What is IBD?
Inflammatory bowel disease (IBD) is a chronic, progressive, relapsing disorder that causes prolonged and recurrent episodes of inflammation in the gastrointestinal tract. It has two types, namely; ulcerative colitis (UC) and Crohn’s disease (CD).
UC is characterized by inflammation limited to colonic mucosa and submucosa. The inflammation always involves the rectum and may affect the entire colon.
CD is characterized by inflammation of the entire thickness of the gastrointestinal tract. It may affect any segment of the gastrointestinal tract, from the mouth to the anus.
Ulcerative Colitis
UC is one of the two types of inflammatory bowel diseases (IBD). It is also the more common of the two types. It is characterized by inflammation of the superficial inner lining of the large intestines (mucosa and submucosa) which leads to ulcers and bleeding. It may affect only one part of the large intestines, such as the rectum, or it may affect the entire length of the large intestines.
Causes of Ulcerative Colitis (UC)
The exact cause of UC is still not yet fully understood. However, various factors may contribute to the disease. These include genetics and disturbances in one’s immune response. Changes in the balance of “good” and “bad” bacteria (dysbiosis) in the large intestines may also play a role.
Risk factors for Ulcerative Colitis (UC)
The risk due to genetics is present in UC but not as prominently as in Crohn’s disease, the other type of IBD. Race is also a risk factor: UC is more common among those with Ashkenazi Jewish ancestry (Eastern Europe). However, even among people in Asia, including the Philippines, the number of patients with UC is increasing.
Symptoms of Ulcerative Colitis (UC)
The symptoms of UC may vary from person to person. The most common symptom is bloody diarrhea. The stool may or may not have mucus. Other less common symptoms include a sense of urgency to defecate, abdominal pain, body weakness, weight loss, or fever.
Up to 1 in 3 patients with UC may also experience symptoms felt in other parts of the body, such as reddish skin rashes or joint pains.
Diagnosis of Ulcerative Colitis (UC)
To diagnose UC, your doctor would need to take a thorough medical history and physical examination. Tests he/she may request include:
- Colonoscopy with biopsy. In this procedure, a long, flexible tube with a tiny video camera at the tip is inserted into the rectum. This allows the doctor to view the inside of the entire large intestines. During the procedure, a small sample of tissue (biopsy) may also be taken for further examination/s in the laboratory.
- Abdominal X-rays, abdominal ultrasound, CT scan, or MRI may also be performed.
- Stool tests may be performed to investigate for other possible causes of diarrhea and other symptoms. A stool test called fecal calprotectin (FC) may be used to determine the severity of the mucosal inflammation and monitor the disease outcome of treatment.
- Other tests may include various blood tests, such as a complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), perinuclear antineutrophil cytoplasmic antibodies (pANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), and tests to assess for levels of specific nutrients in the blood.
Treatment of Ulcerative Colitis (UC)
The treatment of UC may vary, depending on the extent and severity of your condition. For mild disease limited to the rectum, topical (rectal) medications such as 5-aminosalicylic acid (5-ASA) may be recommended. In mild UC affecting the left side of the colon, oral 5-ASA may be used together with topical medications. Oral and/or intravenous medications, usually combined with topical preparations, become the main treatment as UC becomes more extensive.
Some patients who do not respond to 5-ASA may need oral corticosteroids. These drugs may also be used for more severe or extensive disease. cases. Other recommended treatments for severe UC include some oral medications such as thiopurines or tofacitinib, or injectable drugs, such as, infliximab or vedolizumab.
Note that all these treatments require the prescription and supervision of a healthcare professional. Your gastroenterologist will discuss with you the best type of treatment for UC, depending on your specific situation and preferences.
Complications of Ulcerative Colitis (UC)
Complications may occur and, at times, can be fatal. Some of these complications include severe infections, toxic megacolon (extensive distension of the colon due to swelling and inflammation), perforation, life-threatening bleeding, electrolyte imbalance, and malnutrition.
UC is a chronic inflammatory condition that could predispose a patient to colorectal cancer.
Next Steps
If you are experiencing one or more symptoms of UC and these symptoms persist for more than two weeks, see your doctor, preferably a gastroenterologist, as soon as possible.
Furthermore, see your doctor immediately if you experience any of the following:
- Bloody diarrhea
- Severe abdominal pain
- Abdominal distension
- High fever
- Severe weakness
- Difficulty of breathing, chest pain, or palpitations
- Loss of consciousness
If you have had UC for the last 10 years or more, talk to your gastroenterologist about surveillanace colonoscopy and chromoendoscopy.
Crohn’s Disease (CD)
Crohn’s disease (CD) is one of the two types of inflammatory bowel diseases (IBD). CD is characterized by inflammation of the entire thickness of the wall of the gastrointestinal tract. It may affect any segment of the gastrointestinal tract, from the mouth to the anus. The inflamed lining (mucosa) of the intestines form several longitudinal ulcers running along the length of the bowel which often assume a “cobblestone” appearance. Scarring (fibrosis) of intestinal segments badly damaged by the disease results into strictures and mechanical obstruction.
Causes of Crohn’s disease (CD)
The exact cause of CD remains to be unknown. Studies demonstrate that CD may be due to multiple factors such as genetics, environmental exposure, and inappropriate immune response to intestinal microbes.
