Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease (IBD) is characterised by chronic inflammation of the digestive tract. This includes Crohn’s disease and ulcerative colitis (UC). Chronic bowel inflammation puts the patient at a higher risk of developing colorectal cancer.
Crohn’s disease
In Crohn’s disease, inflammation of the bowel involves all the layers of the digestive tract (transmural inflammation), and this can affect any part of the digestive tract, from the mouth to the anus. The most commonly affected area is the lower part of the small intestine (ileum). The perianal region may be affected in some cases as well.
Ulcerative colitis
Ulcerative colitis (UC) refers to inflammation involving only the innermost layer (mucosa), often affecting the rectum, colon, and occasionally, the ileum.
Symptoms of IBD vary depending on the severity of inflammation and part(s) of the bowel affected. These may include abdominal pain, rectal bleeding or bloody stools, persistent diarrhoea, weight loss and fatigue.
The exact cause of IBD is unknown. It may be contributed by an inappropriate immune response among genetically susceptible individuals resulting in chronic inflammation of the digestive tract. It is believed that the combination of environmental and genetic factors triggers the body’s immune system to react and to produce an inflammatory response in the digestive tract.
Environmental factors
Lifestyle and diet choices may contribute to the development of IBD, such as tobacco smoking, the presence of certain bacteria in the gut and excessive consumption of sugar, saturated fat and processed food.
Genetic factors
Both UC and Crohn’s disease have a genetic predisposition, which puts individuals at higher risk of developing IBD should there be a significant family history.
IBD requires a multi-modality management with a team including gastroenterologists, colorectal surgeons, dieticians, nurses, radiologists and pathologist. The treatment is highly individualised, depending on factors such as the severity and extent of inflammation and nutritional status of the patient.
Medication such as steroids and aminosalicylates can help reduce inflammation. In some cases, immune-modifying agents (e.g Anti-TNF agents) may be required.
A colectomy and/or proctocolectomy may be performed for UC particularly if the condition is not responsive to medical therapy. The surgery may involve the removal of the colon and rectum, and creation of an ileoanal pouch as a neo-rectum.
As for Crohn’s disease, the surgery depends on the severity of the disease and the part digestive tract affected. Segmental resection of the diseased bowel, or perianal surgery to drain infection, may be required.