Inflammatory Bowel Disease

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Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is the term used to describe chronic (ongoing and lifelong) inflammatory disorders that affect your digestive tract. There are two main types of IBD:

  • Crohn’s disease – a condition that causes inflammation of the digestive system or gut. It can affect any part but most commonly Crohn’s disease affects the end of the ileum (the last part of the small intestine) or colon. As well as affecting the lining of the bowel it may go deeper into the bowel wall. Areas of inflammation may be patchy with sections of normal gut in between.
  • Ulcerative colitis – a condition that causes inflammation and ulceration of the inner lining of the rectum and colon (large bowel). Ulcers develop which may bleed and produce mucus. Inflammation usually begins in the rectum and lower colon but may eventually affect the entire colon.

Because these are lifelong conditions there is no cure, however you may have times when the condition is in remission and your symptoms are less. Conversely you may have relapses when the symptoms flare up and become worse.

Common symptoms of IBD are:

  • Diarrhoea, which may be mixed with blood, mucus or pus
  • Abdominal cramp which can be very severe, particularly before passing stools or after eating
  • Exhaustion, which may be exacerbated by anaemia or interrupted sleep due to pain or diarrhoea
  • Fever
  • Loss of weight due to the body not absorbing nutrients from food as a result of gut inflammation
  • Anaemia due to blood loss and lack of nutrients
  • Mouth ulcers
  • Abdominal bloating.

Less common symptoms are:

  • Fistulas – an abnormal channel connecting one internal organ to another. These are more common in people with Crohn’s disease
  • Strictures – narrowed sections of the bowel caused by inflammation that has healed causing the formation of scar tissue.

In addition to problems in your gut, you may also develop symptoms in other parts of the body including:

  • Joints – including arthritis of the elbows, wrists, knees and ankles
  • Eyes – including episcleritis, which causes the eyes to become red, sore and inflamed.

If left undiagnosed and untreated, IBD can lead to serious complications including bowel obstruction, abscess formation, perforation and colon cancer.

It isn’t yet known exactly what causes or triggers IBD to develop, but it is likely to depend on several factors. What results  is a malfunction of the immune system whereby it attacks the cells in your digestive tract.

The condition is more common in people who have one or more family members with the disease but most people with IBD don’t have anyone in their family with the disease.

Diet and stress are believed to exacerbate the problem but are not direct causal factors.

  • IBD is most commonly diagnosed in people under the age of 30
  • It can affect people of any race but white people and Ashkenazi Jews are most often affected
  • You are at higher risk of IBD if a close family member – parent, child or sibling – has the disease
  • Smoking is a risk factor, particularly for Crohn’s disease
  • Non-steroidal anti-inflammatory medication may increase your risk of developing IBD or worsen your symptoms
  • Environmental factors are also believed to increase your risk, including a diet high in processed foods or fat. Living in an industrialised country means you are more likely to develop IBD.

Treatment for IBD depends on how much of your gut is affected, what symptoms you have and how severe. Although there is no cure for the condition, the aim is to keep it in remission and prevent relapse.

Anti-inflammatory drugs are one of the main ways of controlling the symptoms of IBD. You may be prescribed:

  • Steroids
  • 5ASAs
  • Immunosuppresants
  • Biological drugs.

You may also be given antibiotics and treatment for diarrhoea.

Surgery may become necessary if medical therapies prove insufficient. Around eight out of every 10 people with Crohn’s disease will need surgery at some point in their lives and one out of every 4 people with ulcerative colitis. If possible, the surgeon will use laparoscopy (keyhole surgery) for a speedier recovery.

Among the common surgical procedures for Crohn’s disease are:

  • Strictureplasty – this treats narrowing of the small intestine. It involves opening up the narrowed section and reshaping it
  • Resection – this removes a damaged part of the gut. Once the section has been removed the two ends of the remaining healthy gut are joined back together
  • Ileocaecal resection – this removes the last part of the small intestine (terminal ileum) and first part of the large intestine (caecum). The healthy end of the small intestine is then joined directly onto the large intestine (colon)
  • Limited right hemicolectomy – this removes the right side of the colon. It is then joined up to the rest of the colon
  • Colectomy with ileostomy – in the case of severe Crohn’s disease, this removes most, or all, of the colon. The end of the small intestine is brought out through an opening in the wall of the abdomen to create a stoma. A bag is needed to collect the stools
  • Colectomy with ileo-rectal anastomosis – this is the removal of the colon but instead of creating an ileostomy, the end of the ileum (small intestine) is joined to the rectum. The operation is not possible in all cases
  • Proctocolectomy and ileostomy – this removes the colon, anal canal and rectum. An ileostomy is created for stool removal
  • Surgery for abscesses and fistulas – abscesses may need to be drained. Fistulas may either be cut open and flattened or have a thread called a seton inserted into them to drain any pus and allow infected tissues to heal.

Among the common surgical procedures for ulcerative colitis are:

  • Colectomy with ileostomy – this removes the colon but leaves the rectum. A temporary stoma is created to collect stools. This may eventually become permanent. The upper end of the rectum is either closed or brought to the surface as a temporary stoma to collect mucus. In some cases, after a colectomy you will be able to have a pouch to connect the ileum to the anus after the rectum has been removed
  • Restorative proctocolectomy with ileo-anal pouch – this is normally is done in two or three operations. In the first the colon is removed and a temporary stoma is created. In the second a pouch is made using the ileum, which is joined to the anus. In the third the temporary ileostomy is closed so the pouch can be used to collect stools, which then passes out of the anus in the normal way. There can be complications following surgery and you are likely to pass stools more often
  • Proctocolectomy with ileostomy – this removes the colon, rectum and anal canal. A permanent stoma is created in the wall of the abdomen
  • Colectomy with ileo-rectal anastomosis – this is performed rarely. It involves removing the colon and joining the end of the small intestine directly onto the rectum. It is only recommended if there is little or no inflammation in the rectum.

Unfortunately it is not always possible to prevent IBD. However, there are certain dietary strategies that may help you to control the symptoms and reduce the chance of a flare up:

  • Avoid foods that result in you needing to suddenly go to the toilet, such as fresh fruit and vegetables, caffeine and prunes
  • Cut back on sugar, which can increase the amount of water in your gut, contributing to watery stool
  • Eat smaller, more frequent meals
  • Decrease alcohol consumption and do not smoke
  • Consider taking nutritional supplements if your appetite is poor and you cannot tolerate solid foods
  • If you have strictures, avoid nuts, seeds and beans.

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