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Inflammatory bowel disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract.
The comprises the:
- small intestine
- large intestine
It’s responsible for breaking down food, extracting the nutrients, and removing any unusable material and waste products.
anywhere along the digestive tract interferes with this normal process. IBD can be very painful and disruptive. In rare cases, it may even be life threatening.
Learn all about IBD, including the different types, what causes it, and its complications.
What are the main types of inflammatory bowel disease?
The Crohn’s & Colitis Foundation of America (CCFA) estimates that in the United States have IBD.
Many diseases are included under the umbrella term IBD. The two most common ones are and .
UC involves inflammation of the large intestine.
Crohn’s disease can cause inflammation in any part of the digestive tract. However, it mostly affects the tail end of the small intestine.
What causes inflammatory bowel disease?
The exact cause of IBD is unknown.
However, the biggest risk factors for developing UC and Crohn’s disease include:
Family history and genetics
People who have a parent, sibling, or child with IBD are at a much higher risk for developing it themselves. This is why scientists believe IBD
The immune system
The immune system may also play a role in IBD.
The immune system normally defends the body from pathogens, which are organisms that cause diseases and infections.
A of the digestive tract can trigger an immune response. The digestive tract becomes inflamed as the body tries to create an immune response against the invaders.
In a healthy immune response, the inflammation goes away when the infection is gone.
In people with IBD, however, digestive tract inflammation can occur even when there’s no infection. The immune system attacks the body’s own cells instead. This is known as an .
IBD can also occur when the inflammation doesn’t go away after the infection is cured. The inflammation may continue for months or even years.
Smoking is for developing Crohn’s disease. Smoking also aggravates the pain and other . It increases the risk of too.
However, UC primarily affects nonsmokers and ex-smokers.
IBD is present in all populations. However, according to , certain ethnic groups, including white people and , have a higher risk for developing the condition.
IBD rates are also rising among Black people in the United Kingdom, according to a conducted by Crohn’s and Colitis UK.
IBD can happen at any age, but in most cases, it starts .
People who live in urban areas and industrialized countries have a higher risk for developing IBD, according to . Residents of industrialized countries tend to eat more fat and .
IBD is also more common among people living in northern climates, where it’s often cold.
reviewing the impact of environmental factors on IBD have found that having increases your risk for IBD too.
On the other hand, some studies, including a
IBD tends to affect men and women equally.
According to a , UC is generally more common among men over 45 years old than it is among women of the same age range.
On the other hand, Crohn’s disease is more common among girls and women over age 14 years.
What are the symptoms of inflammatory bowel disease?
Symptoms of IBD vary depending on the location and severity of inflammation, but they may include:
- , which occurs when affected parts of the bowel can’t reabsorb water
- , which may cause blood to show up in the stool (a condition known as )
- stomach pain, cramping, and bloating due to
- and , which can cause in children
People with Crohn’s disease may also get in their mouths. Sometimes and also appear around the genital area or anus.
IBD can also be associated with problems outside of the digestive system, such as:
What are the possible complications of inflammatory bowel disease?
Possible complications of IBD include:
- with resulting weight loss
- , or tunnels that go through the bowel wall, creating a hole between different parts of the digestive tract
- intestinal rupture, which is also known as
- bowel obstruction
In rare cases, a severe bout of IBD can make you go into . This can be life threatening. Shock is usually caused by during a long, sudden episode of bloody diarrhea.
How is inflammatory bowel disease diagnosed?
To diagnose IBD, your doctor will first ask you questions about your family’s medical history and your .
A physical exam may then be followed by one or more diagnostic tests.
Stool sample and blood test
and blood tests can be used to look for infections and other diseases.
Blood tests can also sometimes be used to . However, blood tests alone can’t be used to diagnose IBD.
A is an X-ray exam of the colon and small intestine. In the past, this type of test was often used, but now, other tests have largely replaced it.
Flexible sigmoidoscopy and colonoscopy
These procedures use a camera on the end of a thin, flexible probe to look at the colon.
The camera is inserted through the anus. It allows your doctor to look for ulcers, fistulas, and other damage or abnormalities in the rectum and colon.
A can examine the entire length of the large intestine. A examines only the last 20 inches of the large intestine — the .
During these procedures, a small sample of the tissue inside the intestine will sometimes be taken. This is called a . This sample can be examined under a microscope and used to diagnose IBD.
inspects the small intestine, which is much harder to examine than the large intestine. For the test, you swallow a small capsule containing a camera.
The camera takes pictures as it moves through your small intestine. Once you’ve passed the camera in your stool, the pictures can be seen on a computer.
This test is only used when other tests have failed to find the cause of Crohn’s disease symptoms.
Plain film or X-ray
A plain is used in emergency situations where intestinal rupture is suspected.
