About inflammatory bowel diseases (IBDs)
What are IBDs?
Ulcerative colitis (UC) and Crohn’s disease (CD) are both relatively rare diseases. They are chronic disorders causing the formation of areas of inflammation and ulceration in various sections of the digestive tract. This inflammation causes persistent and frequent diarrhoea (often blood-stained and passed with urgency), abdominal pain, fever, tiredness and loss of weight.
Inflammatory bowel diseases (IBD) are mainly seen in industrialised parts of the world. They affect all races, though in some populations the incidence is lower. People who move from underdeveloped to developed parts of the world attain the same level of risk of developing IBD as the rest of the population after some time.
There is generally a higher incidence in northern latitudes compared with southern latitudes and in urban areas over rural.
Development of IBDs
Ulcerative colitis and Crohn’s disease affect all age groups and can start at any age, but the highest number of new cases occurs in young people.
The course of UC and CD varies unpredictably in severity and usually cycles between periods of active inflammation (flare-ups) and periods of low activity or even remission when the patient feels well and is free from symptoms.
In their early stages, UC and CD may be difficult to diagnose. Their symptoms resemble those of each other and conditions such as infectious gastroenteritis and irritable bowel syndrome. It may sometimes take years before a correct diagnosis is made and a treatment used which is compatible with the patients and their way of life.
Causes of IBDs
Much work is being undertaken worldwide into the possible causes of IBD but, despite many theories, the causes and the exact changes occurring in the body remain poorly understood.
There seems to be a genetic and environmental impact behind IBD, causing an imbalance in the inflammatory processes of the gut. It is thought that viruses, bacteria, a highly refined diet, stress and smoking may contribute.
The inflammation in ulcerative colitis exclusively affects the superficial layer (the mucosa) of the large intestine. It almost always involves the rectum and spreads in a continuous manner from there. In a small percentage of patients, the whole of the large bowel is involved. The most common age group for UC to be diagnosed is within the 15 to 35 year-olds, with a second peak being seen in 55 to 70 year-olds. Up to 400 people per 100,000 suffer from ulcerative colitis worldwide.
Unlike ulcerative colitis, Crohn’s disease can affect any part of the GI tract, although it mainly presents itself in the small bowel. In Crohn’s, the disease most commonly affects just the small intestine (40%), though it can often affect both the small and large intestine (colon) (30%) and in other cases just the colon (30%).
Crohn’s disease affects up to 150 people per 100,000, and is most commonly diagnosed in the 15 to 25 year-old age groups. Recent statistics appear to indicate a rise in the number of new cases, but it is not clear why this may be.
About 15 to 20 per cent of people with Crohn’s Disease have a close relative with some form of IBD, suggesting a genetic predisposition in these patients.
Complications of IBDs
In cases where diarrhoea is very frequent, or bloody and severe, water loss and poor absorption of nutrients may occur, leading to anaemia, dehydration and severe weight loss.
The inflammation in Crohn’s disease may lead to strictures (narrowing) of the bowel which helps create abdominal pain. Severe cases may lead to life-threatening complications such as blockage or perforation of the bowel, and there has been a definite link between patients with colitis having an increased risk of developing colorectal cancer.
The risk of colorectal cancer increases with the extent and severity of the disease, the age it started and how long the patient has had the disease. For patients suffering from ulcerative colitis, recent trials have shown the risk of colorectal cancer at 10, 20 and 30 years after the diagnosis of the onset of their disease as being 2, 8 and 18 per cent higher (respectively) than the incidence seen in the general population.
Managing and treating IBDs
Most people diagnosed with either ulcerative colitis or Crohn’s disease receive a range of medications designed to control or reduce the inflammation and symptoms, and suppress the body’s immune response.
When inflammatory bowel disease (IBD) is active, the doctor’s main aims are to:
- Control the symptoms of the flare-up as rapidly as possible
- Correct any disturbances to the body’s nutritional, water, vitamin and mineral levels
- Prevent serious complications developing
- Minimise the risk of future flare-ups by choosing an effective maintenance therapy
Maintenance therapy for long-term control of IBD
Long-term control of inflammatory bowel diseases requires regular medication, known as maintenance therapy, to keep flare-ups at bay and reduce the risk of more serious complications developing.
The aminosalicylate group of medications, such as Ferring’s PENTASA® (mesalazine), is commonly prescribed as maintenance therapy for IBD patients.
Clinical evidence has shown that, without mesalazine maintenance therapy, up to 80 per cent of mild/moderate active ulcerative colitis patients relapse within a year, giving way to further flare-up and symptoms. But the research has also shown that if patients take their maintenance therapy correctly, many of these relapses could be prevented.
More severe inflammation may need a number of different therapies to achieve long-term control. Usually, the medication initially required to control the patient’s flare-up should be continued as part of maintenance therapy.
Prevention of serious long-term complications
Individuals feeling quite well and free of symptoms between flare-ups may be less careful about complying with their doctors’ recommendations for taking maintenance medication and attending the gastroenterology clinic for check-ups.
New findings suggest that long-term health benefits and reduction in the risk of developing cancer of the colon and/or rectum can be achieved if patients continue to take their medication as recommended by the doctor.
Diet in controlling IBD
The long-term management of inflammatory bowel diseases to reduce relapses also needs to address the role of stress and diet. Stress reduction (which may be difficult) and an adequate diet containing fibre (except in case of strictures) with vitamin and mineral supplements, is usually recommended by doctors.
A well-balanced, high carbohydrate, high protein diet minimises the possibility of nutritional deficiency due to chronic diarrhoea. Crohn’s disease appears to respond well to special diets and some patients respond to lactose and gluten free diets.
Summary of inflammatory bowel diseases
Characteristics of inflammatory bowel diseases:
|Ulcerative colitis||Crohn’s disease|
|Typical age range at diagnosis||Primary 15 to 35 years
Secondary 55 to 70 years
|Primary 15 to 25 years Secondary over 70 years|
|Prevalence||Up to 400 in 100,000||Up to 150 in 100,000 (rising in some areas)|
|Disease location||Involves only rectum and colon. In case of progression the inflammation spreads upwards from the rectum in a continuous way.||Can involve any part of the gastro-intestinal tract, from the mouth to the anus – most commonly distal part of the small bowel and the beginning of the large bowel (colon). The inflammation of the gut is spread irregularly with normal gut appearance in many areas (so-called skip lesions)|
|Acute symptoms||Bloody diarrhoea Fever Abdominal pain and discomfort||Abdominal pain and discomfort Bloody diarrhoea Sore tongue and lips|
|Chronic symptoms||Diarrhoea Abdominal pain Weight loss Weakness Anaemia||Diarrhoea Abdominal pain Weight loss Loss of appetite Lethargy and malaise Anaemia|
|Chronic complications||Reduced weight Tiredness Cancer of the colon and/or rectum||Fibroses/stenosis of the gut Reduced weight Tiredness|
|Genetic connection||Link between family members||15 to 20 per cent have blood relatives with some form of IBD|
|Symptoms not involving the gut (extraintestinal symptoms)||Joint pain, eye & skin problems||Joint pain, gall stone & renal stone formation|
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