Inflammatory Bowel Disease

Inflammatory bowel disease is a lifelong condition that causes swelling and inflammation in the digestive tract, but with the right treatment and care, most people can lead active lives with long periods free from symptoms.

What is Inflammatory Bowel Disease?
Types of Inflammatory Bowel Disease
Symptoms
Causes and Risk Factors
Complications
Diagnosis
Treatment and Management
Living with Inflammatory Bowel Disease
Outlook and Quality of Life

What is Inflammatory Bowel Disease?

Inflammatory bowel disease (IBD) is an umbrella term for a group of conditions that cause chronic inflammation and swelling of the tissues in the digestive tract (the system that processes food in your body)^[1]. The disease is lifelong, meaning it does not go away on its own^[2].

IBD occurs when the body’s natural defense system mistakenly attacks healthy bowel cells. This causes inflammation that does not go away on its own^[3]. The condition is characterized by repetitive episodes of inflammation caused by an abnormal immune response to gut microflora (the bacteria and other microorganisms that naturally live in your intestines)^[4].

Experts estimate that 1.6 million people in the United States have IBD^[2]. The disease can affect anyone from young children to adults age 65 and older, but it most commonly affects people ages 15 to 35^[2].

Digestive tract
Small intestine
Large intestine (colon)
Rectum
Mouth
Anus

Types of Inflammatory Bowel Disease

Crohn’s disease and ulcerative colitis are the main types of IBD^[2]. Despite some similarities, each impacts different parts of the digestive tract in different ways^[3].

Crohn’s Disease

Crohn’s disease causes sores called ulcers in your digestive tract. It can affect any part of your digestive tract, from your mouth to your anus, but it typically develops in your small intestine and the upper part of your large intestine^[2]. Crohn’s disease most commonly affects the last part of the small intestine, called the ileum, and parts of the colon^[1].

In this type of IBD, the lining of the digestive tract is inflamed. The condition often involves the deeper layers of the digestive tract^[1]. Crohn’s disease results in transmural ulceration, meaning the inflammation extends entirely through the intestinal wall^[4]. The intestine can become inflamed in patches, and inflammation and ulcers can occur in deep layers of the intestine^[7].

Crohn’s disease is usually progressive, which means it’s likely to get worse over time for some people^[5]. The disease is also classified by phenotype—inflammatory, stricturing, or penetrating^[4].

Ulcerative Colitis

Ulcerative colitis causes swelling and sores (ulcers) in your large intestine. It usually starts in your rectum and can spread to part or all of your colon^[2]. This condition involves inflammation and ulcers along the lining of the colon and rectum^[1].

Ulcerative colitis involves diffuse inflammation of the colonic mucosa (the surface layer of tissue in the large intestine)^[4]. Most often, ulcerative colitis affects the rectum, but it may extend into the sigmoid (the last part of the colon before the rectum), beyond the sigmoid, or include the entire colon up to the cecum^[4].

Unlike Crohn’s disease, the inflammation in ulcerative colitis does not go through the entire wall of the intestines and therefore does not result in fistulas (abnormal openings between organs)^[15]. The inflammation in ulcerative colitis tends to be uniform, in that the entire lining in the affected portion of the intestine is inflamed^[7].

Symptoms

IBD symptoms may be mild or severe. They come and go, and you can’t always predict when they’ll happen^[2]. Symptoms of inflammatory bowel disease vary depending on how bad the inflammation is and where it is located^[1].

When symptoms appear, a healthcare provider may say you’re having an IBD flare (active disease). When your symptoms go away after treatment, a provider may say the disease is in remission^[2]. “Remission” refers to periods when symptoms temporarily go away. “Flare-ups” refer to periods of increased symptoms^[3].

Common IBD symptoms include^[2]^[3]:

Diarrhea or changes in bowel movements
Lower abdominal pain that may feel like stomach cramps
Blood in your poop (stool) or stool with blood or mucus
Rectal bleeding
Fatigue (extreme tiredness)
Nausea
Unintended weight loss

Symptoms of both ulcerative colitis and Crohn’s disease usually include belly pain, diarrhea, rectal bleeding, extreme tiredness and weight loss^[1]. For some people, IBD is only a mild illness. But for others, it’s a condition that causes disability and can lead to life-threatening complications^[1].

Some symptoms are more commonly seen in one type of IBD than the other. Bowel urgency, malnutrition, and mouth sores are more commonly seen in Crohn’s disease^[5].

