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Inflammatory bowel disease

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) covers two main conditions: ulcerative colitis and Crohn’s disease.

Inflammation happens when the immune system causes the gut to become red, swollen and sometimes painful. IBD should not be confused with IBS (irritable bowel syndrome), which is a milder condition and does not cause serious problems.

Whereas ulcerative colitis affects only the lining of the colon and rectum in the bowel, Crohn’s disease attacks anywhere from mouth to anus, and typically the full thickness of the bowel wall.

Symptoms commonly start between the ages of 15 and 30, although IBD can start at any age, and generally fluctuate throughout a person’s lifetime.

An estimated 6.5 in 1,000 Australians [1] live with inflammatory bowel disease (IBD), one of the highest rates globally [2].

In IBD there may be tiredness, fever, or loss of appetite.

Gut symptoms may include:

  • Frequent, loose stools which may also contain blood and/or mucus
  • Urgent need to pass stools
  • Constipation
  • Nausea/vomiting
  • Abdominal bloating/pain
  • Anal fissure
  • Abscess formation (a collection of pus)
  • Bowel stricture (narrowing)
  • Fistula formation (a narrow tunnel grows between organs).

Sometimes skin, eye or joint problems can occur.

The causes of IBD are not completely understood, but there seems to be a complex interplay between genetics, environment, gut bacteria, and the immune system [2,4].

IBD is diagnosed after a thorough medical history, physical examination, and appropriate tests, as shown in Table 1.

TABLE 1

Commonly used tests

Stool tests
  • Infection
  • Blood
  • Calprotectin levels (helps to show disease activity)
Blood tests
  • Full blood count and inflammatory markers (to look for anaemia, inflammation, infection), kidney and liver health, vitamin and mineral levels, coeliac test (gluten allergy)
Endoscopy
  • A fibreoptic video camera is used to view the bowel wall, and allows the taking of biopsies (tissue samples)
Capsule endoscopy
  • A tiny wireless camera that is swallowed. Most useful for looking at the small intestine
Imaging tests
  • Imaging tests, such as abdominal X-ray, barium studies, computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI) may be used

In IBD there may be tiredness, fever, or loss of appetite.

Treatment aims at inducing remission and maintenance therapy to avoid flare ups [5] and can include a dietary assessment to ensure:

  • Intake of sufficient energy and nutrients
  • Identification and avoidance of food triggers
  • Symptom reduction [6]

Long term medication is needed by most patients with Crohn’s disease, and many with ulcerative colitis. Depending on condition and severity, drugs range from anti-inflammatory aminosalicylates, to medications suppressing the immune system, including biologics. However, treatments may also cause problems, such as:

  • Some medications need to be given by injection or infusion.
  • As well as side effects, some medications can cause more serious adverse effects such as higher infection rate, liver toxicity, skin reactions, bone thinning and cancer.
  • Need for extra vaccinations.

Unfortunately, 75% of people with Crohn’s undergo surgery if symptoms are drug-resistant or there are complications. Unlike ulcerative colitis, where surgery can be curative, Crohn’s disease often recurs after surgery [6].

Mental health issues should be addressed as they can affect IBD [7].

Stopping smoking is important as it increases the risk of Crohn’s disease and its complications. The relationship of nicotine and ulcerative colitis is more complex [8].

New treatment under development at the Bionics Institute

Bionics Institute researchers are developing an electrical medical device that aims to improve long-term outcomes for people with type 2 diabetes.

How does it work?

•  A tiny electrode array is attached to the vagus nerve just under the diaphragm

•  The vagus nerve connects the brain to the gut and controls natural anti-inflammatory processes in the body

•  The vagus nerve is stimulated by the electrode array in response to gut inflammation caused by Crohn’s disease

•  The vagus nerve initiates a natural anti-inflammatory response to reduce the symptoms of Crohn’s disease

•  The electrode array is powered by a small battery implanted at hip level.

•  The battery only needs to be replaced every 10 years ensuring the device provides a set-and-forget treatment

•  The treatment causes fewer side effects than medications

Read more

This device is safe and has been approved for use in clinical trials.

With your help, we can accelerate the evolution of this device, improving the lives of those with Crohn’s disease.

Medical disclaimer

This article contains general information relating to a medical condition. Such information is provided for informational purposes only and does not replace medical advice given by your healthcare professional.

References

1. Busingye D, Pollack A, Chidwick K. Prevalence of inflammatory bowel disease in the Australian general practice population: A cross-sectional study. (CC BY 4.0). PLoS One [Internet]. 2021 May 1 [cited 2022 Feb 4];16(5):e0252458. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252458

2. Alatab S, Sepanlou SG, Ikuta K, Vahedi H, Bisignano C, Safiri S, et al. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol [Internet]. 2020 Jan 1 [cited 2022 Feb 3];5(1):17–30. Available from: http://www.thelancet.com/article/S2468125319303334/fulltext

3. Australian Government D of H. Inflammatory Bowel Disease National Action Plan 2019. (CC BY 4.0) [Material adapted] [Internet]. 2019 [cited 2022 Feb 3]. Available from: https://www.health.gov.au/sites/default/files/documents/2019/09/national-strategic-action-plan-for-inflammatory-bowel-disease-inflammatory-bowel-disease-national-action-plan-2019_0.pdf

4. Loddo I, Romano C. Inflammatory bowel disease: Genetics, epigenetics, and pathogenesis. Front Immunol [Internet]. 2015 [cited 2022 Feb 3];6(NOV). Available from: /labs/pmc/articles/PMC4629465/

5. De Simone B, Davies J, Chouillard E, Saverio S Di, Hoentjen F, Tarasconi A, et al. WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting. (CC BY 4.0). World J Emerg Surg [Internet]. 2021 [cited 2022 Feb 4];16(23):1–27. Available from: https://doi.org/10.1186/s13017-021-00362-3

6. Bernstein CN, Eliakim A, Fedail S, Fried M, Gearry R, Goh KL, et al. Inflammatory Bowel Disease: Update August 2015. World Gastroenterology Organisation Global Guidelines. 2016. p. 1–36.

7. Hu S, Chen Y, Chen Y, Wang C. Depression and Anxiety Disorders in Patients With Inflammatory Bowel Disease. CC BY. Front Psychiatry. 2021 Oct 8;12:1643.

8. Berkowitz L, Schultz BM, Salazar GA, Pardo-Roa C, Sebastián VP, Álvarez-Lobos MM, et al. Impact of cigarette smoking on the gastrointestinal tract inflammation: Opposing effects in Crohn’s disease and ulcerative colitis. (CC BY). Front Immunol. 2018 Jan 30;9(JAN):1–10.

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