Inflammatory bowel disease (IBD) is a disorder characterized by prolonged inflammation of the gastrointestinal tract that results in ulcerations in the lining of the bowels. It may also create bowel strictures and abnormal communications (fistula) between the bowel and other hollow organs, e.g., urinary bladder, vagina, or with fistula formation to the skin. It is also associated with a risk for future development of colon cancer.
Frequently Asked Questions
Is inflammatory bowel disease (IBD) an autoimmune disease?
Yes. An autoimmune disease is a disease caused by the immune system attacking one’s own healthy tissues. Studies have previously shown that patients with ulcerative colitis, one type of IBD, had antibodies that attack the cells of the lining of the large intestines (colon). Similar autoimmune processes may also contribute to manifestations of IBD beyond the bowels, such as eye symptoms or joint pains in patients with IBD.
Can IBD be inherited by the children of IBD patients?
Yes, IBD tends to run in families. The siblings and children of patients with IBD have a greater risk of developing the condition compared to the general population. This hereditary risk is greater in CD than in UC. However, genetics is not the only factor and many environmental factors also contribute to the development of IBD.
Can stress cause IBD?
No. There are no studies that clearly show that stress causes IBD. However, a patient’s perception, interpretation, and handling of the recurring symptoms of IBS may affect the level of stress they experience. The impact of a long-term illness on mental health may also increase the stress experienced by IBD patients.
Is irritable bowel syndrome (IBS) and IBD similar diseases? Can IBS predispose one to developing IBD in the future?
No. Although both diseases can present with abdominal pain and diarrhea. IBS is a functional disorder and not associated with anatomical abnormalities of the intestines, while, IBD is characterized by inflammation, ulcerations, and structural involvement of the bowel. There is no unequivocal evidence that IBS is an underlying condition contributing to the future occurrence of IBD.
Are the treatments for IBD needed to be taken for an entire lifetime?
In patients with mild IBD, with low risk for severe complications, and with infrequent flares and long periods of remission, there is little need for or benefit from prolonged treatment. However, watchful monitoring is recommended.
In UC, long-term treatment must be considered if certain disease characteristics predictive of poor outcomes, i.e., young age at diagnosis, extensive colitis, and frequent flares needing steroids or hospitalization are present.
In CD, young age at disease onset, ileal or ileocolonic involvement, deep ulcerations, extensive anatomical involvement, perianal or severe rectal disease and fistulizing/stenosing disease are considerations for long-term treatment.
What is the role of fecal microbiota transplantation (FMT) in the treatment of IBD?
FMT is the process of administering stools from individuals whose feces contain very diverse proportions of intestinal bacteria (the gut microbiome). Treatment outcomes of good studies on FMT in patients with UC look very promising. The role of FMT for CD needs further elucidation.
Are there life-threatening complications of IBD?
Acute severe colitis associated with fever, severe diarrhea and marked dilatation of the colon (toxic megacolon) in patients with UC may lead to fatal outcomes. Severe infections due to the immunocompromised status of IBD patients or secondary to complications (intra-abdominal abscesses, intestinal perforation, massive intestinal hemorrhage), and thromboembolic events are life-threatening complications described in IBD patients.
Is there a specific “IBD diet”?
Strictly, there is no specific diet prescribed for patients with IBD. However, certain expert groups have issued several general recommendations. Please refer to the section on Nutrition for additional guidance.
How do I measure success with my long and often expensive IBD treatment?
The current targets of successful IBD therapies are the following: healing of the intestinal ulcers, resolution of rectal bleeding and abdominal pain, normalization of bowel habits, and significant improvement of the IBD patients’ quality of life so that they can “return to Society” as productive individuals. These results are achieved in approximately 55-60% of adequately treated patients.
Is it possible and safe for women with IBD to get pregnant?
Yes. Pregnancy can be planned so that at conception, the disease is in remission and good control. Some IBD medications may increase slightly the risks of adverse events to both mother and child, e.g., methotrexate. The manner of delivery is influenced by the patients’ prior surgeries related to IBD, e.g., IPAA or colostomy.
Are IBD medications safe during pregnancy?