Causes and Risk Factors

IBD happens when immune system cells in your digestive tract mistakenly attack healthy tissue, causing inflammation that leads to Crohn’s disease and ulcerative colitis. Researchers don’t know the exact reason why this happens^[2].

Inflammatory bowel disease occurs in genetically susceptible individuals after an inappropriate immune response to the intestinal flora^[4]. A person may develop IBD due to the interaction between the genes they inherit from their parents and environmental factors, such as where they live and their lifestyle. Together, these factors could trigger an immune response^[5].

Genetic Factors

Researchers are studying mutations in certain genes that normally keep your immune system on an even keel so it doesn’t overreact when it detects intruders, affect your mucosal barrier (the first line of defense in your intestine), and control bacteria growth in your intestine^[2].

When these genes mutate (change), it increases your risk of IBD. Researchers may call these genes susceptibility genes. There are more than 160 different susceptibility genes^[2]. The CARD15 gene has been associated with IBD, but because of its polymorphic features, it is not possible to determine which part of the digestive tract will be affected^[4].

You’re more likely to get IBD if one of your close relatives has it, for example, one of your parents, grandparents, or a sibling^[8].

Triggers

If you inherited any number of susceptibility genes, several everyday activities could trigger IBD symptoms. These activities don’t cause the disease. Common IBD triggers include^[2]:

Antibiotics
NSAIDS (nonsteroidal anti-inflammatory drugs)
Smoking cigarettes
Stress

The role of tobacco is particularly strong with Crohn’s disease. Smoking protects against ulcerative colitis, but it has a strong link with Crohn disease^[4].

Researchers are also investigating if issues with your gut microbiome may play a part in the chronic inflammation that causes IBD^[2].

Food and IBD

No specific diet has been shown to prevent or treat IBD^[15]. Food does not cause IBD, but you may notice that your symptoms get worse after you consume certain foods or liquids. Everyone is different, but food and drink that may make you feel worse may include beverages with alcohol and caffeinated beverages^[2].

Complications

IBD can lead to health complications both inside the gastrointestinal tract and outside the digestive tract. These are called “extraintestinal manifestations”^[3].

Complications Inside the Digestive Tract

Complications inside the digestive tract include^[3]^[6]:

Dehydration
Not absorbing enough essential nutrients (malabsorption)
Increased risk of colon and rectal cancers
Intestinal strictures (narrowing of the intestines)
Fistulas (abnormal openings between organs in the digestive tract)

Complications Outside the Digestive Tract

Complications outside the digestive tract include^[3]:

Low red blood cell count (anemia)
Reduced bone density
Joint pain
Skin changes
Eye irritation
Delayed or impaired growth in some children

Mental and Emotional Well-being

IBD can impact a person’s quality of life, increasing the risk of mental health challenges^[3]. These may include depression, anxiety, feelings of distress or being overwhelmed, and other mental disorders^[3]. Depression and anxiety are common in IBD patients^[13].

Diagnosis

There is no single test to determine inflammatory bowel disease^[7]. Healthcare providers complete a medical history and typically perform a series of tests to diagnose your condition^[7].

Diagnostic Tests

Tests that may be used to diagnose IBD include:

Blood tests: These may include a complete blood count (CBC) to detect infection, anemia or other abnormalities, and an electrolyte panel to measure potassium and other minerals that may be depleted by IBD-associated diarrhea^[7]. Blood tests may also check for screening for liver and bile duct abnormalities sometimes seen in IBD patients^[7].

Stool studies: These can detect bacterial infections^[7].

Biomarkers: Your doctor may check blood biomarkers such as C-reactive protein, which goes up when there’s inflammation in the body^[12]. Another biomarker is fecal calprotectin, which is found in a stool sample and can indicate intestinal inflammation^[12].

Endoscopic tests: If your provider suspects you have IBD, you will most likely undergo colonoscopy and sometimes upper endoscopy, which are used to visually examine your gastrointestinal tract and can also be used to obtain tissue for a biopsy^[7].

Radiologic tests: These can include conventional X-rays, contrast X-rays (using an agent such as barium) or CT scans (often using a new technique called CT enterography)^[7].

MRI (magnetic resonance imaging): This can be used for the assessment of small bowel disease, fistulas, and abscesses. Assessment of the small bowel is done with a new technique called MR enterography^[7].

Treatment and Management

Inflammatory bowel disease is a lifelong illness for which there’s no cure. But there are treatments that manage IBD symptoms, and steps you can take to keep IBD from disrupting your life^[2].

