ulcerative colitis are continuous (rather than patchwork), commonly beginning in the rectum and expanding into the colon.
  
  

2. Crohn's disease

• It can affect any part of the digestive system, from the mouth to the anus.

• Inflammation in Crohn's disease can cause inflammation to spread through the various layers of the GI tract's walls.

• Crohn's disease causes damaged tissues to form in patches close to healthy tissue.

Symptoms Of Inflammatory Bowel Disease 

• Diarrhea associated with blood or mucus
• Constipation
• The urgency to have a bowel movement 
• Fecal incontinence (passing stool at unexpected times)
• Stomach pain
• Nausea and vomiting
• Joint pain
• Rashes, ulcers, and sores on the skin
• Redness, pain in the eyes and blurred vision.
• Painful sores in the mouth

Iron deficiency anemia is common in IBD.

Individuals who have IBD often experience iron deficiency anemia (IDA) as a result of ongoing blood loss along with hindered absorption of iron caused by inflammation in the tissues.

Listen to our expert talk about iron deficiency anemia.

Causes Of Inflammatory Bowel Disease

Although the specific origin of IBD is unknown, it is believed to be a combination of genetic predisposition, viral, immunological, nutritional, and environmental variables. 

In patients who have a genetic susceptibility to IBD, the body's immunological (defense) system may be activated. In most cases, the immune system defends the body against illnesses caused by viruses or bacteria (germs). Once the virus has been eradicated, that element of the immune system "shuts down" until it is required again.

However, in IBD patients, the immune system may overreact to typical microorganisms in the digestive system. When the immune system is activated, it does not shut down when it should. This causes inflammation, which harms the digestive system over time.

Risk Factors For Inflammatory Bowel Disease

1. Genetic predisposition

IBD can run in families. You would have a higher chance of acquiring Inflammatory bowel disease if you have a close relative who suffers from the same.

2. Gut microbiota

Alterations in the composition of the gut microbiota (the community of microorganisms living in the intestines) have been observed in individuals with IBD. 

3. Age

IBD can manifest at any point in life, although it is more commonly diagnosed before or around the age of 30.

4. Auto-immunity

IBD involves the immune system that mistakenly attacks healthy cells in the gut, causing chronic inflammation and symptoms.

5. Stress 

Stress is believed to initiate or reactivate inflammation in the gastrointestinal system, contributing to the worsening of clinical symptoms associated with IBD. 

To find out more about the effects of stress on the body.
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6. Smoking

Individuals who actively smoke have over double the risk of developing Crohn's disease.

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7. Air pollution

It can increase the risk of developing Crohn's disease in children and young adults because it tends to alter the gut microbiome.

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8. Medications

Certain medications have been linked to the development of inflammatory bowel disease. They include:

• Pain relief medications: Long-term use of painkillers or Nonsteroidal anti-inflammatory drugs such as aspirin, and ibuprofen especially in women increases the risk of IBD.
  
  
• Oral contraceptives or HRT (hormone replacement therapy): Both may increase the risk of IBD in women.
  
  Want to know more about oral contraceptives?
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• Antibiotics: Excessive antibiotic exposure during childhood (i.e. before birth to 5 years of age) may increase the risk of IBD or Crohn’s disease.
  
  What are antibiotics? 
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9. Lack of vitamin D

Research has revealed a link between a lack of vitamin D and the development or worsening of IBD. 

Do not let the gap in your nutrition or lack of sun-exposure decrease your Vitamin D levels.

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10. Appendicitis/appendectomy

Studies suggest that individuals who have their appendix removed are less likely to develop ulcerative colitis later in life, but they may be more likely to develop Crohn's disease.

11. Poor dietary choices

Poor dietary habits such as excessive consumption of fast food, sugar, omega-6 fatty acids, trans fats, processed meat and lower fiber diet, etc. have also been associated with an increased risk of developing Crohn’s disease.

Note: IBD or Crohn’s disease are not triggered by eating any one particular food. But for some people, certain foods can aggravate the symptoms. 

Learn about various healthy eating habits

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12. Perinatal (early life) factors

Early events in childhood like how you're fed, hygiene at home, infections around birth, and vaccinations might affect the development of inflammatory bowel disease. 

