What Is Inflammatory Bowel Disease?
Inflammatory Bowel Disease (IBD) is an inflammatory bowel disorder which causes inflammation (swelling and irritation) in the digestive system. The inflammation can most commonly exist in the large intestine or colon. This disease can also cause problems outside the digestive system.
The inflammation occurs when a person’s immune cells attack the digestive system i.e. the gastrointestinal tract. Research suggests that IBD occurs when a person with genes that makes him susceptible to IBD is exposed to something in the environment that makes his intestine’s immune system react against the bowel. When inflammation occurs, the intestine becomes red and swollen.
Types of Inflammatory Bowel Conditions
Inflammatory Bowel Disease is a general term that usually refers to one of three different conditions: Crohn’s Disease (CD), ulcerative colitis (UC) and indeterminate colitis (IC).
- Crohn’s Disease and ulcerative colitis are diseases of the digestive tract, sharing many of the same characteristics and symptoms. Crohn’s disease affects the lining of the digestive tract whereas ulcerative colitis causes inflammation in the digestive tract. These conditions are treated differently.
- On diagnosis, if it isn’t clear which type of IBD exists, the physicians term the condition as indeterminate colitis.
IBD is not the same as irritable bowel syndrome, or IBS. IBS is a bowel disorder that causes many of the same symptoms as IBD.
Snippet Highlight: IBD is a chronic disease that affects the digestive system. A person with IBD would have evidence of inflammation but no evidence of an infection that would cause the inflammation.
Statistics From Around The World
Inflammatory bowel disease is a global disease in the 21st century. The highest reported prevalence was in Europe (ulcerative colitis 505 per 100000 in Norway; Crohn’s disease 322 per 100000 in Germany) and North America (ulcerative colitis 286 per 100000 in the USA; Crohn’s disease 319 per 100000 in Canada).
The prevalence of inflammatory bowel disease exceeded 0.3% in North America, Oceania and many countries in Europe. Since 1990, incidence has been rising in newly industrialised countries in Africa, Asia, and South America.
The incidence of IBD is accelerating in newly industrialized countries whose societies have become more westernized. Although incidence is stabilizing in western countries, burden remains high as prevalence surpasses 0.3%. Hence, the need for research in the prevention of IBD and innovations in health-care systems to manage this complex and costly disease is highly required.
Causes And Risk Factors
IBD is said to result from the interaction between genetic, immune function, bacterial infection and environmental factors that influence the normal intestinal flora to trigger an inappropriate immune response.
- Genetic Factors - According to the Crohn’s and Colitis Foundation of America (CCFA), roughly 20 percent of Crohn’s and Colitis patients have a close relative with IBD.
- Immune Function - The intestinal inflammation seen in IBD seems to be the result of an overactive immune response. When a foreign substance enters the intestinal lining, the body overreacts, causing an unusual amount of inflammation that does not go away once the threat has been eliminated.
- Bacterial Infection - Many people with Crohn’s Disease often show evidence of having been infected with E.coli. People can be infected by these bacteria if they drink water or eat food that has been contaminated by fecal matter from other infected individuals.
- Environmental Factors - Numerous environmental risk factors exist that can lead to IBD including smoking, oral contraceptive pills, appendectomy, dietary animal protein and high sugar content, non-steroidal anti-inflammatory drugs, antibiotics, postmenopausal hormone use, stress and depression.
The following list includes the risk factors that may be involved in causing inflammatory bowel disease.
- Most find out they have IBD as adolescents or young adults. Children as young as a few months old can have IBD.
- Smokers have a 2-fold increased risk of Crohn’s disease compared with persons who have never used tobacco products.
- In developed countries, IBD seems to affect all ethnic groups, although, it is most common among Caucasians.
- People of Jewish descent living in Europe, North America, and Israel have roughly a five times higher risk of developing IBD.
- People with a close relative with IBD are more susceptible.
- Use of antibiotic and non-steroidal anti-inflammatory drugs can alter the flora in the intestine and increase the risk of disease.
- Individuals raised in smaller households and with fewer siblings were highly prone to Crohn’s disease.
- Lower birth rank is associated with an increased risk of IBD.
- Exposure to pets like cats in early ages is a risk factor in the onset of Crohn’s disease.
- Densely populated areas are associated with an increase in incidence of IBD.
- Differences in lifestyles and environmental exposures for e.g. the diet may contribute to higher occurrence of IBD in urban areas.
Diagnosis - The Symptoms
The symptoms of IBD are often common symptoms of any illness that affects the GI tract.
Each person experiences IBD a little differently. It is rare to find two people who have exactly the same symptoms during a flare-up. Most people with IBD suffer from some of the following symptoms:
- Abdominal cramping and pain
- Appetite loss
- Weight loss
- Joint pain
- Rectal bleeding
- Slowed Growth and Late Puberty in children
Snippet Highlight: Symptoms vary greatly in severity from person to person. Some people experience only minor discomfort and are able to manage the disease with medication or diet or both. Other people suffer more serious pain and complications that can lead to hospitalization or surgery. Any long-lasting or severe abdominal pain should be evaluated by a doctor.
Tests And Assessments
The diagnosis of IBD is based on a combination of the symptoms, physical examination and test results. The tests include simple blood and stool tests, X-rays and scans, and endoscopies.
- Blood tests
- Radiological tests including X-rays, CT scans, MRI and Ultrasound
The recent evolution in diagnostic methods holds great promise in overcoming the limitations of the present methods.
Novel techniques include:
- laboratory tests like the blood serum and fecal markers
- new endoscopic methods like the capsule endoscopy and double-balloon enteroscopy
- radiologic studies and,
- endoscopic imaging techniques
These new methods represent significant advancements both in the diagnosis and long term management of IBD.