The goal of treatment is to reduce inflammation, which can reduce symptoms^[6]. Treatment varies depending on the severity of the inflammation, the location of the inflammation, and the patient’s unique needs^[6].

Treatment Goals

In the short term, doctors want patients to feel better. This is called clinical remission, and it means the symptoms have gone away^[12]. The secondary goal is ensuring that inflammation has improved^[12].

The long-term goal is mucosal healing, which is a clinical standard that means the inner lining of the intestine looks normal when viewed via imaging tests^[12]. For Crohn’s disease, there may still be a little redness in the intestines, but doctors don’t want to see any deep ulcers^[12].

Medications

Keeping up with medication is the best way to control IBD symptoms and flare-ups^[3]^[13]. Common medications include:

Aminosalicylates: These help reduce inflammation in the digestive tract. They are also called 5-aminosalicylic acids or 5-ASA^[3]. These anti-inflammatory medications can be given either orally or rectally^[6].

Corticosteroids: These are strong anti-inflammatory steroids that work fast. They are given in large doses, then lowered, and eventually stopped^[3]. While effective in the short-term, these are not recommended for long-term use^[6].

Immunomodulators: These block the immune reaction that leads to inflammation. They are also called immunosuppressive agents^[3]. These medications help to keep the immune system in check and reduce inflammation^[6].

Biologics: These block the immune system chemicals that trigger inflammation. They are made from living sources (like human, animal, or microorganism)^[3].

Surgery

Surgery may be done to remove or widen the areas of the intestines that have been severely affected. It is typically considered after other treatments have failed^[3]. If going on a long trip, discuss your plans with your healthcare provider. He or she can teach you what to do if you have a flare-up while on the road^[19].

Living with Inflammatory Bowel Disease

Living with IBD means it’s not always possible to be symptom-free. But there are things you can do to help manage flare-ups^[5].

Creating a Care Plan

Work closely with your health care team to optimize your treatment plan. Tell them about how you feel, your symptoms, and your experiences with flare-ups. Be honest about your life, diet, and activities^[13].

Daily Planning

Make this your goal: “Crohn’s disease won’t keep me from the activities I enjoy.” You may need to do some planning to reach that goal^[19]. Here are some tips:

Know where to find clean bathrooms
Eat more small meals instead of three big meals, especially when on the road or when you don’t have easy access to bathrooms
If you’ve had a recent flare-up, eat foods that you know will limit your symptoms. Keep those foods on hand, both at home and at work

Plan your day. Be intentional, create structure, and build-in ample time for rest. Plan activities you enjoy, and try to maintain a positive anticipation for them^[13].

Diet and Nutrition

There is no single, perfect diet to reduce symptoms and replace lost nutrients. So, it is important to pay attention to your individual responses to food^[15]. Some diet strategies help control symptoms^[15].

Keeping a record of foods eaten and then taking note of when symptoms worsen may help you identify patterns that indicate problem foods^[15]. If one kind of food often gives you trouble, stay away from it^[19].

Generally, eating habits known to be most inflammatory include greasy, fibrous, spicy, and milk-heavy foods, as well as caffeinated, carbonated and alcoholic beverages. The least inflammatory are soft, bland foods and eating smaller meals every two to four hours^[13].

Healthy Habits

Diet and other health behaviors can help control IBD symptoms and flare-ups. Following your treatment plan maximizes your time without symptoms^[13]. Additional behaviors include:

Drink more water
Quit smoking
Get enough sleep and physical activity
Stay current on vaccines (particularly the flu shot)
Get regular health and cancer screenings
Get some exercise every day
Take a stress reduction class

Mental Health Support

Living with a chronic, often painful, disease is not easy. Maintaining mental health is just as important as managing physical symptoms^[13].

Discover your circle. Find support groups and get involved with the IBD community^[13]. Crohn’s disease support groups can help you with the many concerns you may have. Other people have felt much of what you may be feeling. Just knowing that you’re not alone can be a great comfort^[19].

Outlook and Quality of Life

Most people with IBD can control their symptoms and lead active lives^[3]. Most people with IBD lead active lives with long periods of remission^[13]. The effects of IBD may seem intimidating, but the right treatment can control symptoms and allow people to get back to doing the things they love^[3].

Living a quality life with IBD is possible. Most patients lead active lives with long periods of remission, despite occasional flare-ups^[13]. Many people are able to get back to the things they loved doing before their diagnosis^[18].

It’s been well studied that actually inflammatory bowel disease does not significantly change the overall lifespan of the patients^[9].