Learning to live with an inflamed bowel

Inflammatory bowel disease (IBD) affects over 5 million people worldwide. The most common types of IBD are ulcerative colitis (UC) and Crohn’s disease (CD).

UC and CD affect the gut, or gastrointestinal tract. They cause inflammation, which leads to a variety of symptoms both in the gut, and other parts of the body. Both these conditions are chronic diseases, which means they tend to be ongoing and lifelong.

They also typically relapse and remit, which means most patients with IBD will have periods without symptoms, and other times when they ‘‘flare up’’ and become symptomatic again. The major symptoms include: Diarrhoea.

Abdominal pain, sometimes associated with the diarrhoea.

Blood or mucous mixed through the bowel motion.

Weight loss. Tiredness. Fever. Nausea and loss of appetite. Feeling generally ‘‘unwell’’. Other symptoms, outside of the gut, can, but won’t necessarily, include: Mouth ulcers. Joint pain, especially the hip, pelvis and back area. Skin rashes. Eye symptoms, including inflammation known as ‘‘uveitis’’.

No-one really knows exactly what causes IBD. It tends to occur in people from 15 years and up, but can occur sometimes in younger children. You are more likely to be affected if you have a relative with the same condition, so there is definitely a genetic component.

If you smoke, you are far more likely to develop CD, and more likely to have a more severe version of it – however, unusually, for ulcerative colitis, non-smokers are more at risk.

Diagnosing IBD requires referral to a specialist, either a gastroenterologist or a colorectal surgeon. They will review your history, take some blood tests to look for inflammation and anaemia, and then organise a special test known as a colonoscopy.

This minor procedure involves inserting a flexible camera into the bowel through the anus. The camera can view the lining of the gut, looking for inflammation or ulcers, and biopsies can be taken to sample the wall of the gut. This test is usually performed under light sedation.

If you are diagnosed with IBD, your treatment will focus on two outcomes:

Settling down your flare-up and reducing your symptoms as soon as possible

Reducing the number and frequency of remissions.

During an acute flare-up, your doctor will probably prescribe steroids (prednisone). These drugs settle down inflammation quickly.

Steroids can be given rectally as an enema if your symptoms are confined to the lower part of the gut, or orally as tablets. Unfortunately, steroids are not suitable for ongoing use as they have side-effects when used longterm.

Another medication often used in IBD is mesalazine. This is one of a group of drugs known as aminosalicylates. Like steroids, these drugs can be used orally or rectally depending on the site of the inflammation. They are used to settle down flare-ups, but can also be used long-term to prevent recurrence.

In more severe cases of IBD, stronger medication known as immunosuppressants may be needed. These can work really well to reduce the number and severity of recurrences, but unfortunately are not without some risk as they lower your body’s general immunity.

If you think you may have symptoms of IBD, it is really important to get it checked out promptly. Occasionally flare-ups, especially of CD, can be very severe and even life-threatening. Both types of IBD carry a very small increased risk of cancer in the long-term, so ongoing surveillance with regular colonoscopies is important.

For more information visit crohnsandcolitis.org.nz.