JOIN USInflammatory bowel disease (IBD) indicates longstanding abnormal injury to the intestinal lining. It comprises of two diseases — ulcerative colitis and Crohn’s disease. While ulcerative colitis is limited to the colon, Crohn’s disease can affect any part of the intestine.
The exact cause of inflammatory bowel disease remains unknown. Inflammatory bowel diseases are triggered by an abnormal immune reactions that can lead to diarrhoea, abdominal cramps, rectal bleeding, fever, joint pain, loss of appetite, fatigue, weight loss and occasionally fistulas. When the immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract along with the virus. A few individuals may develop serious complications that can require surgery to remove the colon.
Though it’s more common among the Western population, we have been seeing a lot of these cases in India too. It usually affects the middle-age population. Both men and women are equally affected. Risk factors include genetic or a family history of IBD, smoking, a sedentary lifestyle and eating processed food, intestinal infections, use of drugs like nonsteroidal anti-inflammatory drugs and analgesics. A high-fat or a high-sugar diet may also be one of the risk factors.
Complications include bleeding leading to anaemia, perforation in the intestine, narrowing of the intestine causing obstruction, tumour formation in the intestine and malnutrition. Inflammatory bowel disease can also be associated with jaundice, and recurrent eye and skin infections.
Physical examination followed by colonoscopy with biopsy of the affected intestine is the most important test. Upper gastrointestinal endoscopy may be required in patients with suspected involvement of upper gastrointestinal tract.
However, certain blood tests like complete blood count, erythrocyte sedimentation rate, C-reactive protein, stool tests like faecal routine, faecal occult blood, faecal calprotectin are also helpful in diagnosing IBD. A few patients may require capsule endoscopy or computed tomography scan to look for small bowel involvement. Endoscopic ultrasound or magnetic resonance imaging may be required to assess fistulas. Patients also require surveillance colonoscopy once they have long-term disease to detect cancers of the intestine.
Treatment: The first step in the treatment includes anti-inflammatory medications like aminosalicylates. However, many patients may require steroid medications as well. Steroids may be administered either orally or as injectables. When patients have recurrent symptoms, they may require immune modulators. Some patients with severe disease may require biological agents like infliximab or adalimumab which are recent drugs with good success rates, but have a few adverse effects.
Long-term medication
These medications need to be taken for a long time and in some cases, for life. Non-compliance is one of the most common causes of flaring up of the disease. Other causes of flaring up of underlying IBD include infections, stress and analgesics. A few individuals who don’t respond to any of the above treatments may require surgical intervention leading to the removal of a part of the intestine. Complementary alternative medicines have been tried with variable success.
Although there is no firm evidence that what you eat actually causes inflammatory bowel disease, certain food and beverages can aggravate the symptoms, especially during a flare-up. The following tips may help. Limit dairy products, include a low-fat, low-fiber diet and have small, frequent meals and plenty of water. Avoid a spicy diet, alcohol and caffeine. Dietary restrictions should be individualised and any factor which aggravates symptoms should be avoided. Maintain a diet diary and identify the culprit food accordingly.
Since stress is an aggravating factor, exercise, relaxation, yoga and meditation will be helpful. With regular follow-up and medication, most patients can be managed effectively. Do not neglect any blood in the stool. It could be IBD. Visit a gastroenterologist and take treatment accordingly. Inflammatory bowel disease is treatable with medications and compliance of medication is very important in this case. Only a few patients may require surgical intervention. All patients with IBD require regular follow up and surveillance colonoscopy to detect or prevent cancer.
(The writer is Consultant, Medical Gastroenterology, BGS Gleneagles Global Hospitals)