Inflammatory bowel disease (IBD) is a term mainly used to describe two diseases, ulcerative colitis and Crohn’s disease.
Both ulcerative colitis and Crohn’s disease are long-term (chronic) diseases that involve inflammation of the gastrointestinal tract (gut).
Ulcerative colitis only affects the colon (large intestine), while Crohn’s disease can affect the entire digestive system, from the mouth to the anus.
It is sometimes difficult to tell the difference between the two main types of IBD. If this is the case, it is known as indeterminate colitis.
There are other, rarer types of IBD called collagenous colitis and lymphocytic colitis. Together these are often called microscopic colitis.
Causes of IBD
The cause(s) of IBD are not known, but there are several theories. One theory is based on genetics, indicating that IBD does run in families. About 15 percent to 30 percent of patients with IBD have a relative with the disease.
There is research underway to find out if a specific gene or a group of genes makes a person more susceptible to getting the disease.
Many changes in the body’s immune system (body’s natural defense system against disease) have been discovered in patients with IBD.
What is still unknown is what causes those changes to happen. There is a large amount of research being done in this area, including studies to find out if IBD is caused by an infectious agent.
There is little evidence that stress causes IBD. As with other illnesses, stress may aggravate symptoms and require a treatment program.
IBD occurs most frequently in people in their late teens and twenties. There have been cases in children as young as two years old and in older adults in their seventies and eighties.
Men and women have an equal chance of getting the disease.
What are the symptoms?
The main symptoms of ulcerative colitis and Crohn’s disease are similar. They include:
- abdominal (tummy) pain – this is more common in Crohn’s disease than in ulcerative colitis
- recurring or bloody diarrhoea
- weight loss
- extreme tiredness
Not everyone has all of these symptoms, and some people may experience additional symptoms, including nausea and fever.
The symptoms of IBD can come and go over long periods. People may experience periods of severe symptoms (flare-ups), and go through long periods when they have few or no symptoms at all (remission).
The exact causes of ulcerative colitis and Crohn’s disease are unclear. It is thought that several factors may play a part, such as:
- genetics – there is evidence that you are more likely to develop IBD if you have a close relative with the condition
- disruption to the immune system (the body’s defence against infection) – inflammation may be caused by the immune system attacking healthy tissue inside the digestive system whilst fighting off a virus or bacteria
Ulcerative Colitis and the Risk of Colon Cancer
The risk of colon cancer is higher in ulcerative colitis patients with involvement of the entire colon and in patients who have had the diagnosis for eight to 10 years or more.
Patients with a diagnosis of left-sided ulcerative colitis for 15 to 20 years also fall into a higher risk group for developing cancer.
Individuals who fall into these groups should consult their gastroenterologist and plan for periodic colonoscopy with biopsy.
There is currently no cure for ulcerative colitis or Crohn’s disease. Treatment aims to relieve symptoms and prevent them from returning.
Mild ulcerative colitis may not need treatment as symptoms can clear up after a few days.
Medications used to treat ulcerative colitis or Crohn’s disease may include:
- aminosalicylates, or in more severe cases, corticosteroids – to reduce inflammation
- immunosuppressants – to block the harmful activities of the immune system
An estimated 20% of people with ulcerative colitis have severe symptoms that often don’t respond to medication.
In these cases, it may be necessary to surgically remove an inflamed section of the digestive system.
Around 60-75% of people with Crohn’s disease will require surgery to repair damage to their digestive system and treat complications of the condition.
Who is affected?
It is estimated that IBD affects about one person in every 250 in the UK. There are around 120,000 people with ulcerative colitis and 90,000 with Crohn’s disease in the UK.
- IBD is usually diagnosed in people in their late teens or early 20s, but it can appear at any age.
- IBD is more common in white people than in black people or those of Asian origin. The condition is most prevalent among Jewish people of European origin.
- IBD affects slightly more women than men.