Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD) refers to a group of chronic, immune-mediated conditions, that are characterised by significant inflammation of the gastrointestincal tract. The two most common are Crohn’s disease and ulcerative colitis. At its core, IBD happens because the immune system becomes overactive, mistakenly attacking the lining of the digestive tract and causing chronic inflammation.

Crohn’s disease and ulcerative colitis share many symptoms, such as persistent diarrhoea (often containing blood or mucus), debilitating abdominal pain, unexplained weight loss, and extreme fatigue. T

he symptoms of Inflammatory Bowel Disease (IBD) vary depending on the severity and location of the inflammation, but they primarily present as gastrointestinal distress. For some people this will be persistent, for others (around 80% of people with IBD) they will experience ‘flare-ups’ after a period of symptom remission. The hallmark clinical signs include chronic diarrhoea—often containing blood, mucus, or pus—and intense abdominal pain or cramping. The symptoms of IBD are similar to the symptoms of other gastrointestinal disorders, such as IBS, but the treatments are different, so the key is an accurate diagnosis.

Crohn’s disease and ulcerative colitis differ in the location of the inflammation:

• Ulcerative Colitis: This is restricted to the large intestine (colon) and rectum. It usually starts at the rectum and spreads upwards in a continuous, unbroken line.
• Crohn’s Disease: This can affect any part of the digestive tract, from the mouth to the anus. Unlike ulcerative colitis, it often appears in patches, leaving healthy areas of the gut in between—these are known as “skip lesions.”

For most people with IBD, they will experience flare-ups of symptoms, followed by periods with no symptoms. However, around 15-20% of people with IBD will experience persistent symptoms that may vary in severity, but are always present.

An IBD diagnosis involves several steps, including:

• Tests – a faecal calprotectin test which is a stool test that measures a certain protein released by the white blood cells in the gut. This helps doctors distinguish between IBD and IBS.
• Blood tests are used to check for inflammation, low iron and vitamin deficiencies as they are commonly experienced by people with IBD.
• Endoscopies – to get a definitive diagnosis, an endoscopy is needed – where a very thin fibre optic camera is used to examine the inside of the gastrointestinal tract. A biopsy (a small amount of tissue) is removed and tested in labs. The type of endoscopy needed will depend on symptoms. Haven Medical is able to carry out transnasal gastroscopies on site, or arrange for additional tests to be carried out at a partner site.

The goal of IBD treatment is ‘remission’ which means the symptoms have disappeared, your gut lining has a chance to heal and you start to feel normal and be able to get back to ‘normal’ life. For this reason, treatment can include getting a flare up under control, followed by keeping the disease ‘quiet’

Treatment options for IBD include:

1. Medications: specialist medication can be used to bring flare ups under control, to dampen the immune system response and to target specific proteins in the immune system. Specialist understanding, from a Gastroenterolgist with expert knowledge in the field, is needed to access these medications.
2. Surgery: for some people, removing damaged parts of the bowel is needed.
   The first step is an accurate diagnosis, which can then allow the correct IBD treatment to be put in place.

Colitis is inflammation of the colon that encompasses several conditions, including ulcerative colitis, microscopic colitis and indeterminate colitis. Symptoms commonly include abdominal pain, persistent diarrhoea and rectal bleeding. It can range from mild to severe and, like other forms of IBD, often requires specialist diagnosis and ongoing medical management.

A fistula is an abnormal tunnel forming between two parts of the body not normally connected. Most commonly a complication of Crohn’s disease, they can also occur with ulcerative colitis. Chronic inflammation causes the bowel wall to break down, sometimes connecting to nearby organs, and often requires specialist treatment.

The exact cause of Inflammatory Bowel Disease (IBD), including Crohn’s disease and Ulcerative colitis, is not fully understood. It is thought to result from a combination of genetic susceptibility, immune system dysfunction, and environmental factors. In people with IBD, the immune system mistakenly attacks the gut, causing chronic inflammation. Triggers may include gut bacteria imbalances, infections, smoking, diet, and stress, although none act alone. IBD is not contagious and cannot be caused by a single factor. Instead, it develops through a complex interaction between the body’s immune response and environmental influences over time.