Inflammatory bowel disease (IBD) is a gastrointestinal condition with symptoms that range from mild to life-changing. It is not the same as irritable bowel syndrome (IBS), which can be challenging to live with but is generally not as serious.
Research is ongoing into the causes of IBD. There is a known genetic component, and some environmental factors may contribute to its development. There is also good evidence IBD is an autoimmune disorder.
In this article, we’ll talk about what IBD is, how it presents, what triggers IBD flares, and how IBD is diagnosed and treated.
What Is Inflammatory Bowel Disease?
Inflammatory bowel disease includes two disorders that cause chronic inflammation of the digestive tract: ulcerative colitis and Crohn's disease. These very different conditions are usually easy to tell apart, but if a firm diagnosis can’t be made a person might be said to have indeterminate colitis.
Ulcerative colitis is a condition characterized by chronic inflammation of the colon and rectum, together known as the large intestine, with ulcers (open sores) forming along its inner lining. (Source)
Crohn’s disease can affect any part of the gastrointestinal (GI) tract from the mouth to the anus, and is divided into types depending on which part or parts are affected. Inflammation from Crohn’s can penetrate the entire thickness of the intestinal wall. (Source)
A third diagnosis, indeterminate colitis, can be given if it isn’t possible to tell whether a patient has ulcerative colitis or Crohn’s disease. However, this diagnosis is not common.
Signs and Symptoms
Signs and symptoms of IBD vary depending on the specific condition, the severity of inflammation, and the parts of the GI tract affected. Some features that are common to both ulcerative colitis and Crohn's disease include:
- abdominal pain and cramping
- rectal bleeding or bloody stool
- reduced appetite
- weight loss
IBD vs. IBS
Inflammatory bowel disease and IBS may have similar symptoms, but are two distinct conditions that require different treatments.
Irritable bowel syndrome is considered a functional GI disorder, meaning it disrupts bowel function without damaging the GI tract. It affects approximately 10% to 15% of adults in the United States, impacts women more often than men, and is one of the most frequently diagnosed GI conditions.
Symptoms of IBS
Signs and symptoms of IBS vary in severity but may include:
- chronic and persistent abdominal pain
- mucus in the stool
- abdominal bloating or feeling full
- being unable to have a bowel movement despite feeling the need
Differences Between IBD and IBS
There are several key differences between IBD and IBS:
- IBD is classified as a disease, and IBS is classified as a syndrome, or group of symptoms.
- IBD can cause harmful gut inflammation, but IBS does not.
- IBD can cause visible damage to the colon, but with IBS a colon exam is normal.
- IBD incurs an increased risk for colon cancer, but IBS does not.
It is possible to have both IBD and IBS. There is no evidence that having IBS increases the risk of developing IBD. (Source, Source)
Causes and Triggers of IBD
The exact cause of IBD is unknown, but it is likely due to an abnormal relationship between the gut microbiome and the immune system. Normally, the immune system attacks foreign invaders, such as viruses and bacteria. However, in IBD, the immune system may attack healthy cells in the digestive tract, giving rise to the characteristic inflammation of that region. (Source)
It isn’t entirely clear why this happens, but it seems to be a combination of intestinal microbes causing inflammation of the gut lining and a tendency of the immune system to respond inappropriately to microbes that are harmless or even beneficial. (Source)
There is also a genetic component to IBD, and if you have family members with the condition you may be more likely to have it. However, most people with IBD do not have this family history. (Source)
It was once thought IBD was caused by diet and stress. Research has shown, however, that while diet and stress can make IBD symptoms worse, they don’t cause the condition. (Source, Source)
A flare is a resurgence or worsening of IBD symptoms. Common symptoms of ulcerative colitis or Crohn’s disease flares are:
- frequent and/or urgent bowel movements
- bloody stool
- abdominal pain
- weight loss
- loss of appetite
- nausea and vomiting
IBD Flare Triggers
- Missing, skipping, or taking the incorrect dose of medication: Not taking, or taking an incorrect dose of, prescribed IBD medication can trigger a flare-up.
- Antibiotics: Antibiotics used to treat bacterial infections can alter the bacteria in the gut, causing diarrhea or inflammation.
- Stress: Physical or emotional stress can exacerbate IBD symptoms.
- Foods that irritate the digestive tract: Certain foods, such as those that are fried or greasy, can trigger IBD symptoms.
