Let me first say that, having worked in the UK and treated the more severe end of this condition, it is not a condition anyone would wish for. IBD is a very serious disease, has life-changing effects and unfortunately, this predominant western condition has already landed on our eastern shores.
IBD stands for Inflammatory bowel disease and is a group of conditions of idiopathic chronic inflammatory intestinal conditions, the 2 main types of which are Crohn’s disease(CD) and Ulcerative Colitis (UC). Both can look and behave like each other but are also distinct from each other. How it happens is incompletely understood but it is the result of a defective immune system.
The risk factors for IBD include, age ( usually below 30 but can also occur in the 50’s and 60’s, some races, a family history of IBD, cigarette smoking (although smoking can be protective in UC, the overall benefits of stopping smoking far outweighs), NSAIDs, and it is also more common in developed countries and in higher socioeconomic groups.
Typically, UC is more common in developing countries but after a while it is CD. One thing is certain that although more common in the western hemisphere, numbers although at different rates are increasing with time also in Asia. It’s a global disease.
What’s the difference between UC and CD?
In brief, UC starts in the rectum and spreads further continuously up to involve the colon and damages the initial layers of the colon. CD, on the other hand, occurs in patches and can involve any part of the gastrointestinal tract including the small bowel, stomach and oesophagus. It damages the colon in multiple layers which adds to its complication list and importantly can also present like UC.
What to look out for?
IBD can present with loose stool, rectal bleeding, abdominal pain, fevers, anaemia, weight loss and sometimes constipation. Certainly, in Asia loose stools are not uncommon but when not settling, recurring or with other symptoms, you should be suspicious. Once suspected, the investigation into IBD will involve at least blood tests, stool sampling and endoscopy and may require imaging studies in way of x-rays, CT scans or MRI scans. It is important to make a firm diagnosis as treatment is often lifelong.
Can it be cured?
As it stands there is a treatment to control the condition but technically speaking for UC, if the colon and rectum are removed, then that is a cure but it is rare for anyone to opt for this. There is no current cure for Crohns Disease only treatment. Treatment starts with tablets moving to injections and infusions in the form of aminosalicylates, steroids, immunomodulators and then biologics. If all fails, then it is surgery. It is also very important to remember that with correct management, patients can lead a normal active healthy lifestyle. Examples of individuals with more than normal lifestyles include Larry Nance Jr (NBA basketball player for the LA Lakers) and, Olympic Kayaker Carrie Johnson who both have Crohn’s disease while in entertainment, both Shannon Doherty (actress from Beverly Hills 90210 and Charmed) and Anastasia (singer) also have Crohn’s disease.
And if left untreated?
IBD should never be left in an active state as the ongoing inflammation can lead to serious complications. Complications to IBD include an increased risk of colorectal cancer, blood clots, bleeding, anaemia, primary sclerosing cholangitis (a progressive liver disease more with UC) which in itself increases the risk of cholangiocarcinoma’s and colorectal cancers, megacolon (a dilated large bowel) again more in UC and obstruction because of strictures, fistulas (connections between different sections of the bowel, urinary tract or vagina), abdominal abscesses and malnutrition with CD. In addition, women in childbearing age should know that conceiving during a disease flare is not advised and can lead to low birth weight baby or premature delivery. It is always safest to have the disease in remission/control before embarking on the journey to motherhood.
What it’s not.
It’s important to remember, TB (tuberculosis) can present like CD and vice versa and is especially important in developing countries but can also happen in developed nations where TB is still a problem. Another thing IBD I not, is IBS (irritable bowel syndrome). IBS causes no inflammation and does not damage the bowel wall in the same way as IBD but can present in a very similar fashion e.g. abdominal pains and loose stools and has been known to be mistaken for the latter. Of course, there are other conditions that can present in fairly similar ways but most importantly, if you do have symptoms, to have the appropriate investigation if for nothing else to avoid the aforementioned compilations.
