JOIN USThe ABC of IBD
Chronic illness known as Inflammatory Bowel Disease (IBD) produces ulcers and inflammation in the digestive tract. Although it is frequently observed in young adults, it can afflict people of all ages, including infants and the elderly. Ulcerative colitis and Crohn’s disease are two subgroups of IBD. Crohn’s disease can affect any portion of the intestine, from the mouth to the anus, but ulcerative colitis only affects the large intestine. The condition typically has flare-ups and quiet periods that have a substantial impact on the patient’s quality of life. IBD was seen as a Western disease and was uncommon in India 30 years ago. As a result of changes in dietary habits and improved hygiene, the microbiome of the intestine has changed, and we are now seeing more patients in our country. Of course, more case detection has been brought about by greater awareness and improved diagnostic tools.
What causes IBD?
What causes IBD is an area of intense research. Multiple factors have been considered including genetics, dietary factors, and environmental toxins. Smoking and frequent use of antibiotics in childhood are thought to be major culprits in causing changes to the microbiome. These factors result in an unregulated immune system which causes inflammation of the intestines.
Symptoms
Patients with IBD usually present with diarrhoea, blood in stools, abdominal pain, weight loss, and anal fistula. It can also affect areas outside the intestine and cause symptoms like joint pain, low back aches, skin lesions, and eye symptoms.
Diagnosis
Diagnosis is often delayed because symptoms are attributed to tuberculosis, amoebiasis, or piles and are often ignored. Systemic evaluation with colonoscopy, blood, and stool tests are necessary. A CT or MRI scan is often necessary for Crohn’s disease.
Treatment
IBD needs to be diagnosed and treated early so as to avoid intestinal damage resulting in surgery and cancer as chronic inflammation in the digestive tract can result in complications within and outside of the digestive tract. Currently, there are a plethora of medications available for treating patients with IBD. A gastroenterologist specialising in IBD must be consulted for choosing the appropriate medication wisely and managing this condition. A single, short-term course of steroids rapidly brings down the symptoms, but, unfortunately, does not control the disease and can result in many complications. Immunomodulators and newer drugs like biologics and small molecules are increasingly being used with good results. Surgery may be necessary for patients with very severe diseases. Faecal microbiota transplant (FMT) is an evolving treatment strategy and can be a game-changer in difficult cases of IBD. Diet plays an important role in this condition. Avoiding processed and refined food and the use of an anti-inflammatory diet will go a long way in preventing as well as controlling the disease. Exclusive enteral nutrition is a specialised form of liquid-based diet that is excellent in controlling the disease, particularly in children. Therefore, IBD is best managed by a multi-disciplinary team of IBD specialists, GI surgeons and nutritionists.
Monitoring
Regular medications, close monitoring and follow-up with the team ensure good control of disease and excellent quality of life. This is integrated into the “Treat to target” strategy and will necessitate blood tests, stool tests, and timely escalation of medications. Exciting developments include routine use of stool calprotectin and intestinal ultrasound which helps in monitoring IBD.
(The authors are gastroenterologists.)