IBD Flare Treatments
- Corticosteroids: Corticosteroids have anti-inflammatory properties and can be used to achieve short-term IBD remission, but long-term steroid use may have side effects.
- Check drug levels: It is possible to become resistant to IBD medication. If your usual medication is not preventing IBD flares, you may have actually developed antibodies against it.
- Change medication: Switching medication dosage, trying a new medication, or adjusting your medication regimen may alleviate flares.
IBD Risk Factors
- Genetic predisposition: Research has pinpointed a number of genes that may be involved in susceptibility to IBD. Risk may increase if a close blood relative, such as a parent or sibling, has Crohn’s or ulcerative colitis. (Source)
- Early antibiotic exposure. In the US, an association has been found between receiving an antibiotic in the first year of life and later development of IBD, presumably because of disruption in the normal gut microbiome. In other countries where infants are exposed to more pathogens, however, early antibiotic exposure may have a protective effect. (Source)
- Race and ethnicity: IBD affects people of all races and ethnicities, but in the US the incidence is significantly higher among white people. Studies have shown increasing incidence in recent years among both white and non-white people. (Source)
- Age: Most people are diagnosed between the ages of 15 to 29, although they may have symptoms for years before they receive a diagnosis. (Source)
- Smoking: Cigarette smoking increases your risk of developing Crohn's disease, although we aren’t sure why. Oddly, some studies have found a lower incidence of ulcerative colitis among smokers. (Source)
- Non-steroidal anti-inflammatory medications: Medications such as ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and diclofenac sodium (Voltaren), may increase risk of developing IBD or worsen the condition. (Source)
How Is IBD Diagnosed?
Your health care provider will likely only diagnose IBD once other causes for your symptoms are ruled out. Specific diagnostic tests and procedures are conducted to confirm the condition.
IBD Lab Tests
Lab tests are used both to make sure symptoms are not due to infection or another medical problem, and to confirm the suspicion that symptoms are due to IBD.
- Blood tests: Blood tests are often ordered to check for anemia, which may be caused by intestinal bleeding, and for evidence of infection or inflammation. If an IBD diagnosis appears likely, antibody tests may be done to confirm it. (Source)
- Stool tests: Stool may be tested for the presence of bacteria, parasites, or other disease-causing pathogens. It may also be tested for blood and for certain proteins that reveal the presence of gut inflammation. (Source)
IBD Endoscopic Procedures
These procedures are more invasive than blood and stool tests, but they allow visual inspection of the GI tract.
- Colonoscopy: Under current U.S. guidelines, colonoscopies to check for colon cancer are recommended for everyone aged 45 and over. Colonoscopy, which allows visualization of the entire colon by way of a thin, flexible, lighted tube with a camera on its end, is also used to diagnose IBD. Tissue samples for biopsy may be taken during the colonoscopy.
- Flexible sigmoidoscopy: A sigmoidoscopy also involves a thin, flexible, lighted tube with a camera, but is only inserted as far as the last part of the colon, known as the sigmoid. Ulcerative colitis usually begins in the rectum, and this much less invasive procedure may be more appropriate than colonoscopy if ulcerative colitis is suspected. (Source)
- Upper endoscopy: Like other procedures, an upper endoscopy involves a flexible, lighted tube with a camera, but it is inserted through the mouth rather than the rectum and visualizes the upper GI tract including the esophagus, stomach, and beginning of the small intestine. It may be used to diagnose Crohn’s disease, which can affect any part of the GI tract, and to look for other causes of symptoms such as nausea, vomiting, and abdominal pain.