Diagnosis Of Inflammatory Bowel Disease

A combination of tests and procedures will be required to help confirm an IBD diagnosis, that include:

1. Medical history and symptoms

It consists of checking the following:

• If you have IBD (Crohn's or colitis) in your family, such as a grandmother, parent, sibling, or child,

• If you smoke (past or present)

• If you have had prior hospitalization or operation

• If you are on any medications (for example, antibiotics and hormonal medications like oral contraceptives)

• If you have other illnesses (for example, colorectal disease, celiac disease, and arthritis)

• If you have had any prior infection with Clostridium difficile (C. difficile or C. diff)

2. Blood tests

• Complete blood count (CBC): This test measures the number of red blood cells, white blood cells, and platelets in your blood. Low red blood cell count (anemia) and elevated white blood cell count can indicate inflammation.
  
  
• C-reactive protein (CRP): CRP is a marker of inflammation in the body. Elevated CRP levels in the blood suggest ongoing inflammation, which is common in IBD.
  
  
• Erythrocyte sedimentation rate (ESR): It measures how quickly red blood cells settle at the bottom of a test tube. Higher rates can indicate inflammation.
  
  
• Antibody tests: This test is used to differentiate between Crohn’s disease and ulcerative colitis. It tests for antibodies like anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear antineutrophil cytoplasmic antibodies (pANCA).

3. Stool test

This analysis detects the presence of bacteria or parasites, particularly beneficial in excluding infections that contribute to persistent diarrhea. A type of stool test done particularly for IBD is

• Fecal calprotectin: This stool test measures the presence of calprotectin, a protein released during inflammation. Elevated levels suggest intestinal inflammation and can help differentiate between IBD and other conditions.

4. Endoscopic procedures

• Endoscopy, and colonoscopy: These are invasive tests in which a probe is inserted via the mouth (endoscopy) or the rectum (colonoscopy) to visualize the inner structures of the digestive tract in real-time. It provides IBD specialists with a direct look at the gastric mucosa of the intestinal tract.

• Capsule endoscopy: In capsule endoscopy, a capsule is swallowed containing a tiny camera which then travels through your digestive system taking pictures and allowing the doctor to visualize inside the digestive tract.

5.  Imaging techniques

• Abdominal X-ray: It is performed in suspected cases of IBD to visualize inflammation, structural changes, and complications in the intestines

• Ultrasound: It can aid in diagnosing IBD by visualizing the intestines, detecting inflammation, and assessing complications without using radiation.

• Barium X-rays and fluoroscopy: For the procedure, you will be requested to position yourself in front of an X-ray machine and ingest barium. The barium will enhance the visibility of your upper GI tract on the X-ray images to detect the changes.

• CT scan : Computed tomography, employs a machine to capture a sequence of X-rays in order to create an image of the digestive tract to czech for signs of inflammation.

•  Magnetic resonance enterography (MRE): MRE is a diagnostic imaging test that generates detailed pictures of your small intestine and helps in the diagnosis of IBD.

6. Biopsy

Bio[sies of the colon can be taken to confirm the diagnosis. This technique is very effective in diagnosing the disease and in differentiating the type of inflammation.

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Prevention Of Inflammatory Bowel Disease

Here are some preventive measures and lifestyle choices that can be beneficial:

1. Avoid triggers

Some individuals with IBD may find it helpful to avoid specific trigger foods, such as spicy foods, fatty foods, caffeine, alcohol, and high-fiber foods.

2. Stick to dietary guidelines

Opt for a diet rich in fiber, including fruits, vegetables, legumes, and whole grains.

Restrict the intake of low-fiber foods such as processed and packaged foods, as well as milk and meat products.

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3. Maintain optimum hydration

Ensure that you drink an adequate amount of water, aiming for at least eight glasses throughout the day. Limit the consumption of alcohol, coffee, and soft drinks, as they can cause dehydration.

4. Exercise regularly

Maintain an active lifestyle by engaging in regular exercise. It can help prevent IBD by promoting a healthy immune system and reducing inflammation in the body.

5. Quit smoking

If you are a smoker, quitting or avoiding smoking altogether is highly recommended. Smoking has been associated with an increased risk of developing Crohn's disease and can worsen symptoms in individuals with IBD.

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Doctor To Visit

To effectively diagnose and address the symptoms of inflammatory bowel disease, it is necessary to schedule an appointment with a qualified professional in the field, such as

• General physician
• Inetrnal medicine specialist
• Infectious disease specialist
• Gastroenterologist
  
  

A general physician can assist with IBD by diagnosing, managing symptoms, coordinating care, and referring to specialists for comprehensive treatment. 

An internal medicine and infectious disease specialist diagnoses and treatments acute and chronic diseases caused by bacteria, viruses, etc. He/she can assist in managing IBD by addressing infections that may occur due to weakened immune systems and treatments, ensuring optimal care.

