Inflammatory Bowel Disease (IBD) is a chronic condition with repetitive inflammation episodes caused by an immune response to gut bacteria.
IBD divides itself into two types of conditions, Crohn’s disease and Ulcerative colitis. In both of them, there is swelling of the gastrointestinal tract, although differing in several other elements, as we will see further. Around 1.5% of adults in the US suffer from this disease.
Moreover, inside this article, you will find explanations to some of the most customary inquiries about this disease. You will also learn the difference between Inflammatory Bowel Disease and Irritable Bowel Syndrome. Still, before reaching that point, there will be brief explanations on basic notions about the disease.
By reading this article, you will receive significant insights concerning Inflammatory Bowel Disease, for example, its causes, symptoms, complications, and many more. So, please proceed reading to know pearls on this particular topic by the hand of a doctor.
What is Inflammatory Bowel Disease?
To fully comprehend Inflammatory Bowel Diseases, first, people should know a little about the gastrointestinal (GI) tract. The gastrointestinal tract goes from the mouth to the anus. It begins within the mouth and the tongue, going through the esophagus, reaching the stomach. Importantly, within the mouth, the food gets triturated so it can be easier to digest.
Then, it reaches the stomach through the esophagus; within the stomach, the acids will dissolve the food transforming the food into a semiliquid state. After this, the food will enter into the small bowel (the beginning of the intestinal tract).
The small bowel divides itself into three portions, the duodenum, the jejunum, and the ileum. Moreover, the intestinal content will receive the bile salts within the duodenum to digest the nutrients better.
After this, it will reach the jejunum and the ileum, portions that will absorb the food’s nutrients. It will then contact the large bowel or colon; it absorbs the remaining water and gives form to feces to later excrete them through the anus.
Inflammatory Bowel Disease is a condition in which the GI tract tissue will suffer from a swelling or inflammatory response.
Episodes of inflammation are very repetitive and are caused by an abnormal response of the immune system. The immune system is reacting and attacking the GI tract’s normal microflora (healthy germs residing in the gut).
The IBD divides itself into two types of conditions, Ulcerative Colitis and Chron’s disease. Ulcerative Colitis is a condition that affects only the superficial layers of the colon. Therefore, only affecting the large bowel and sparing all other portions of the GI tract. It is the most common form of IBD, and it starts in the rectum.
The other type is Crohn’s disease; this type of IBD can affect any GI tract portion from the mouth to the anus. Crohn’s disease affects the whole layers of the intestinal wall too. Most of the cases involve both small and large bowel.
What is the difference between Inflammatory Bowel Disease and Irritable Bowel Syndrome?
Inflammatory Bowel Disease is a chronic disease with the affection of the GI tract. The immune system plays a significant role in this condition. The IBD has a genetic component that makes people with these genes to suffer from inappropriate immune response to the intestinal flora. Also, patients who suffer from IBD have a tendency or a predisposition to developing Colon Cancer.
On the other hand, as its name says, Irritable Bowel Syndrome (IBS) is not a disease but a group of symptoms that characterize an entity. It is one of the most common gastrointestinal diseases across the world.
IBS is the presence of abdominal pain or discomfort with an alteration of bowel habits. Of course, this only occurs if there is no other disease that might explain these symptoms.
IBS has a wide variety of causes and symptoms. Among the abnormalities, there are the following: alterations in the intestinal motility, visceral sensation, brain-gut interaction, and even psychosocial distress.
Most of the time, at least one of the causes can be found in each patient. There are environmental contributors as well for this syndrome, like early life stressors, food intolerance, antibiotics, and gut infections.
The main difference with Inflammatory Bowel Disease is that Irritable Bowel Syndrome does not cause inflammation of the gastrointestinal tract. Chronic inflammation is the main characteristic of IBD. On the other hand, as the physician performs tests, there will not be any colon abnormality in IBS.
Also, IBS has a major “perk,” which is that these patients do not have an increased risk for Colon Cancer. Although it can be very uncomfortable, IBS is a condition that will not cause destructive inflammation and permanent harm to the intestines.
What is the difference between ulcerative colitis and Crohn’s disease?
Inflammatory Bowel Disease has two variants; none of them are mutually exclusive. Both of them can coexist in a patient. Ulcerative colitis is a condition that causes inflammation and ulcers or sores within the gastrointestinal tract. Inflammation affects only the most superficial layers of the intestines. The colon’s lining becomes granular and fragile or easy to rupture. It usually begins in the rectum and the sigmoid reaching the descending colon.
Patients with Ulcerative Colitis usually suffer from rectal bleeding with mucus discharge. The onset of this disease is very slow, making it difficult to diagnose in its first stages. Patients with ulcerative colitis rarely suffer from inflammation in the small intestine. It has four different types depending on the location of the disease.
The types of ulcerative colitis are the following:
- Ulcerative Proctitis: The inflammation is limited to the anus. These patients suffer from constipation and rectal bleeding.
- Proctosigmoiditis: The inflammation involves the rectum and the sigmoid colon.