CT and MRI scans
are basically computerized X-rays. They create a more detailed image than a standard X-ray. This makes them useful for examining the small intestine. They can also detect complications of IBD.
use magnetic fields to form images of the body. Since they don’t require radiation, they’re safer than X-rays. MRIs are especially helpful in examining soft tissues and detecting fistulas.
can be used to determine how much of the intestine is affected by IBD.
How is inflammatory bowel disease treated?
There are a number of different treatments for IBD.
Anti-inflammatory drugs are the first step in IBD treatment. These drugs help decrease inflammation of the digestive tract. However, they have many side effects.
, a subcategory of , are examples of anti-inflammatory drugs used for IBD. They include:
- budesonide (Uceris)
- prednisone (Prednisone Intensol, Rayos)
- prednisolone (Millipred, Prelone)
- methylprednisolone (Medrol, Depo-Medrol)
These drugs are available in a variety of forms, from oral tablets to injections to rectal foams. They’re usually given at the lowest dose possible for the shortest amounts of time.
5-ASA drugs (aminosalicylates)
5-ASA drugs (aminosalicylates) also decrease inflammation, mainly in the last part of the small intestine and in the colon. They include:
- mesalamine (, Asacol HD, Canasa, Pentasa)
- olsalazine (Dipentum), which is only available as a brand-name drug
In 2019, the released treatment guidelines for adults with extensive mild to moderate UC. For this group, they strongly recommended:
- standard-dose oral mesalamine
- diazo-bonded 5-ASA drugs, such as balsalazide and olsalazine
They’re preferred over low-dose mesalamine, sulfasalazine, or no treatment. However, the AGA also says it’s fine to take sulfasalazine, as long as you’re aware that it comes with greater side effects.
People who don’t respond to standard-dose mesalamine or diazo-bonded 5-ASA drugs should try a combination of rectal mesalamine and high-dose oral mesalamine.
Immunomodulators may be an option if corticosteroids and 5-ASA drugs aren’t enough. They prevent the immune system from attacking the bowel and causing inflammation.
- (Otrexup, Trexall, Rasuvo)
- (Azasan, Imuran)
- mercaptopurine (Purixan)
The Food and Drug Administration (FDA) hasn’t approved these drugs for the treatment of IBD. However, your doctor may prescribe them anyway. This is referred to as .
OFF-LABEL DRUG USE
Off-label drug use is when a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat medical conditions in their patients.
So your doctor can prescribe a drug however they think is best for your care.
are genetically designed drugs that may be a choice for people with moderate to severe IBD.
Some biologics . TNF is a chemical that causes inflammation and is produced by the immune system. Excess TNF in the blood is normally blocked, but in people with IBD, higher levels of TNF can lead to more inflammation.
TNF-alpha inhibitors include:
- adalimumab ()
- infliximab ()
Other biologics include:
- certolizumab ()
- natalizumab ()
- ustekinumab ()
- vedolizumab ()
Biologics aren’t available as generic drugs. Biosimilars, which are cheaper and have been reverse-engineered to produce the same results as biologics, are available for some of these drugs, though.
In 2020, the released treatment guidelines for people with moderate to severe UC. They recommended that people who’ve never tried a biologic before opt for infliximab or vedolizumab over adalimumab. Adalimumab is less effective.
Adalimumab can be self-administered, which may make it more convenient than the other drugs. If convenience is a concern, it’s fine to choose adalimumab instead.
Other drugs block separate pathways causing inflammation, including the UC drug tofacitinib (Xeljanz). Due to safety concerns, the recommends that this oral drug only be taken during a clinical or registry study.
are used to kill bacteria in the small intestine that may trigger or aggravate the symptoms of Crohn’s.
and can also be used to treat IBD symptoms.
Shop for and online.
Lifestyle choices are important when you have IBD.
helps to compensate for those lost in your stool. Avoiding dairy products and stressful situations also improves symptoms.
and , if you smoke, can further help improve your health.
Vitamin and mineral supplements can help with nutritional deficiencies. For example, can help treat anemia.
Talk with your doctor before adding any new supplements to your diet.
Surgery can sometimes be necessary for people with IBD. Some IBD surgeries include:
- strictureplasty to widen a narrowed bowel
- , for people with Crohn’s disease
- removal of the entire colon and rectum,
Routine colonoscopy is used to monitor for colorectal cancer, since those with IBD are at for developing it.
How can inflammatory bowel disease be prevented?
The hereditary causes of IBD can’t be prevented. However, you may be able to reduce your risk for developing IBD or prevent a relapse by:
- , if you smoke
IBD can cause some discomfort, but there are ways you can manage the disease and still live a healthy, active lifestyle.
Visit the for resources and more information on IBD, including UC and Crohn’s disease.
It can also be helpful to talk with others who understand what you’re going through.
IBD Healthline is a free app that connects you with others living with IBD through one-on-one messaging and live group chats while also providing access to expert-approved information on managing IBD.
Download the app for .