Inflammatory Bowel Disease

Inflammatory Bowel Disease (IBD) is a condition where the bowel becomes red and inflamed. There a re two main types of IBD: Crohn's disease and ulcerative colitis . Although they have many similarities they are distinctly different diseases and both can have flare-ups (relapses) and periods of well-being (remissions). Both usually affect people aged 20-40 years but can sometimes occur in children and the elderly.

Ulcerative Colitis is inflammation of the outer lining of the colon (large bowel) only, hence the term colitis.

Crohn's disease, named after the gastroenterologist Burrill Bernard Crohn, can affect any part of the gut from the mouth to the anus, but most commonly affects the colon or ileum (small bowel) and can involve the full thickness of the bowel wall.

Symptoms

Both types of inflammatory bowel disease may have similar symptoms depending on the site and severity of the inflammation.

Ulcerative Colitis

During periods of remission people with ulcerative colitis feel well most of the time. However, during a flare-up the following symptoms can occur:

  • Frequent passage of blood, mucus or loose stool, often associated with the need to go to the toilet urgently.
  • Diarrhoea which may be severe
  • Abdominal pain
  • Tiredness and lack of energy

More rarely there may be:

  • Weight loss
  • Loss of appetite
  • Fever

Crohn's Disease

This disease also has periods of remission and flare-ups but the pattern of the disease can be more varied as Chron's disease can affect any part of the bowel. During a relapse the main symptoms are:

  • Diarrhoea, occasionally with bleeding
  • Abdominal pain, crampy pains and bloating
  • Weight loss and poor absorption of nutrients
  • Abscesses or collections of pus
  • Fistulae, abnormal channels between bowel and the skin or other organs such as the bladder

Other Symptoms

In addition to those listed above, both types of IBD can be associated with symptoms that manifest outside of the gut. These are far less common and can affect the following:

  • Inflammation of the joints
  • Thickened, painful red skin, especially on the shins
  • Painful, gritty, watery eyes
  • Jaundice and impaired digestion.

Treatments

Medical Treatment

The principles of both types of IBD are similar but there are important differences.

Drugs for Ulcerative Colitis

  • Steroids, for example prednisolone, can be used to alleviate acute attacks and can be very effective. However, these may be associated with side effects such as high blood pressure, water retention and osteoporosis. Steroids can be given orally, by injections or as enemas. Once a person has overcome an acute attack, steroids are gradually withdrawn.
  • 5-ASA drugs such as mesalazine, are also used to treat the inflammation and can be taken in tablet, suppository or enema form. These drugs are often used during both flare-ups and as a regular medication to prevent relapses.
  • Azathiprine

Biologics i.e infliximab are antibodies grown in the laboratory that inhibits certain proteins in the body from causing Inflammation. Biologics therapies offer a distinct advantage in the IBD treatment because their mechanisms of action are more precisely targeted to the factors responsible for IBD. Biologics known as anti tumor necrosis factor ( anti TNF) agents bind and block a small protein called necrosis factor (TNF alpha) that promotes inflammation in the intestine as well as other organs and tissues.

Drugs for Chron's Disease

Steroids are used as for ulcerative colitis

5-ASA drugs can be used as for ulcerative colitis

Antibiotics, such as metronidazole, may be used for acute attacks, particularly if the disease involves the anus and rectum.

Azathiprine is being increasingly used to try to avoid the use of steroids and to prevent disease flare-ups. These drugs have particular side effects such as allergic reaction and a predisposition to infection and require careful supervision by your doctor.

Biologics i.e infliximab/ humira can be used as for ulcerative colitis

It is very important to take the medications as prescribed, even if you are feeling well, if this is what your doctor suggests as this will help keep the diseases in remission and prevent flare-ups.

Surgical Treatment

Although some patients may never need an operation surgical treatment may be used for the following reasons:

  • Failure to respond to medical treatment
  • Acute deterioration of symptoms where there is a danger of rupture (perforation) of the bowel
  • The development of cancer or pre-cancerous tissue change

Surgery for Ulcerative Colitis

This usually involves the removal of the colon and sometimes also the rectum. This necessitates the formation of an ileostomy which may be permanent or temporary. In some cases a special pouch can be formed from the remaining small bowel to function as an artificial rectum. The normal sphincter mechanism is left intact to ensure normal continence. Please see your local Stoma Care and/or colorectal nurse specialist for further information on this type of surgery.

It should be remembered that even though surgery is only performed if absolutely necessary, removal of the colon is a cure for ulcerative colitis and people often experience a greatly improved quality of life after surgery.

Surgery for Crohn's Disease

People with Crohn's disease are more likely to require surgery to:

  • Remove parts of the large or small bowel that are diseased (this may or may not result in the formation of a stoma)
  • Deal with narrowing (strictures) or fistulas
  • Drain abscesses.

Diet

A key component in the treatment of IBD is a healthy diet. A balanced diet from all food groups is recommended to ensure and adequate supply of carbohydrates, proteins and fats. This includes grains, dairy, fruit and vegetables, meat and alternatives. A balanced diet gives the body the nutrients needed for growth, to repair damage and fight illness.

Most people with IBD know which foods they can tolerate and in general it is spicy, fatty and raw foods more difficult to digest. Some people often feel ‘full' so eating smaller, more frequent meals can improve low energy levels and supply needed nutrients. If the disease is severe it may be necessary to take nutritional supplements to help prevent weight loss, to restore the balance of nutrients, to allow the bowel to rest and to possibly relieve pain.

Further advice is available from your colorectal nurse specialist or dietician.