- Left-Sided Colitis: The inflammation goes from the rectum and invades the descending colon.
- Pancolitis: It affects the entire colon and causes bloody diarrhea that may be severe.
Conversely, Crohn’s disease is a disease that can affect any part of the intestinal tract. Also, the inflammation extends through the entire thickness of the bowel wall. About a third of the patients have small bowel involvement, another 20% only colon involvement, and around 50% of them suffer from both.
Crohn’s disease has several symptoms that can seriously progress from mild to moderate inflammatory conditions to severe penetrating disease.
What are the symptoms of IBD?
The symptoms and manifestations of Inflammatory Bowel Disease will depend on which area of the intestinal tract is involved. Nonetheless, IBD symptoms will likewise depend on the type of IBD the patient has. Either if it is Crohn’s Disease or Ulcerative Colitis, some symptoms will be similar and others not so much. Also, the symptoms vary, depending on the severity of the inflammation.
Importantly, symptoms may range from mild to severe symptoms. People are very likely to have periods of active illness and periods of remission. Among the general symptoms that IBD patients suffer are the following:
These are symptoms that are common for both types of Inflammatory Bowel Disease. Symptoms tend to vary a little bit depending on each disease. For example, the symptoms for ulcerative colitis are the following:
- Rectal Pain
- Urgency to defecate
- Inability to defecate despite urgency
- Failure to grow in children patients with IBD (pediatric IBD)
- Erythema nodosum
- Ankylosing spondylitis
On the other hand, these are specific symptoms for people who have Crohn’s Disease. Crohn’s disease patients also tend to suffer more from extraintestinal manifestations (symptoms outside the GI tract) that may become troublesome in the future.
- Mouth sores
- Fistula: It involves pain or discharge near the anus due to inflammation. In this case, a fistula is a tube that goes from the digestive tract to the skin.
- Joint pain
- Inflammation of the skin and eyes
- Inflammation of the liver or bile ducts
- Kidney stones
- Iron deficiency or anemia
What are the complications of Inflammatory Bowel Disease?
Inflammatory Bowel Disease has several complications; some are common for both Ulcerative Colitis and Crohn’s disease. On the other hand, others are specific to each condition.
Among them are the following:
- Colon Cancer: Ulcerative colitis and Crohn’s disease can increase the patient’s risk of having colon cancer. Patients should begin their screening tests after eight to ten years after the diagnosis.
- Skin, Eye, and Joint Inflammation: These diseases can cause certain disorders during IBD flare-ups. Among them are arthritis (joint swelling), skin lesions, and uveitis (eye swelling).
- Medication side effects: Some medications used for treating IBD correlate directly with developing certain types of cancer. These medications are corticosteroids. Corticosteroids are also associated with the risk of developing osteoporosis, high blood pressure, and other conditions.
- Primary Sclerosis Cholangitis: The inflammation can cause scarring of the bile ducts. It will ultimately produce the narrowing of the bile ducts and liver damage, leading to hepatic failure.
- Blood clots: The inflammation process can increase the risk of developing blood clots in veins and arteries. Blood clots can ultimately cause infarction (death) of any tissue, acute coronary syndrome, strokes, among others.
Crohn’s disease Complications
- Bowel Obstruction: Crohn’s disease causes any part of the bowel to thicken and narrow over time due to inflammation. This is mainly because Crohn’s disease affects the whole wall of the intestine. Therefore, the thickening of the wall will cause the block of the flow of digestive contents, leading to a life-threatening complication like this one.
- Malnutrition: The inflammation of the intestinal wall, diarrhea, abdominal pain, and cramping makes it difficult for the intestines to absorb the nutrients. Hence, these patients tend to develop anemia and vitamin B-12 deficiency.
- Fistulas: Inflammation can extend through the intestinal wall creating a duct that receives the name of fistula. It is an abnormal connection between body parts. The most common type of fistulas is around the anal area. These fistulas tend to become infected and form an abscess (a pus collection)
- Anal Fissure: It directly correlates with painful bowel movements; it creates small cracks in the tissue of the anus. Sadly, very often, these fissures can become infected.
Ulcerative Colitis Complications
- Toxic Megacolon: It is an acute form of colonic distension in which the colon rapidly widens and swells. Therefore, it can be a deadly complication that includes fever, abdominal pain, and shock. The colon can be perforated and cause sepsis.
- Perforated Colon: It is one of the most common complications of toxic megacolon. Sadly, after the colon’s acute distension, it becomes very easy to perforate, leading to a life-threatening condition.
- Severe dehydration
How is the IBD diagnosed?
In order to diagnose Inflammatory Bowel Disease, your doctor will rule out first all of the other possible causes. The doctor will perform a complete history in which it will ask for antecedents. Among the most important are a familiar history of IBD, colon cancer, celiac disease, and smoking.
To help confirm the diagnosis, the doctor will ask for a combination of the following tests.
- Complete blood count: The doctor will look for signs of anemia or infections to rule out these possible causes. The complete blood count enables the doctor to see the red blood cell count to diagnose anemia.