Snippet Highlight: It is normal to require a combination of these tests and many of them are also useful in monitoring the progress of the condition. These tests may need to be repeated to reassess the disease. Check with the doctor for the exact test to be taken as not all hospitals provide all tests and some tests are better than others for looking at specific problems.
Post-Diagnosis: The Path To Follow
People with IBD may typically need treatment through their lives as these diseases especially Crohn’s disease, can reoccur. Treatment options often include hospitalizations, surgery and medications, and they rarely include a holistic approach that incorporates acupuncture, a new diet (potentially wheat-free), stress reduction, psychotherapy, yoga and meditation, naturopathic medicine and a special protocol in detoxification.
Medication - Conventional And Alternative Treatments
Integrative care combines the best in conventional or allopathic medicine and the best in natural or complementary medicine to provide a whole-body approach to healing. People with IBD can benefit from integrative care.
- Specialized medication including antibiotics and corticosteroids are used to help relieve symptoms, reduce inflammation and prevent exacerbation.
- Biologic Therapy using TNF inhibitors is used to treat by affecting substances in the body to block inflammation.
- Surgery is a last resort treatment; however, about 20% of people with ulcerative colitis will require surgery at some time in the course of illness. Approximately, 75% of people with Crohn’s disease who have disease in the small bowel will have surgery in the first 10 years after diagnosis.
Complementary and alternative medicine is frequently used by patients with IBD; the most common are massage, acupuncture and moxibustion therapy (using herbs in acupuncture points through burning or needling). These therapies have been shown to improve inflammation and symptoms.
However, current clinical trials are of insufficient quality to recommend these therapies as alternative treatments for IBD. Nonetheless, because these therapies seem generally to be safe, they may have a role as complementary to conventional therapy.
There are no controlled clinical trials of homeopathic treatment for IBD, although the homeopathic literature contains evidence for its use in the form of accumulated clinical experience.
Homeopathic treatment can be used safely for IBD, either alone or in combination with other treatment methods, both alternative and conventional. Any one of many homeopathic medicines may be used to treat IBD, depending on the characteristics of the person being treated; sophisticated homeopathic analysis and long-term follow-up are required.
In traditional Chinese medicine and Ayurveda, herbal extracts are used in treatment for IBD and appear to be effective. Polyphenols, found in food substances produced from plants, are believed to play a biologically active role.
- Turmeric has been used in Ayurvedic medicine since ancient times. Administering 1 gram of curcumin or turmeric twice daily results in improvement of symptoms like inflammation and decrease in the rate of relapse.
- Administering 350 mg of the Ayurvedic herb, Boswellia serrata (Indian frankincense) 3 times a day improves symptoms of active Crohn’s disease.
Many nutrients seem to be deficient in patients with Crohn’s disease. This may be a result of insufficient absorption or an increased requirement for antioxidant nutrients due to their increased oxidative stress.
- Nutritional supplements for supplying antioxidants that include beta carotene, vitamin C, vitamin E, selenium, zinc, magnesium and vitamin D are given for people with IBD.
- People with IBD should avoid all allergens especially that are most commonly implicated in IBD: wheat, chocolate, dairy, corn, artificial sweeteners, eggs and yeast.
- Elimination diet high in complex carbohydrates and fiber and low in sugar and refined carbohydrates is good for consumption for people with IBD.
- Eating a diet that is rich in whole foods and consists of fresh fruits and vegetables and protein derived from fish and plant sources would provide all the essential nutrients and fiber.
- Probiotics including plant-derived yeast and prebiotics including wheatgrass juice and inulin are beneficial in treating symptoms of IBD like diarrhea.
In addition to promoting good health, exercise may help counteract IBD related complications, such as improving bone mineral density, immunologic response, psychological health, weight loss, and stress management ability.
Exercise and physical activity also may help people with IBD cope with and minimize symptoms related to intestinal issues related to IBD. Further research, however, is needed to make recommendations regarding exercise regimens for people with IBD. Different exercises including walking, running, swimming and yoga have a significant impact on stress reduction which leads to improved quality of life.
Low-intensity and moderate intensity exercise are also shown to improve the immune system.
Yoga, meditation and exercise are an integral part of living a healthy and happy life with IBD.
Moving meditation practices such as walking meditation, yoga, tai chi and qigong follow the same general principles of meditation but add movement to the mix.
Breathing techniques like pranayama, qigong movements coordinated with breathing and a type of meditation called Open Focus Attention Training were found to be beneficial in increasing mindfulness and managing stress.
IBD is a chronic disease and unpredictable flare-ups cause anxiety and fear. Symptoms and medication side effects cause embarrassment, and missed activities cause disappointment.
The first step is to embrace a well-being mindset. Support from friends, family and peers is invaluable during times of stress. For those interested in meeting others who are diagnosed with IBD, support groups, peer mentors and camps can be identified and the people can engage with each other.
Prevention- How to reduce risks
Preventive measures to reduce the risk is an important part of management of people with IBD.
- Reduction of exposure to infection may be achieved by hand-washing, careful food and personal hygiene.
- Avoiding unpasteurized milk and cheese, uncooked meat and eggs, raw vegetables and raw seafood prevents food poisoning risk.
- For female patients with IBD receiving immunosuppressive treatment, more frequent cervical pap smear is recommended to reduce infection risk.
- Consultation with the doctor is essential before travel to regions with infection risk.
- People with IBD should safeguard themselves from insect bites which may transmit disease and be careful with food and water intake to reduce infection risk, skin infection and gastroenteritis.