The medications for IBD are relatively safe to use during pregnancy. Only the following medications are not allowed to be taken by a pregnant IBD patient, i.e., ciprofloxacin, diphenoxylate-atropine and loperamide. Steroids are associated with a very slight increase in the risk for cleft lip, cleft palate, low birth weight, and premature delivery. Other IBD medications are generally safe during pregnancy, i.e., 5-ASA, azathioprine, mercaptopurine, infliximab, adalimumab, and certolizumab pegol.
Consult your IBD doctor regarding medications you can continue safely during pregnancy.
Can IBD increase the risk of colorectal cancer?
Yes. The chances of developing colon cancer in patients with long-standing IBD, i.e., 8 years of illness or longer, is increased slightly. It is higher in patients with poor control of intestinal inflammation and in those with frequent exacerbations. Thus, enrolling an IBD patient into a colorectal cancer surveillance program is recommended.
What are the risks associated with COVID-19 among IBD patients?
Patients over 60 years old, presence of co-morbidities and current high dose corticosteroid use are associated with a severe course of COVID-19. As diarrhea and abdominal pain may occur in COVID-19 infection, new-onset symptoms must be investigated among IBD patients. Tight control of IBD by continuing diligently on-going medications is essential. Consulting your doctor is also encouraged.
Myths & Fallacies
A Filipino IBD patient must always have a foreign ancestry (in his blood line)?
FACT: Over the last 30 years, we have seen, diagnosed, and treated patients of truly Filipino ancestry who presented with symptoms, endoscopic, radiologic, and biopsy features compatible with IBD. They have also responded and had disease control with established medications for ulcerative colitis (UC) or Crohn’s disease (CD).
IBD occurs only in Caucasians, especially individuals with Jewish descent. IBD does not occur among Filipinos.
FACT: While IBD was first described in the West and is more commonly seen in some ethnic groups, e.g., Ashkenazy Jews, it is also seen with increasing frequency among Asians in the last 50 years. Likewise, the number of Filipinos living in the Philippines with IBD is also growing.
Probiotics are good alternative therapies for IBD
FACT: Certain probiotics (i.e., VSL#3) may be effective in preventing the onset and in maintaining the remission of pouchitis (inflammation of the ileal pouch, an artificial rectum created for patients who have undergone a colectomy, which may be done in patients with UC). It may also be effective in maintaining the remission of UC. Therefore, these specific probiotics may be good as adjunctive therapies to supplement IBD treatment, but not as alternatives that could replace conventional IBD therapies.
Patients with IBD will never live normal lives again
FACT: IBD can be a challenging situation to live with, but it does not necessarily hinder patients from living the lives they want to live. Patients should work closely with their medical professional(s) to effectively manage the disease and ensure an optimal quality of life.
Only a total colectomy will cure UC
FACT: If UC is severe and/or unresponsive to conventional treatments, removing the entire colon, rectum and anus may be an option. It is an extensively major operation which can eliminate your bowel symptoms, e.g., diarrhea, bloody stools, but you may still experience other symptoms associated with UC, e.g., joint pains, fatigue.
Gastrointestinal tuberculosis (GI TB) is very difficult to differentiate from CD
FACT: There are distinct differences in the symptoms and natural history of CD that may differentiate it from GI TB. Your doctor will perform a few examinations so that the diagnosis of either disease can be arrived at with good certainty. GI TB does not progress to CD.
Surgery in IBD is performed only as a last therapeutic resort
FACT: Many IBD patients respond to medical treatments and can be maintained on remission with such medications. Emergency surgery is performed for IBD-related complications like bowel perforation, obstruction and, severe GI bleeding. In patients with severe, refractory perianal CD, a temporary surgical diversion of colonic contents thru an abdominal stoma offers complete bowel rest and healing of fistulae.
Life expectancy is short in patients with IBD
FACT: UC and CD are serious diseases, often with complications needing surgery and prolonged treatment. However, they are not considered extremely fatal conditions. It is important that they are recognized early and treated aggressively so that patients live long and productive lives.
The Inside Story
What you need to know about Inflammatory Bowel Disease or IBD?
A project of The IBD Club of the Philippines and The Philippine Society of Gastroenterology.
Your Next Steps
See your doctor, specifically a Gastroenterologist if you experience a persistent change in your bowel habits or if you have signs and/or symptoms compatible with inflammatory bowel disease.
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