Some hope for sufferers
NFLAMMATORY BOWEL disease (IBD) is a group of poorly understood conditions that cause longterm inflammation of the digestive system. Crohn’s disease and ulcerative colitis (UC) are the two main forms of IBD, affecting more than 300,000 people in the UK and millions more around the world. Both Crohn’s and UC are increasing in incidence worldwide. The disease can start at any age but symptoms usually appear between age 10 and 40. IBD is a major cause of illness and hospitalisation in young people and represents a significant healthcare burden.
Although both UC and Crohn’s disease cause inflammation of the gut, they vary in how they do this. Crohn’s disease can affect any part of the gut. The areas of inflammation are often patchy, with sections of normal gut in between. Ulcerative colitis, however, is found only in the large bowel, where inflammation starts from the rectum but can involve the entire large bowel in some people.
SYMPTOMS OF IBD
Patients may have times when they feel healthy, or flare-ups when their symptoms are especially troublesome. These symptoms include abdominal pain and diarrhoea (often mixed with blood or mucus), tiredness, mouth ulcers, loss of appetite and a drop in weight. Joint and eye problems are common in IBD. Occasionally, some people with IBD develop complications that require major surgery. This is far more common in Crohn’s disease than in UC.
WHAT CAUSES IBD?
We do not know exactly — but we believe that it is caused by a combination of factors including our genetic makeup and an excessive reaction of the immune system to intestinal bacteria, along with other environmental factors such as smoking (which doubles the risk of developing Crohn’s).
IBD is especially common in Caucasians of European descent, especially Ashkenazi Jews, for whom it is two to eight times more common. Researchers have found unique genetic differences between Jewish and non-Jewish patients with IBD but the significance of this is still under investigation.
HOW CAN IT BE TREATED?
Treatments are tailored to the individual and aim to reduce inflammation in the bowel, improve symptoms and improve the quality of life. Current options are medicines, surgery or a combination. If the condition is mild, it may be appropriate to give no treatment at all. Doctors may recommend nutritional supplements or special diets, especially for children.
Many medications used to help control IBD are anti-inflammatory drugs, such as 5ASAs and steroids. Others, such as Azathioprine or Methotrexate, suppress the immune system. Antibiotics such as Metronidazole and Ciprofloxacin may also have a role.
Despite the medicines available, most patients with Crohn’s disease have surgery at some point. Ulcerative colitis can usually be managed by medication but surgery may be needed if symptoms are very bad.