What are the other Names for this Condition? (Also known as/Synonyms)

• IBD (Inflammatory Bowel Disease)

What is Inflammatory Bowel Disease? (Definition/Background Information)

• Inflammatory Bowel Disease (IBD) is an umbrella term that encompasses two gastrointestinal conditions, ulcerative colitis (UC) and Crohn’s disease
  • Ulcerative colitis (UC) is a type of IBD affecting only the large bowel (colon and rectum). The entire colon typically appears red and inflamed with ulcers
  • Crohn’s disease is a condition in which there is chronic, long-standing inflammation of the gastrointestinal tract (digestive tract). This condition can affect any region in the gastrointestinal tract, but it most commonly (and firstly) affects the ileum (ileitis)
• The gastrointestinal (GI) tract begins from the mouth, esophagus (food pipe), stomach, small intestine (that includes the duodenum, jejunum, and ileum), large intestine, rectum, and ends in the anus
• Inflammatory Bowel Disease can affect individuals of any age group but tends to affect older adults more often. It is also more prevalent in Caucasians and people of Jewish descent
• The risk factors for Inflammatory Bowel Disease include, but are not limited to, smoking, a positive family history of the condition and living in temperate climates. The exact cause and mechanism of Inflammatory Bowel Disease is currently unknown
• Some common signs and symptoms of Inflammatory Bowel Disease are mouth ulcers, cramping, diarrhea, among others. IBD can generally be diagnosed with a thorough physical examination; however, in some cases, a colonoscopy may be required
• Colorectal cancer, eye inflammation and joint pain are some of the many possible complications associated with Inflammatory Bowel Disease
• Inflammatory Bowel Disease is a chronic condition. At the present time, there is no cure for this condition. IBD requires treatment during flare-ups and maintenance medications during remission periods
• Individuals with Inflammatory Bowel Disease can lead relatively normal lives with prompt treatment and medical therapy. The prognosis of the condition is generally good

Who gets Inflammatory Bowel Disease? (Age and Sex Distribution)

• Inflammatory Bowel Disease typically manifests in older adults but can affect individuals of any age
• While ulcerative colitis is observed in both males and females without any predilection, Crohn’s disease is slightly more common in females
• The condition is more common in Caucasians and Jews than individuals of any other race or ethnic group

What are the Risk Factors for Inflammatory Bowel Disease? (Predisposing Factors)

The risk factors for Inflammatory Bowel Disease include:

• A positive family history of the condition
• Smoking
• Caucasians have a higher risk for IBD
• Being of Ashkenazi Jews descent
• Intake of high dietary fat
• Living in temperate climates

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Inflammatory Bowel Disease? (Etiology)

Presently, the exact cause of Inflammatory Bowel Disease has not been identified. However, several hypotheses have been proposed that include: 

• Environmental factors triggering the onset of the disease in genetically susceptible individuals
• Autoimmune cause, where the body fights against its own cells
• Genetic factors
• Certain acne medications

What are the Signs and Symptoms of Inflammatory Bowel Disease?

The signs and symptoms of Inflammatory Bowel Disease may vary from one individual to another in type and severity and may include:

• Diarrhea, which may be bloody: It is one of the most common symptoms in both ulcerative colitis and Crohn’s disease. The diarrhea stool can be mixed with pus and/or blood 
• Cramping both in the rectum and the abdomen
• Feeling of illness due to fatigue, decreased appetite, and nausea or vomiting
• Mouth ulcers
• Fever
• Weight loss due to decreased appetite
• Fistula formation: It is an abnormal tunneling between two bowel loops, between the bowel and vagina, urinary bladder, or skin. Mucus may pass through this abnormal tract to the skin. Also, bowel contents may leak through the vagina or urine
• Anemia from blood loss
• Inflammation of inner eye called uveitis/iritis
• Joint inflammation causing pain and swelling
• Scarring of the common bile duct, which drains bile from the gallbladder to the small bowel. 
• Small painful pustules with ulceration of the skin (pyoderma gangrenosum)

How is Inflammatory Bowel Disease Diagnosed?

A diagnosis of Inflammatory Bowel Disease is achieved by: 

• Thorough physical examination and evaluation of medical history
• An assessment of symptoms
• Complete blood count that may reveal anemia and other markers of infection
• Metabolic panel; to help assess electrolyte disturbances, kidney and liver function
• Colonoscopy (visualizing the colon using a fiber optic tube with a camera) 
• Colon biopsy
• Stool examination

Other diagnostic tests that may be undertaken depending on the particular segment of the intestines affected by Inflammatory Bowel Disease include: 

