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) due to ongoing blood loss and hindered absorption of iron caused by inflammation in the tissues.

Listen to our expert discuss iron deficiency anemia.

Although the specific origin of Inflammatory Bowel Disease (IBD) is unknown, it is believed to result from a combination of:

• Genetic predisposition
• Viral factors
• Immunological responses
• Nutritional influences
• Environmental variables

In patients with genetic susceptibility to IBD, the body's immune system may become activated. Typically, the immune system defends the body against illnesses caused by viruses or bacteria. Once the virus is eradicated, that part of the immune system "shuts down" until it is needed again.

However, in IBD patients, the immune system may overreact to normal microorganisms in the digestive system. When activated, the immune system fails to shut down appropriately, leading to inflammation that can damage the digestive system over time.

• Genetic predisposition: IBD can run in families. You have a higher chance of acquiring inflammatory bowel disease if you have a close relative who suffers from the same.
• 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.
• Age: IBD can manifest at any point in life, although it is more commonly diagnosed before or around the age of 30.
• Auto-immunity: IBD involves the immune system mistakenly attacking healthy cells in the gut, causing chronic inflammation and symptoms.
• Stress: Stress is believed to initiate or reactivate inflammation in the gastrointestinal system, contributing to the worsening of clinical symptoms associated with IBD.
• Smoking: Individuals who actively smoke have over double the risk of developing Crohn's disease.
• 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.
• Medications: Certain medications have been linked to the development of inflammatory bowel disease, including:
  • 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 hormone replacement therapy (HRT): Both may increase the risk of IBD in women.
  • 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.
• Lack of vitamin D: Research has revealed a link between a lack of vitamin D and the development or worsening of IBD.
• 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.
• Poor dietary choices: Poor dietary habits, such as excessive consumption of fast food, sugar, omega-6 fatty acids, trans fats, processed meat, and a lower fiber diet, 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.
• Perinatal (early life) factors: Early events in childhood, such as feeding practices, hygiene at home, infections around birth, and vaccinations, might affect the development of inflammatory bowel disease.

A combination of tests and procedures is required to help confirm an IBD diagnosis, which includes:

1. Medical history and symptoms
   • Family history of IBD (Crohn's or colitis), such as a grandmother, parent, sibling, or child.
   • Smoking status (past or present).
   • Prior hospitalization or surgery.
   • Current medications (e.g., antibiotics and hormonal medications like oral contraceptives).
   • Other illnesses (e.g., colorectal disease, celiac disease, and arthritis).
   • Prior infection with Clostridium difficile (C. difficile or C. diff).
2. Blood tests
   • Complete blood count (CBC): Measures the number of red blood cells, white blood cells, and platelets. Low red blood cell count (anemia) and elevated white blood cell count can indicate inflammation.
   • C-reactive protein (CRP): A marker of inflammation; elevated levels suggest ongoing inflammation, common in IBD.
   • Erythrocyte sedimentation rate (ESR): Measures how quickly red blood cells settle; higher rates can indicate inflammation.
   • Antibody tests: Differentiates between Crohn’s disease and ulcerative colitis by testing 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.
   • Fecal calprotectin: 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: Invasive tests where a probe is inserted via the mouth (endoscopy) or rectum (colonoscopy) to visualize the inner structures of the digestive tract in real-time.
   • Capsule endoscopy: A capsule containing a tiny camera is swallowed, allowing the doctor to visualize the digestive tract as it travels through.
5. Imaging techniques
   • Abdominal X-ray: Performed in suspected cases of IBD to visualize inflammation, structural changes, and complications in the intestines.
   • Ultrasound: Aids in diagnosing IBD by visualizing the intestines, detecting inflammation, and assessing complications without radiation.
   • Barium X-rays and fluoroscopy: Involves ingesting barium to enhance visibility of the upper GI tract on X-ray images.
   • CT scan: Uses a machine to capture a sequence of X-rays to create an image of the digestive tract to check for signs of inflammation.
   • Magnetic resonance enterography (MRE): Generates detailed pictures of the small intestine and aids in the diagnosis of IBD.
6. Biopsy
   • Biopsies of the colon can be taken to confirm the diagnosis, effectively diagnosing the disease and differentiating the type of inflammation.