Risk factors for Crohn’s disease (CD)
The risk due to genetics is evident in CD. Those of Caucasian descent (especially of Eastern European [Ashkenazi] Jewish descent) and a family history of CD are known risk factors of CD.
Among Westerners, CD is most common among individuals aged 15-30 years with a smaller increase at ages 60-70 years. Asians with genetic predispositions may develop CD at the age of 20-39 years. In the Asia Pacific region, CD is more common among males (1.67:1 to 2.9:1) unlike in the West, where CD has either a female predominance or no without gender differences.
Cigarette smoking is also a significant risk factor for the development of CD. Individuals who smoke are almost four times more likely to develop CD. A higher intake of fatty acids, like frequent fast-food consumption also increases the risk by three- to four-fold.
Symptoms of Crohn’s disease (CD)
Symptoms of CD depend on the location and severity of the disease. Some patients may have symptoms for years before being diagnosed correctly. In children, failure to thrive and stunted growth are common symptoms.
Hallmark symptoms of Crohn’s disease are abdominal pain, diarrhea, fatigue, and weight loss. Abdominal pain is usually described as crampy and most prominent in the lower right part of the abdomen. Diarrhea, with or without blood, is a common symptom. As the disease progresses, fatigue, weight loss, and anemia may also occur.
Up to 1 in 3 patients with CD may also experience symptoms felt in other parts of the body, such as joint pains, skin rashes, and eye symptoms.
Diagnosis of Crohn’s disease (CD)
To diagnose CD, your doctor would need to take a thorough medical history and physical examination. Tests he/she may request include:
- Colonoscopy with biopsy. In this procedure, a long, flexible tube with a tiny video camera at the tip is inserted into the rectum. This allows the doctor to view the inside of the entire large intestines. During the procedure, a small sample of tissue (biopsy) may also be taken for further examination/s in the laboratory.
- Abdominal X-rays, abdominal ultrasound, CT scan, or MRI may also be performed.
- Stool tests may be performed to investigate for other possible causes of diarrhea and other symptoms. A stool test called fecal calprotectin (FC) may be used to determine the severity of the mucosal inflammation and monitor the disease outcome of treatment.
- Other tests may include various blood tests, such as a complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), perinuclear antineutrophil cytoplasmic antibodies (pANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), and tests to assess for levels of specific nutrients in the blood.
Treatment of Crohn’s disease (CD)
Mild to moderate CD may be treated with oral mesalamine (also known as mesalazine or 5-aminosalicylic acid) or other drugs that modulate inflammation (immunomodulators). These drugs include thiopurines, methotrexate, or steroids.
Moderate to severe disease is best treated using a combination of immunomodulators and biologics (e.g., infliximab, adalimumab, golimumab, vedolizumab, ustekinumab, etc) or biologics alone.
Surgery may be needed to treat complications, such as, bowel obstruction, abscess, fistula, or perforation.
Note that all these treatments require the prescription and/or supervision of a healthcare professional. Your gastroenterologist will discuss with you the best type of treatment for CD, depending on your specific situation and preferences.
Complications of Crohn’s disease (CD)
CD may lead to complications, such as, obstruction, fistula (abnormal tunnels connecting two hollow organs), abscesses, and bowel perforation. Other complications of CD include cancer, malnutrition (due to decreased food intake and malabsorption), and gastrointestinal bleeding.
Next Steps
If you are experiencing one or more symptoms of CD and these symptoms persist for more than two weeks, see your doctor, preferably a gastroenterologist, as soon as possible.
Furthermore, see your doctor immediately if you experience any of the following:
- Bloody diarrhea
- Severe abdominal pain
- Abdominal distension
- High fever
- Severe weakness
- Difficulty of breathing, chest pain, or palpitations
- Loss of consciousness
If you have had CD for the last 10 years or more, talk to your gastroenterologist about surveillanace colonoscopy and chromoendoscopy.
Nutrition for IBD patients
Your nutrition is important if you have IBD. Many patients with IBD may become at risk of for malnutrition. Therefore, you should ensure that you eat enough calories, proteins, and foods rich in vitamins and minerals to avoid malnutrition. While there is really no specific “IBD diet”, keep the following nutritional tips in mind:
For patients with Ulcerative Colitis (UC)
Increase consumption of natural sources of omega-3 fatty acids (e.g., from wild salmon and other natural sources, but not from supplements). Avoid the food enumerated above for CD, and possibly red and processed meat.
For patients with Crohn's Disease (CD)
Regular intake of fruits and vegetables (if you do not have intestinal strictures). Avoid saturated-, trans-, and dairy-fat, processed dairy or foods rich in maltodextrins, artificial sweeteners containing sucralose or saccharin, highly processed foods, and additives.
For patients with either CD or UC
No recommended changes in the consumption of wheat, gluten, poultry, alcoholic beverages (except binge drinking), refined sugars, and pasteurized dairy products.
Mental wellness of IBD patients
IBD may cause significant stress and mental distress (due to insomnia, fatigue, treatment concerns, and stigma), which may progress to anxiety and depression. If you are experiencing any of these mental difficulties, talk to your physician soon. He/She can help you address some of these concerns and may also refer you to a psychologist or psychiatrist to help you cope. Furthermore, reach out to family and friends who can provide emotional support.
Contact or join patient support groups so you can learn from them many more positive insights about your condition. In the Philippines, the organization called Crohn’s & Colitis Philippines (C&Cph) is a very active patient support group composed of patients with IBD.