- Capsule endoscopy: A capsule endoscopy allows visualization of the small intestine, which is out of reach of most other methods. A wireless camera encased in a capsule about the size of a large vitamin is swallowed, and as it moves through the GI tract it transmits images to a recorder worn on a belt. Painless and less stressful than more invasive procedures, a capsule endoscopy does not allow tissue sampling for biopsy. (Source)
- Balloon-assisted enteroscopy: The small intestine is narrow but very long (between 20 and 25 feet!) and is twisted and packed into a small space, making it hard to advance an endoscope through it. This kind of endoscope has one or two balloons attached to it, which can be inflated to open the intestine and clear a passage for the endoscope. It is sometimes used in conjunction with capsule endoscopy. (Source)
Prognosis of IBD
The prognosis or outlook of IBD varies from person to person because of factors including:
- severity of the disease
- age at diagnosis
- amount of inflammation
- underlying health conditions
IBD is a lifelong condition that isn’t expected to decrease life expectancy. Studies of mortality rates among IBD patients have been inconclusive, but rates may be higher among people with Crohn’s than with ulcerative colitis. With treatment, symptom management and even remission is possible and reduces the chance of severe complications of the disease. (Source, Source)
Potential Complications of IBD
Potential complications of IBD include:
- increased risk of colorectal cancer
- anal fistula (tunnel between an infected anal mucus gland and the anus)
- anal stenosis or stricture (narrowing of the anal canal)
- anemia (low red blood cell count)
- blood clots
- kidney stones
- liver disease
- malabsorption (inability to absorb nutrients through the small intestine) and malnutrition
- osteoporosis (weak, brittle bones)
- perforated bowel (tear in the large intestine)
- toxic megacolon (extreme dilation of the colon)
Treatment of IBD
Inflammatory bowel disease treatments vary according to the severity and chronicity of symptoms. Some treatments provide relief during flares but are not safe for long-term use, while some may succeed in achieving actual remission. There are both pharmacological and surgical treatments.
Pharmacological Treatments for IBD
- aminosalicylates: drugs to reduce gut inflammation, such as mesalamine, budesonide, and sulfasalazine
- immunomodulators: drugs to reduce immune activity, such as azathioprine and methotrexate
- biologics: medications genetically engineered to target specific pro-inflammatory proteins and enzymes, such as adalimumab and infliximab
- antibiotics: to treat infections and abscesses
- corticosteroids: drugs that reduce both inflammation and immune activity, such as hydrocortisone and prednisolone
- over the counter medications and supplements
- anti-diarrheal drugs
- pain relievers
- vitamins and probiotics
Surgical Treatments for IBD
There are a number of different surgical options for IBD, as different parts of the GI tract may be affected. In general, options include:
- bowel resection: removal of damaged part of the large or small intestine, with reconnection of the healthy ends
- colectomy: removal of the colon (large intestine)
- proctocolectomy: removal of the colon and rectum
(Source, Source, Source)
Diet does not cause IBD, but certain foods can worsen symptoms or contribute to IBD flares. You may find it helpful to keep a food diary to identify foods that trigger symptoms. If you need to eliminate certain foods from your diet to control your IBD, talk with a dietician to make sure you’re still getting all the nutrients you need.
Foods and beverages that often cause problems for those with IBD include:
- spicy foods
- processed foods
- nightshade vegetables
- fatty foods
It is also recommended to:
- eat smaller, more frequent meals (e.g., five or six small meals versus two or three large meals)
- stay well hydrated
Holistic Approach to IBD Treatment
Given the role dysbiosis, or disruption of the gut microbiota, is thought to play in many autoimmune disorders including IBD, it isn’t surprising that holistic or natural treatments emphasize use of probiotics, prebiotics, and synbiotics. Research has produced inconsistent, if promising, results, and more research is needed.
Probiotics are living microbes introduced into the GI tract for their beneficial effects. They are thought to work in several different ways, including interfering with the growth of pathogenic bacteria and modulating immune responses. Probiotics that have been studied for their ability to improve gut health and possibly reduce IBD symptoms include:
- Escherichia coli Nissle 1917
- Saccharomyces boulardii
- Clostridium butiricum VSL#3
Prebiotics are carbohydrates that are not digested, but are fermented by bacteria in the colon. This process creates favorable conditions for growth of probiotic bacteria. Prebiotics that have been studied for this use include:
- oligofructose and inulin
- germinated barley foodstuff
- fructo- and milk-oligosaccharides
Synbiotics are created by combining pro- and prebiotics to get the benefits of both at the same time. Many different combinations are being tested to see if they can achieve predictable results.
IBD Support Groups
There are also IBD support groups that can provide emotional support, share experiences, talk about new treatment options, and foster community among people with the condition. Many hospitals have IBD support groups, and your health care provider may be able to help you find a group in your local community.
Online support sites include:
Crohn’s & Colitis Foundation
IBD Support Foundation
Smart Patients Inflammatory Bowel Disease Community
When Should I See a Health Care Provider About IBD?
Consult with a health care provider about your IBD when:
- Adjusting your diet or vitamin/supplement regimen
- Thinking about starting a family, as it can be difficult for women with Crohn’s disease to become pregnant
- Experiencing severe flare-ups
- Experiencing new or unusual symptoms of any kind
Where Can I Find the Best Resources About IBD?
Some reliable sources of IBD information include: