Photo by Sora Shimazaki.

Inflammatory Bowel Disease (IBD) is an umbrella term that includes both Crohn’s Disease (CD) and Ulcerative Colitis (UC). Up to 3.1 million Americans suffer from these often debilitating digestive conditions and the number is steadily growing. Elsewhere in the world, IBD is increasing even more rapidly in countries that are modernizing and adopting a Westernized lifestyle along with its associated environmental factors. IBD is now considered to be a major world health concern.

Differentiating between UC and CD

Both conditions can cause severe emotional distress.

There is overlap in the symptoms of the two forms of IBD, as both include periods of flare-ups and periods of remission, systemic symptoms that range from fever to fatigue, blood in the stool, appetite loss and weight loss, diarrhea, and increased risk for colorectal cancer, so arriving at an exact diagnosis can be tricky.

A thorough workup with your provider will start with a look at your medical history, a physical exam including gentle palpation of the abdomen for signs of tenderness or pain, a blood test to rule out other causes of your symptoms, a stool test, and nobody’s favorite: endoscopic procedures. Scopes for the upper GI tract, colonoscopy for the lower end, and even a tiny camera that you swallow that goes all the way through the entire digestive tract, snapping thousands of pics as it travels may all be employed. Biopsies can also be taken during a colonoscopy and can help differentiate between UC and CD.

Sometimes imaging such as MRI, CT scan, and X-Ray can show signs of tissue damage, inflammation, bleeding, or obstruction.

UC affects the more superficial lining of the colon, or large intestine, causing ulcers and creating inflammation.

CD can affect the entire digestive tract, from the mouth to the anus, and can cause damage to deeper layers of its tissues.

Both conditions can cause severe emotional distress due to pain, unpredictability of bowel movements, and the social isolation that these discomforts often lead to.

Causes of IBD

Many sufferers of IBD have a close relative who has the same diagnosis.

The exact cause of the related conditions is unknown, although some environmental factors are suspected, given that until recently they have been much more prevalent in developed countries. Additionally, the diseases seem to involve the immune system turning on itself and causing damage to the tissues of the digestive tract in an unusual immune response. Genetics also may play a role as many sufferers of IBD have a close relative who has the same diagnosis.

Those with a history of Irritable Bowel Syndrome (IBS) may have a predisposition to IBD. Childhood environmental factors can also play a part. Being mostly bottle-fed, being underexposed to natural germs in the environment, having an intestinal infection, or being prescribed antibiotics in the first year of life have all been shown to contribute to the risk for IBD.

Further risk factors include smoking and the use of over-the-counter non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, and diclofenac.

Complications of the severe stages of IBD include colon cancer, blood clots, severe dehydration, narrowing of the bile ducts leading to liver damage, and skin, eye, and joint inflammation.

Treatment options

There are a number of treatments available, with about 70% of patients achieving remission.

While there is no cure, there are a number of treatments available, with about 70% of patients achieving remission. For those unable to feel better with conservative treatments, surgery can remove sections of the affected digestive structures, providing relief.

Conventional treatments of mild to moderate disease involve a class of anti-inflammatory drugs called aminosalicylates or a time-limited course of corticosteroids. Because steroids are immune-suppressing, they can induce remission in IBDs when one’s immune system is not functioning as it should.

Other immune suppressants such as mercaptopterine, azathioprine, and methotrexate work to decrease damage caused by the chemicals released into the intestines by inflammation.

Another class of drugs that seeks to correct the immune system’s errant behavior is known as “small molecules”. A recent study has shown that one of these drugs, tofacitinib (brand name Xeljanz) is associated with heart issues and cancer development, so please discuss these findings with your provider before having it prescribed.

Biologics are a newer and more expensive class of drugs that focus on targeting proteins in the body that cause inflammation in the digestive system. These drugs are used when the more basic drug therapies have not been successful and the disease has progressed to moderate-to-severe. Because biologics can make you susceptible to infection, you will need to be treated for and cleared of any infection before beginning them.

Other drugs such as antidiarrheals and acetaminophen can help reduce symptoms of urgent bowel movement and pain. Nutritional support such as vitamin and mineral supplements can be helpful if you’re not absorbing enough nutrients.

A number of complementary and alternative natural therapies have been shown to help reduce IBD symptoms. It is essential to check with your provider before trying any of these natural remedies to be sure there is no conflict with any conventional medicines you may have been prescribed.

Acupuncture and moxibustion have been proven helpful with IBD symptoms.

Andrographis paniculata, curcumin, aloe vera, and boswellia are herbal remedies that have been shown to relieve inflammation by providing antioxidants to your system.

Lifestyle changes to reduce symptoms

Managing stress and depression can be key to restoring normalcy to your life.

Numerous lifestyle changes can also be beneficial in reducing symptoms of IBD. Staying well hydrated, eating small meals, reducing fiber intake, and avoiding buttery or greasy food are helpful, as can cutting back on dairy products. Check with your provider regarding supplements such as calcium and vitamin D for your specific case.

Managing stress and depression can be key to restoring normalcy to your life. Exercise regularly, join an IBD support group online or in person, and stay connected to friends and loved ones. Try meditation if it suits you or find an absorbing hobby or pastime that serves as a kind of meditation. Stop smoking and cut down on alcohol consumption.

If all else fails, you may need surgery to remove damaged areas of the colon or small intestine. In the case of UC that may mean removal of the entire colon. For CD, up to 2/3 of sufferers will require at least one surgery to remove damaged tissue, drain abscesses, or resolve abnormal structures known as fistulas.

See your provider if your digestive system seems off. Most people diagnosed with IBD are in their 30s and often begin with mild cases. Untreated, IBD symptoms worsen over time and become more severe, taking their toll on quality of life. With early intervention and a multifaceted approach to care, there is a good chance you will learn to live with IBD in greater comfort. Many achieve long remissions that give you back your quality of life.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.