What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) refers to two chronic inflammatory conditions of the digestive tract: Crohn’s Disease (CD) and Ulcerative colitis (UC). Ulcerative colitis creates sores in the innermost lining of the colon and rectum. Crohn’s disease creates inflammations along the lining of your digestive tract and most commonly impacts the small colon.

What is the difference between IBD and IBS?

Inflammatory bowel disease (IBD) is often confused with irritable bowel syndrome (IBS). Both conditions have similar symptoms of cramping and diarrhea, however the internal process for the two are different. IBD causes inflammation of the bowel wall, which often leads to deep ulcerations, narrowing of the intestines, and inner bowel lining damage. IBS is a disorder in the gastrointestinal tract. No cause has been determined for IBS and patients can sometimes be diagnosed with both conditions.

What are the symptoms of IBD?

People who suffer from IBD typically experience periods of relief and flares of symptoms. These symptoms include fever, weight loss, iron deficiency, diarrhea, abdominal cramps, and rectal bleeding to name a few.

What causes IBD?

Currently, the cause of IBD is unknown. However, research has led many people to believe that it may be caused by genetics as IBD is known to run in families. Other researchers speculate that an infection or virus causes the disease.

Who is susceptible to these diseases?

Crohn’s disease typical affects men and women at the same rate and is often considered to be hereditary. Although it affects people of all age groups, it is often diagnosed between the ages of 20 and 30. People of Jewish heritage have an increased risk of developing the disease while African Americans have the least risk. Ulcerative colitis can occur at any age but is typically diagnosed between the ages of 15 and 30. It is less frequent for individuals between the ages of 50 and 70 to be diagnosed with the disease. It is also considered to be a hereditary condition and occurs at a higher rate among Caucasians and people of Jewish descent.

Is inflammatory bowel disease hereditary?

Over 100 different genes have been implicated in the development of IBD. A mutation in any one of these genes may increase a person’s risk of the disease. Up to 20% of patients diagnosed with IBD have a first degree relative (mother, father, sister or brother) with IBD. The genetic predisposition appears to be stronger for Crohn’s disease than for Ulcerative colitis: 50% of identical twins share the diagnosis of Crohn’s disease, whereas only about 20% of identical twins share the diagnosis of Ulcerative colitis. Therefore, environmental factors play at least as much of a role in causing inflammatory bowel disease as genetics.

What factors are implicated in the development of IBD?

Many environmental factors have been implicated in IBD. They include lack of breastfeeding, certain GI infections in infancy, antibiotic use during infancy, an increase in refined sugar consumption and a low consumption of fruits and vegetables. However, a lot of studies implicating environmental factors lack in methodological rigor. In addition, smoking doubles the risk of Crohn’s disease but appears to be protective against the development of Ulcerative colitis.

Will I need surgery for Crohn's disease?

The goal of medical therapy is to avoid surgery. However, about 50-60% of people diagnosed with Crohn’s disease require surgery at some point during their lifetime. The most common surgery that patients undergo is the resection of the very end of the small intestine, which is where the disease most commonly occurs. The surrounding healthy segments of bowel are then reconnected. Indications for surgery include a narrowing of the intestine, an abnormal connection which forms between a diseased intestinal segment and a neighboring organ (a fistula), an abscess within the intestinal wall or severe inflammation that does not respond to medications. Even after surgery, Crohn’s disease may come back. Therefore, many patients will be started on a long-term medication after surgery to prevent disease recurrence.

Will I need surgery for Ulcerative colitis?

About 20-30% of patients with Ulcerative colitis will require surgery during their lifetime. The surgery most commonly performed is a colectomy (removal of the colon) with an ileal-pouch anal anastomosis, where a new rectum (a pouch) is constructed out of a small intestine and reconnected to the anus. This surgery allows patients to preserve bowel continuity. The indications for colectomy include severe inflammation unresponsive to medications and colon cancer. With the widespread use of new medications (such as biologic therapy), many surgeries can now be avoided.

Will I need to be on medications for the rest of my life?

Both Crohn’s disease and Ulcerative colitis, are chronic conditions that require long-term therapy. The majority of people require maintenance medications to keep their disease under control and to avoid disease flares. Studies are currently ongoing to investigate whether medications can be stopped and restarted if disease symptoms return. At this point, the data on stopping maintenance medications is preliminary and requires longer-term exploration. These preliminary data suggest that it might be possible to stop medications in a select group of patients with no evidence of inflammation based on blood tests and endoscopy.

Can I have an uneventful pregnancy if I have IBD?

Women with well-controlled disease have fertility rates that are no lower than the general population. The risk of congenital malformations is no higher in women with IBD than in the general population. However, pregnant women with IBD are at an increased risk for premature delivery and for having infants with low birth weights. Poor pregnancy outcomes are related to active or uncontrolled inflammation during pregnancy. Therefore, the goal is to keep the mother’s disease under control at the time of conception and throughout pregnancy. Most medications are safe in pregnancy; however, specific medication choices should be discussed with a physician prior to contemplating pregnancy.

What symptoms should prompt me to see a doctor?

Persistent abdominal cramping or pain, diarrhea, rectal bleeding, weight loss or fever are symptoms that should warrant an evaluation by a physician. These could represent an underlying infection, a new diagnosis of inflammatory bowel disease or an IBD flare.