Understanding IBD and how you can manage it

In this article, we speak to King Edward VII’s Hospital consultant, Dr Ed Seward, about IBD, what the symptoms are, getting a correct diagnosis and what support is available.

What is IBD?

IBD is a condition that results in gut inflammation. Both Crohn’s disease and ulcerative colitis cause similar symptoms and can have a significant impact on day to day life. Around 1 in 700 people in the UK have Crohn’s disease and around 1 in 400 have ulcerative colitis.

Of the two main types of IBD, both are associated with inflammation in the gut, commonly causing ulceration, but affect different parts of the gastrointestinal, or GI, tract.

Crohn’s disease can affect any part of the GI tract, which begins at the mouth and ends in the anus. Ulcerative colitis only affects the large intestine, or colon, and the rectum.

Anyone can develop IBD, but it’s most commonly diagnosed in those between 15 and 40 years old.

What is the difference between IBD and IBS?

IBD is different from IBS, or irritable bowel syndrome. IBS is a common condition that also affects the gut, typically causing cramping, pain, bloating and periods of constipation followed by periods of diarrhoea. It can flare up for weeks or months at a time, before settling down again and can be a lifelong condition.

IBS has no cure, but it can be managed with the right lifestyle and diet approach. It can be incredibly frustrating and can impact day to day life.

Unlike IBD however, IBS doesn’t cause inflammation in the gut but instead is thought of as a disturbance in function of the gut. IBS will not show visible signs of disease during a colon examination called a colonoscopy where a small camera is inserted into the large bowel via the anus, whereas IBD usually will. IBS is also unlikely to require hospitalisation and will never require surgery, whereas someone with IBD might need such hospital treatment.

What are the symptoms of IBD?

Symptoms of IBD vary, and can affect people differently. The main symptoms of IBD include:

• Stomach pain or cramping
• Frequent diarrhoea
• An urgent need to open your bowels
• Blood in the stools
• Unexplained weight loss
• Loss of appetite or nausea/vomiting
• Extreme fatigue
• Anaemia

Because IBD is associated with inflammation, having IBD can also mean developing other inflammatory conditions elsewhere in the body, such as arthritis, that causes painfully inflamed joints.

The eyes can also become inflamed (such as in uveitis), as can the skin (painful red bumps within the skin called erythema nodosum can form). Mouth ulcers can also occur in someone with Crohn’s disease (but not ulcerative colitis since it doesn’t affect the upper GI tract).

The symptoms of IBD can come and go, with periods of remission where there are no symptoms, followed by flare ups – periods of mild, moderate or severe symptoms.

What causes IBD?

It’s still unclear exactly what causes IBD, but doctors think there are some risk factors that can increase your chances of having the condition. These include:

• Genetics – having a close family member with IBD
• A problem within the immune system that causes it to mistakenly attack the GI tract
• Having a stomach bug
• Having an imbalance of gut bacteria
• Smoking

How is IBD diagnosed?

If you think you might have IBD, getting a proper diagnosis is important. Sometimes, mild cases can be confused with IBS and therefore proper IBD care and support can be missed.

There is no one definitive test for IBD. Instead, you may have a range of tests, and your doctor will look at your results from all of them before giving a diagnosis. IBD tests include:

• Blood tests for various markers of inflammation and anaemia
• Stool tests for markers of inflammation and gut infections
• CT or MRI scans
• A colonoscopy to look for inflammation and ulcers within your bowel
• A gastroscopy to look for inflammation in the upper gut

During a camera examination, your surgeon may also take samples of tissue from your bowel, called biopsies, for further laboratory tests.

How is IBD treated?

At present, there is no cure for IBD. Instead, the condition is managed in a variety of ways to help control your symptoms, depending on what they are and how severely they affect you.

Your doctor will discuss all of your options with you so that together you can decide on your best course of treatment. Some people with IBD don’t need any treatment and instead have regular monitoring visits to their medical team.

Treatment for Crohn’s disease:

• Young people with Crohn’s disease can benefit from a short term liquid diet, to give their digestive tract a temporary rest. Special drinks provide all the necessary nutrients for a few weeks, and this allows the bowel inflammation to settle.
• Steroids can be prescribed for flare ups of Crohn’s disease. These are usually in the form of a daily tablet, although they can be given as injections. They’re usually prescribed for a few months at a time and help to relieve the symptoms of the condition by reducing inflammation.
• Some people with Crohn’s disease can benefit from immunomodulatory medications that ‘dampen down’ the immune system, helping to stop it attacking the GI tract. They can be used on a longer term basis to help prevent the symptoms of Crohn’s disease from returning. Immunosuppressant medications are most commonly taken as daily tablets, but they can also be given as injections.
• If these options have little effect on your symptoms, you may benefit from taking medications called biological medications. These are generally given by injection or a drip every few weeks.
• Sometimes, if other treatments are proving to be ineffective, surgery can help. This generally involves keyhole surgery under a general anaesthetic to remove the diseased section of bowel before stitching the two ends together in a surgical procedure called a resection. You can expect to be in hospital for around a week following a resection. It may also be necessary to perform an ileostomy, where you have a temporary bag attached to your stomach to allow faeces to leave your body. The full procedure will be explained to you beforehand.

Treatment for ulcerative colitis:

• Often, the first treatment for ulcerative colitis is a type of medication called an aminosalicylate, or 5-ASA. These help to reduce inflammation, allowing the areas of ulcerated large bowel to heal. They can be taken on a short or long term basis via a tablet or rectal suppository.
• Other anti-inflammatory medications called corticosteroids can be used alongside 5-ASAs or on their own, and can also be administered orally or into the rectum. They tend to be used on the short term to manage flare ups.
• Medications to suppress the immune system can also be used to manage mild or moderate flare ups and work by stopping the immune system attacking the digestive system, exactly as the immunomodulators for Crohn’s disease.
• Severe flare ups of ulcerative colitis are usually treated in hospital using stronger immunosuppressing medications. These are usually administered via a drip for around seven days.
• Like for Crohn’s disease, biological medications can also be used to reduce inflammation by blocking the function of the immune system, in severe cases of ulcerative colitis.
• Similarly, surgery can also be an option for ulcerative colitis that isn’t responding to other treatments. This involves a complete removal of the colon, in a procedure called a colectomy. An ileostomy, or another procedure that allows you to pass stools normally, called an ileoanal pouch, will then be performed in order for your body to pass waste. Again, the full procedure will be explained to you beforehand.

Find out more about living with IBD and how it can effect your sexual health.

More information

• If you’re experiencing symptoms that you’re concerned might be being caused by IBD, speak to your GP. (If you don’t have a GP, you can make an appointment with one of our private GPs.)
• The King Edward VII’s Hospital Gastroenterology Department offers a first class diagnosis and treatment service, from expert gastroenterology consultants, including those who specialise in IBD.
• Support groups such as Crohn’s and Colitis UK also provide lots of useful information.