Getting your tests done has never been easier. Book your tests now.

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

• 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.
• 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.
• 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.
• 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.
• 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.

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 medications:
  • Anti-diarrheal medications: Over-the-counter drugs like loperamide can help control diarrhea.
  • Pain relievers: Such as acetaminophen, 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 medications, 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: This surgical procedure is 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.

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.

• Aloe vera: It has shown potential in reducing intestinal inflammation in individuals with IBD, but its effectiveness and safety have not been extensively studied.
  • How to use it? You can eat the aloe chunks raw or use a cooking method like steaming to make it palatable.
  • Buy aloe vera juices online.
• 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.
• 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.
• 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.

Patients with inflammatory bowel disease (IBD) or the medications used to treat it can be 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: This is a narrowing of a section of the intestine caused by scarring, which can result in an intestinal blockage.
• Ulcers: These are open sores that can occur in the mouth, intestines, anus, or perineum (bottom area).
• Abscess: A collection of pus, most commonly found in the abdomen.
• Anal fissures: These are small tears in the anus.
• Malabsorption and malnutrition: This includes deficiencies of vitamins and minerals, such as anemia.
• Bone disorders: These can include joint pain, arthritis, and fibromyalgia (chronic pain).
• Skin conditions: These may present as tender bumps, painful ulcerations, and other sores or rashes.
• Eye disorders: Conditions such as uveitis (eye inflammation) and dry eyes may occur.
• Kidney stones: These can develop as a complication of IBD due to factors like dehydration, inflammation, and medication use.
• Liver disorders: These include hepatitis, gallstones, and primary sclerosing cholangitis (PSC), a severe form of swelling and scarring that develops in the bile ducts.
• Anxiety and depression: These can arise due to the impact of chronic illness on mental well-being.

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. These include:

• Common mind-body techniques: Stress and emotional variables may impact IBD symptoms. These treatments include cognitive behavior therapy (CBT), relaxation techniques, meditation, and yoga. They can aid in stress management, promote relaxation, and enhance overall well-being in individuals with IBD.
• Probiotics: Probiotics 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 include yogurt and tofu.
• Prebiotics: Prebiotics serve as nourishment for the beneficial bacteria residing in your digestive system. Some sources of prebiotics include asparagus, legumes, and bananas. Probiotics and prebiotics can effectively maintain gut health.
• Acupuncture: Acupuncture is a traditional Chinese medicine practice involving the insertion of tiny needles into specific points on the body. Research suggests that acupuncture may help reduce inflammation and relieve symptoms of IBD.
• Moxibustion: Moxibustion is a type of traditional Chinese medicine often used in conjunction with acupuncture. It involves burning dry herbs near the skin, frequently around acupuncture sites, to alleviate Crohn's symptoms.

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:

• Educate Yourself: Learn about inflammatory bowel disease, its symptoms, triggers, and treatment choices.
• 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.
• Communicate with Your Healthcare Team: Maintain a positive relationship with your healthcare providers. Communicate your symptoms, concerns, and treatment response regularly to ensure you receive appropriate care.
• Adhere to Your Medications: If you have been prescribed medication for IBD, it is critical that you take it exactly as directed by your doctor. Adhering to your treatment plan will help you control your disease and lower your risk of flare-ups.
• Immunize Yourself: Immunizations play a vital role in the primary prevention of infections, especially for individuals with IBD, who are at higher risk of contracting vaccine-preventable diseases like influenza, pneumonia, and shingles. Immunization is a crucial method for disease prevention.
• 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.
• Take Vitamin Supplements: Your doctor may advise you to take vitamin supplements if your body does not get all the nutrients it requires from food due to IBD. You may require vitamin B12, folic acid, vitamin D, calcium, or iron supplements.