- Stool Studies: The doctor will ask for a stool sample to check the presence of blood and infectious organisms within the stool.
- Colonoscopy: This test consists of a thin tube that goes through the anus enabling the doctor to see inside the colon. Also, the doctor will take samples of the tissue for further analysis and rule out other certain conditions.
- Flexible Sigmoidoscopy: It is very similar to the colonoscopy; the only difference is that the tube is flexible. This enables the doctor to see the rectum and the sigmoid. Besides, it is very useful when the colon inflammation is severe.
- Upper Endoscopy: It is a very rare test for this disease unless the patient suffers from nausea, vomiting, and difficulty eating. The doctor will introduce a flexible tube through the mouth to examine the esophagus, stomach, and the first part of the small intestine.
- X-Ray: If the symptoms are severe, the doctor will perform a simple x-ray of the abdomen to rule out serious complications like toxic megacolon or a perforated colon.
- CT Scan: This test provides a more detailed image of the entire bowel and its surroundings.
- Magnetic Resonance Imaging (MRI): It is an imaging test that helps with the soft tissue images. MRI is very useful in patients with a fistula around the anal area.
What medical treatments are available for IBD?
The main goal of the therapy for Inflammatory Bowel Disease is to reduce the inflammation of the intestines. This will reduce the symptoms and the possibility of a complication. The options for IBD treatment include either drug therapy or surgery by a colorectal surgeon.
The options are the following:
- Anti-Inflammatory Drugs: These drugs are the first line of treatment that includes corticosteroids and aminosalicylates. Your IBD specialist will use these medications to reduce the inflammation of the intestines and decrease symptoms.
- Immune System Suppressors: The most common of these medications is methotrexate. They work in several ways, trying to reduce the immune system’s effect within the body to reduce the damage caused by your immune system within the intestines.
- Biologics: This is a new type of drug therapy whose main target is to neutralize the body’s proteins that cause the inflammatory process.
- Antibiotics: Although it is not very common, they are very useful when there are signs of infection. For example, perianal fistulas can become an abscess.
- Another type of medications: These include over the counter drugs that may help relieve the symptoms more instantly. Among them are anti-diarrheal medications, pain relievers, and vitamins and supplements.
- Nutritional support: Nutrition plays a major role in IBD. If the weight loss is severe, the doctor may recommend a special diet through a feeding tube or the vein. This will ultimately improve the patient’s overall condition and allow the bowel to rest, reducing the inflammation.
- Surgery: If none of the previous therapies work, surgery might be the best option. Despite that, the type of surgery will depend if it is Ulcerative Colitis or Crohn’s Disease. In Ulcerative colitis, the colorectal surgeon will remove the entire colon and rectum. If it is Crohn’s disease, the surgeon will remove the damaged portions and reconnect the intestines’ healthy portions.
What foods should you avoid if you have IBD?
Nutrition is indeed a serious problem within the Inflammatory Bowel Disease, so the diet is essential. Still, what the patient eats will not completely alleviate their symptoms; it may help with the disease’s overall development. Eating certain foods can lead to severe discomfort.
That is why you should try to avoid the following foods:
- High fiber content foods like beans.
- Nuts, seeds, and popcorn.
- High-fat content foods
- Caffeine and alcohol
- Spicy foods
- Raw fruits and vegetables
Moreover, it is also very important for patients to identify foods that cause problems while eating them. Keeping track of these foods has been very useful for patients and doctors in IBD care and management. Nonetheless, always ask your doctor first before removing food from the diet.
Is IBD an autoimmune condition?
This is a topic that has been in discussion for years within the medical community. The main problem in Inflammatory Bowel Disease is the activity of the Immune System. Nonetheless, it can happen through many processes. Many scientists believe that there can be an autoimmune component within the disease.
However, some scientists believe that this can be an Immune-Mediated pathology, but what does that mean? Very simple, within the gut, lives the healthy and normal bacterial flora that helps the intestines in their processes. The trouble is that in Inflammatory Bowel Disease, a genetic component may affect the immune cells.
Usually, the immune cells recognize the gut flora as a non-invasive pathogen (which will not harm the body) and part of the body. In IBD, the genetic defect can cause the immune cells to lose tolerance for the flora. This loss of tolerance will ultimately lead to an immune cell response and attack that will lead to inflammation. Although there are no conclusive studies yet, this is one of the most accepted theories for this disease.
Does IBD get worse over time?
This will depend on the care that you receive. Every person is very different from each other, and many people can react to therapies differently. Consequently, your doctor will always do everything on its reach to avoid further complications of the disease and to keep it under control.
Keep in mind that the medications’ main goal is to reduce this disease’s flare-ups, prevent them, and maintain remission. Therefore, if left untreated, this condition can worsen over time, leading to several complications that can be life-threatening. Also, without proper treatment, people can suffer from complications like bowel obstructions, tissue breakdown, and malnutrition.
Do you have IBD symptoms?
This tool is an IBD Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for inflammatory bowel disease. Therefore, it would tell anybody who uses it the likelihood of their symptoms because of IBD. Using the tool is free and would only take a few minutes.