A gastroenterologist specializes in the diagnosis and treatment of disorders of the gastrointestinal tract and related organs.

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Treatment Of Inflammatory Bowel Disease

The approach known as "treat to target" or "tight control" is rapidly gaining recognition as the preferred method for treating and managing IBD. It is a strategy where treatments are adjusted regularly based on specific goals to achieve the best possible outcomes The treatment options for IBD include:

1. Medications 

• Aminosalicylates: These medications help reduce inflammation in the intestinal lining and are commonly used for mild to moderate cases of ulcerative colitis. They include:

  • Balsalazide

  • Mesalamine

  • Olsalazine

  • Sulfasalazine 

• Corticosteroids: These powerful anti-inflammatory drugs are used for short-term symptom control during flare-ups. They include:

  • Budesonide

  • Hydrocortisone

  • Methylprednisolone

  • Prednisone

• Immunomodulators: These medications dampen the immune system, leading to reduced inflammation in the digestive tract. The drugs include:

  • Azathioprine

  • 6-mercaptopurine

  • Cyclosporine

  • Tacrolimus

  • Methotrexate

• Other medicine:

  • Anti-diarrheal medications: Over-the-counter drugs like loperamide can help control diarrhea.

  • Pain reliever: Such as acetaminophen is used for mild pain.

  • Nutritional supplements: These may be recommended to address nutrient deficiencies or support healing.

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2. Biologic therapies

These are special medicines made from living cells that help calm down the body's immune system and reduce inflammation in the gut. They are indicated for people with moderate to severe active disease who have not responded well to conventional therapy. The drugs used include:

• Adalimumab

• Certolizumab

• Infliximab

• Natalizumab

• Golimumab

• Vedolizumab

• Ustekinumab

Note: A healthcare physician may recommend adding an additional therapy, known as combination therapy. It involves using multiple medications together to better control inflammation and manage symptoms.

3. Surgical treatment

Even with medicines, many people will need surgery to treat IBD (including Crohn’s disease and ulcerative colitis) 

a. Surgical treatments for Crohn's disease

• Proctocolectomy and colectomy: Colectomy is a surgical treatment that removes part or all of the large intestine, also known as the colon. If the rectum has been affected by inflammation, a surgeon may remove it as well, a technique known as proctocolectomy. 
  

• Stricturoplasty: It is a surgical procedure used when the intestines have strictures (narrowing). Instead of removing the restricted segment, the surgeon makes longitudinal incisions in the stricture and then stitches them. 
  
  

• Limited bowel resection:  This normally entails removing only the affected bowel to relieve the problems caused by the diseased segment of the bowel.
  
  

• Bowel diversion with an ostomy: This entails redirecting stool flow through the colon by cutting the intestine above the severely damaged bowel and bringing it to the skin surface via an ostomy (surgical procedure). 
  

b. Surgical treatments for ulcerative colitis

• Proctocolectomy with end-ileostomy: This procedure removes the colon, rectum, and anus completely. It is mainly reserved for patients suffering from severe ulcerative colitis.

• Total colectomy with ileal pouch-anal anastomosis (IPAA): This procedure includes creating an internal pouch from a piece of the small intestine (ileum). The pouch is then attached to the anus, allowing bowel motions.

• Total colectomy with ileorectal anastomosis: The large intestine is removed with a straight link between the end of the small bowel and the anus, with no pouch created. 

Home care For Inflammatory Bowel Disease

While some people may explore home remedies for managing IBD symptoms, it's important to note that the safety and effectiveness of such remedies can vary widely. 

How to use it? 

You can eat the aloe chunks raw or use a cooking method like steaming to make it palatable.

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2. Turmeric (Haldi): Curcumin, present in turmeric, can be helpful for conditions like inflammatory bowel diseases due to its antioxidant and anti-inflammatory characteristics.

How to use it?

Drink turmeric milk daily to see the results.

Learn about 5 more ways to use turmeric for a healthy body.
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3. Boswellia: It is a resin derived from the bark of certain trees, known for its potential anti-inflammatory properties and its use in traditional medicine for various health conditions including IBD.

How to use it?

Typical dosing recommendations advise oral intake of 300–500 milligrams (mg) two to three times daily.

4. Peppermint oil: It acts as an antispasmodic medication, aiding in alleviating stomach cramps, bloating, and flatulence, especially effective for individuals with irritable bowel syndrome (IBS).

How to take it?

The typical dosage for peppermint oil is 1 to 2 capsules, administered three times daily.

