Inflammatory bowel disease

What is IBD?
The term Inflammatory Bowel Disease (IBD) covers a group of chronic diseases characterised by inflammation of the gastrointestinal tract, primarily the intestines. It is estimated that over 75,000 Australians have an IBD, although the number is likely higher, and it usually first presents in individuals aged 15-30 years, although all ages can be affected.

What causes IBD?
The cause of IBD remains unknown but it is believed to be a combination of genetic, environmental and immunological factors. The current hypothesis is that in genetically predisposed individuals, the immune system fails to 'switch off' it's normal defence mechanism (inflammation) following exposure to an environmental factor – possibly viruses or bacteria for example – and this prolonged inflammation damages the intestinal tract and causes the symptoms of IBD.

Symptoms of IBD
Symptoms of IBD include abdominal pain, diarrhoea and fatigue, and appear in cycles of remission – where the patient has no or very mild symptoms and feels generally well – and relapse – when symptoms flair up once more. There is currently no cure for IBD with current treatments focussed on managing symptoms and extending periods of remission. Symptoms can range in presence and severity between individuals and additional complications affecting joints, eyes, liver, kidney and skin may also arise.

Types of IBD
The two main types of IBD are Crohn's disease and ulcerative colitis. Diagnosis of either Crohn's disease or ulcerative colitis (or another bowel condition) can be delayed as they both present with similar symptoms and cycle through periods of relapse and remission. However there are some key differences between Crohn's disease and ulcerative colitis:

Differences between Crohn's disease and ulcerative colitis
Factor
Crohn's disease
Ulcerative colitis
Primarily affected region
Ileum (last part of small intestine) and colon
Colon (large intestine) and rectum
Pattern of inflammation
Patchy
Continuous
Depth of inflammation
Throughout entire bowel wall
Bowel wall lining only
Rectal bleeding?
Uncommon
Common
Strictures/fissures?
Common
Uncommon
Association with smoking
Strongly associated with smoking along with worse outcome
Associated with non-smokers or ex-smokers - smoking may protect against disease

Diagnosis and treatment of IBD

Diagnosis usually requires a number of medical investigations including:

  • Medical history
  • Physical examination
  • Blood tests
  • X-rays
  • Examination of stools
  • Colonoscopy (direct visualisation of the bowel using a miniature camera attached to a long flexible tube that is inserted inside the anus)
  • Biopsy

Following a diagnosis, treatment of IBD may include a combination of:

  • Anti-inflammatory agents – to control inflammation, and induce and maintain remission of disease.
  • Immunosuppressive agents – to suppress the immune system to control inflammation.
  • Antibiotic agents – to prevent and control bacterial infections.
  • Nutritional supplementation – to combat nutritional deficiencies.
  • Surgery – to solve additional complications.

Resources

Crohn's and colitis Australia
https://www.crohnsandcolitis.com.au/about-crohns-colitis/
https://www.crohnsandcolitis.com.au/site/wp-content/uploads/PwC-report-2013.pdf

Personal stories of those affected by IBD
https://www.crohnsandcolitis.com.au/about-crohns-colitis/member-stories/

Gastroenterological society of Australia
http://www.gesa.org.au/resources/patients/inflammatory-bowel-disease/

The Gutsy Group
http://www.thegutsygroup.com.au/crohns-colitis/what-are-crohns-colitis/

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