There is an increase in the incidence of IBD throughout the world and lifestyle and environmental factors also seem to be the cause, says Dr Maneesh Paliwal
As the name suggests, Inflammatory Bowel Disease (IBD) is chronic inflammation of the digestive tract. Mainly of two types, its classic symptoms are, pain in the abdomen, diarrhoea, blood in stool, fatigue, and loss of weight usually for over a month. The exact causes are not known, currently, malfunction of the immune system in genetically prone individuals is a major factor. Lifestyle factors like western diet, obesity, and environmental factors like childhood hygiene, air pollution are also considered to be contributory factors. There is an increase in the incidence of IBD throughout the world including India.
IBD is predominantly of two types, Ulcerative colitis — a type of IBD in which inflammation or swelling occurs only in the large bowel (intestine) or colon of the digestive tract, and in Crohn's disease the entire digestive tract, from mouth to bottom (anus) can have inflammation, but mostly limited to parts of the small bowel and or large bowel.
The exact causes are unclear and appear multifactorial. Our immune system normally recognizes environmental bacteria and viruses as foreign environmental agents and protects us against their invasion. In some people who have a specific genetic makeup and develop IBD, this becomes defective. The immune system confuses our own protective intestinal population of useful microorganisms (good bacteria and fungi) which maintain gut health, as foreign. The immune cells then attack the area of the intestines where they are living and cause inflammation.
Diagnosis
The diagnosis is on the basis of symptoms along with appropriate tests. The gastroenterologist first analyses the symptoms. To confirm the suspicion of IBD, blood tests, stool tests, and endoscopic examination of the intestines, especially a procedure called colonoscopy is needed. Using these investigations the gastroenterologist is able to find out the cause and also the type of IBD, ulcerative colitis, or Crohn's disease. During a colonoscopy, they also take a small tissue sample (biopsy) from the intestine to confirm the diagnosis. Sometimes additional tests like capsule endoscopy, MRI of intestines are done.
Treatment
Treatment largely depends on the form, severity, and extent of the disease as seen by gastroenterologists on endoscopic examination. Oral medication, suppositories, medicated enemas, intravenous or subcutaneous medicines are used. Most people require oral medications in combination. IBD is the result of disordered immune cells mounting an attack on our own intestinal tissue. Therefore, most drugs either modify our immune systems by suppressing these disordered cells or prohibit them from attacking the intestinal tissue. Some of these medications are steroids (anti-inflammatory and suppress immune cells), mesalamine (anti-inflammatory), immunosuppressants of various types, and biological therapy (antibodies created in laboratories that suppress defective immune cells). In select populations who have severe disease or fail to respond to medication, surgical therapy is offered to remove the diseased part of intestines or complications caused by the disease.
Causes
Severe infections of any part of the body including intestines, severe stress, pain killers belonging to the group called nonsteroidal anti-inflammatory type, for example, ibuprofen, diclofenac( NSAIDs) and development of cancers of the intestines.
Myths
Multiple myths about this disease are propagated like any, blood in the stool is only hemorrhoids, besides some have even spread this myth that women suffering from IBD can not conceive. In addition, people mix it up with other diseases like IBS, and last but not the least, IBD patients should not take COVID vaccination. Contrary to this all frequent rectal bleeding should be evaluated as IBD is one important cause. Women with IBD can easily have normal pregnancies. IBS and IBD are different disease entities. Covid vaccination is recommended by doctors for IBD patients.
Prevention
This is currently not known and is an active area of research. IBD is a lifelong chronic illness, easily managed with medicines, and adopting a healthy lifestyle will definitely prevent its flare. Most people do well and the disease remains under control with medication and can continue living a normal life.
The writer is Senior Consultant Gastroenterology, PSRI Hospital, New Delhi