Note: Always consult your physician before starting any of these remedies.

Complications Of Inflammatory Bowel Disease

Patients with (IBD, or the medications used to treat it, can be put at risk of developing complications and other conditions. Here are some common complications associated with IBD:

• Fistulas: These are ulcers on the intestine's wall that spread and form a tunnel (fistula) to another part of the intestine, the skin, or another organ.

• Stricture: It is a narrowing of an intestine section caused by scarring, which can result in an intestinal blockage.

• Ulcers: These are open sores in your mouth, intestines, anus, or perineum (bottom area).

• Abscess: A collection of pus most commonly in the belly.

• Anal fissures: These are small tears in the anus.

• Malabsorption and malnutrition, including deficiency of vitamins and minerals (such as anemia)

• Bone disorders: Such as joint pain, arthritis, and fibromyalgia (chronic pain).

• Skin conditions: Tender bumps, painful ulcerations, and other sores/rashes.

• Eye disorders: Like uveitis (eye inflammation), dry eyes, etc.

• Kidney stones: These can develop as a complication of IBD due to factors like dehydration, inflammation, and medication use.

• Liver disorders: Such as hepatitis, gallstone, and primary sclerosing cholangitis (PSC), a form of severe swelling and scarring that develops in the bile ducts.

• Anxiety and depression: It can be due to the impact of chronic illness on mental well-being.

Alternative Therapies For Inflammatory Bowel Disease

Alternative therapies for IBD encompass non-conventional approaches aimed at complementing conventional medical treatments, offering a diverse range of options to manage symptoms and improve overall well-being> There include:

1. Common mind-body techniques

Stress and emotional variables might have an impact on IBD symptoms. These treatments include cognitive behavior therapy (CBT), relaxation, meditation, yoga, and others. It may aid with stress management, relaxation, and overall well-being in those with IBD.

Know more about how cognitive therapy can be beneficial in anxiety disorders.
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2. Probiotics

These aim to rebalance the gut by introducing beneficial bacteria. They can enhance digestion and certain strains have demonstrated the ability to alleviate symptoms of Crohn's disease.

Food sources rich in probiotics consist of yogurt, tofu, and more. To learn more about the advantages of probiotics for health,
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3. Prebiotics

Prebiotics serve as nourishment for the beneficial bacteria residing in your digestive system. Some sources of prebiotics include asparagus, legumes, bananas, and others.

Probiotics and prebiotics have the potential to effectively maintain gut health. Explore our range of prebiotics and probiotic supplements to aid with IBD symptoms.
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4. Acupuncture

Acupuncture is a traditional Chinese medicine practice that includes inserting tiny needles into particular spots on the body. According to research, acupuncture may help reduce inflammation and relieve symptoms of IBD.

5. Moxibustion

It is a type of traditional Chinese medicine that is usually used in combination with acupuncture. Dry herbs are burnt around your skin, frequently around acupuncture sites to alleviate Crohn's symptoms.

Living With Inflammatory Bowel Disease

Living with inflammatory bowel disease (IBD) can be challenging, but with proper management and lifestyle adjustments, it is possible to lead a fulfilling life. Here are some strategies that can help you live with IBD:

1. Educate Yourself: Learn about inflammatory bowel disease, its symptoms, triggers, and treatment choices.

2. Join a support group: Connect with others who have IBD or local support groups to share stories, ask advice, and receive support from people who understand what you're going through.

3. Communicate with your healthcare team: Maintain a positive relationship with your healthcare providers. Communicate your symptoms, concerns, and treatment response on a regular basis to ensure you receive appropriate care.

4. Adhere to your medications: If you have been taking medication for IBD, it is critical that you take it exactly as prescribed by your doctor. Adhering to your treatment plan will help you control your disease and lower your risk of flare-ups.

5. Immunize yourself:  Immunizations play a vital role in the primary prevention of infections, especially for individuals with IBD as they are at higher risk of contracting vaccine-preventable diseases like influenza, pneumonia, and shingles. 

Note: Immunization is a crucial method for disease prevention. Find out more about the significance of immunization.

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6. Manage your stress:  Stress can worsen symptoms and trigger flare-ups. Adopt stress management techniques such as meditation, deep breathing exercises, yoga, regular physical activity, and engaging in hobbies to help reduce stress levels.

Try some relaxation techniques to manage stress.
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7. Take vitamin supplements: Your doctor may advise you to take vitamin supplements if your body does not get all of the nutrients it requires from meals due to IBD. You may require vitamin B12, folic acid, vitamin D, calcium, or iron supplements.

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