• Additional blood tests to assess overall health (well-being)
• Stool tests to rule out bacterial and other parasitic diseases
• Upper GI series (barium meal): Barium, a contrast agent, is given to swallow and it is followed by a series of abdominal X-rays to examine the bowel contour. This test is mostly performed in individuals with symptoms that involve the small intestine
• Lower GI series (barium meal): Barium is given through enema and it is followed by a series of abdominal X-rays to assess the bowel contour. This test is performed in individuals with symptoms referring to the large intestine
• Colonoscopy and sigmoidoscopy: A lighted tube is inserted through the anus to visualize the bowel directly and take tissue biopsy samples for examination. With colonoscopy, it is possible to visualize the entire large intestine; whereas with sigmoidoscopy, only a partial segment of the large intestine can be visualized
• Upper GI endoscopy to visualize the esophagus, stomach, and duodenum
• Imaging procedures, such as CT or MRI scans, may be undertaken to visualize the entire abdomen and to check for any complications

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Inflammatory Bowel Disease?

The complications of Inflammatory Bowel Disease may include:

• Intestinal obstruction: The food and stool do not move in the bowel due to scar tissue formation
• Intestinal ulcer formation
• Bowel perforation (hole through the bowel wall)
• Emotional distress during flare-ups
• Nutrition deficiency of protein, vitamins, minerals, etc., due to chronic inflammation, decrease absorption, decreased appetite, and nausea
• Inflammation of the joints (arthritis)
• Perforation in the colon
• Massive internal bleeding in the colon
• Colorectal cancer
• Colon narrowing
• Inflammation in the eye
• Primary sclerosing cholangitis
• Pyoderma gangrenosum (skin ulcers)
• Ankylosing spondylitis and spondyloarthropathy (bone problem involving the spine)

How is Inflammatory Bowel Disease Treated?

The treatment for Inflammatory Bowel Disease is dependent upon multiple factors, such as the stage and intensity of the condition, the age of the patient, and whether the condition is newly diagnosed. The healthcare provider makes treatment decisions considering the overall health evaluation of the patient.

• Individuals with mild Crohn’s disease may not need any treatment
• Lifestyle changes, such as exercise, following a dietician-approved diet and avoiding certain medications that can trigger flare-ups, can help improve one’s quality of life
• In severe cases of IBD, hospitalization may be recommended
• Medications that are prescribed for the symptoms during a flare-up include:
  • Codeine for diarrhea
  • Intravenous fluids, in individuals who are dehydrated
  • Total parenteral nutrition (nutrition through the veins) for malnourishment
  • Painkillers
  • Antibiotics, such as metronidazole, may be given in case of an associated infection
• Oral iron may be administered in case of anemia
• Nutritional supplements may be necessary in case of nutritional deficiency
• Surgery is indicated when symptoms do not respond to medications. It is also needed for treating complications, such as intestinal obstruction, fistulas, and stricture
• The entire colon may be removed (total colectomy) in severe cases of ulcerative colitis
• Crohn’s disease-specific medications: 
  • Corticosteroids (oral, intravenous, or enema) are effective in quickly controlling the inflammation in case of a flare-up. However, these medications have certain side-effects, and are prescribed by healthcare providers accordingly
  • Anti-inflammatory medications, such as mesalazine, may be given in a flare-up or to prevent a flare-up
  • Immunomodulators, such as azathioprine and methotrexate, are useful in acute flare-ups and in situations where corticosteroids are not helpful. These medications help modulate the abnormal immune response in an affected individual
  • Biological therapies, such as adalimumab or infliximab, are very effective in decreasing inflammation. These medications also help control abnormal immune response by directly acting on the harmful immune products. Both immunomodulators and biological therapies can help avoid long-term corticosteroid use
• Ulcerative colitis-specific medications: 
  • Mesalamine and 5-ASA for moderate disease condition are initially administered; however, a rectal suppository is normally tried before starting oral medications
  • If the disease does not respond to Mesalamine, then it is treated with cytotoxic drugs, such as Azathioprine and Cyclosporine
  • Steroids are used in severe cases that do not respond to any medication
  • Avoidance of NSAIDs (pain medications) is advised, as they worsen the effect of the drugs used for treatment

How can Inflammatory Bowel Disease be Prevented?

Currently, there is no effective method to prevent Inflammatory Bowel Disease, as the definitive cause is unknown. 

• However, seeking medical treatment at the onset of symptoms may help avoid severe signs and symptoms through medication and/or lifestyle changes
• A regular follow-up with one’s healthcare provider is highly recommended

What is the Prognosis of Inflammatory Bowel Disease? (Outcomes/Resolutions)

The prognosis of Inflammatory Bowel Disease depends on the severity of one’s signs and symptoms.

• Severe cases of ulcerative colitis may be cured through the removal of the entire colon, but this procedure is infrequently
• Although Crohn’s disease is an incurable, chronic and long-standing illness, affected individuals can lead relatively normal lives with prompt treatments and regular follow-ups with their healthcare provider. 

Additional and Relevant Useful Information for Inflammatory Bowel Disease:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/digestive-center/