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Understanding inflammatory bowel disease (IBD)

Sure, having an upset stomach from time to time is a normal part of life. Our digestive systems are more complex and sensitive than we often give them credit for. We might have a stomach ache for a variety of reasons, like overeating, eating greasy or difficult-to-digest foods, viruses, constipation or stress.

But if you’re experiencing repeated digestive discomfort, or something just doesn’t seem right, your symptoms might be related to an underlying cause. One of those possibilities is inflammatory bowel disease (IBD). An estimated 3.1 million adults in the U.S. (1.3%) have been diagnosed with IBD, and many more don’t yet know they have it.

If you’ve ever questioned, How do I know if I have IBD? What’s the difference between IBD and IBS? We have the answers for you. Learn more about IBD below, including the signs, causes and treatment options for managing your symptoms and improving your quality of life.

What is inflammatory bowel disease (IBD)?

It’s a common misconception that IBD is just another phrase for IBS (irritable bowel syndrome) – in fact, they’re very different conditions and shouldn’t be used interchangeably. IBD is a chronic disease involving gastrointestinal (GI) damage from inflammation. IBS is a GI disorder with uncomfortable symptoms, but no long-term health complications.

The two conditions may have similar symptoms of digestive discomfort, but the health implications and treatment methods aren’t the same. That’s why it’s important to get an accurate diagnosis as soon as possible and begin the appropriate treatment plan to manage it. Let’s talk about IBD first.

Inflammatory bowel disease is a condition involving chronic inflammation of the tissues in the digestive tract (mainly, the intestines). These are typically long-term conditions that one must manage throughout their life. IBD can be mild for some people or debilitating for others. Severe IBD can greatly impact one’s quality of life and even lead to life-threatening complications.

With IBD, there are often phases of improvement (remission) and phases of flare-ups, when symptoms get worse. The unpredictable nature of this cycle of relief and setbacks can be very distressing for patients, commonly leading to mental health challenges like anxiety and depression. For that reason, it’s very important that patients get quality care for both the physical and mental aspects of IBD.

The two main types of IBD are ulcerative colitis and Crohn’s disease.

Ulcerative colitis (UC)

Ulcerative colitis is an inflammatory bowel disease that leads to inflammation (swelling) and ulcers (sores) in the digestive tract. It especially affects the inner lining of the large intestine (also called the colon) and the rectum. Symptoms of UC tend to happen gradually, rather than suddenly, and can include abdominal pain and cramping, diarrhea, urgency to go, rectal pain, rectal bleeding, blood in stool, weight loss, fever and fatigue.

UC typically develops before the age of 30, but it can happen at any age. Gastroenterologists (digestive health experts) treat UC with medications, including anti-inflammatory drugs, immunosuppressants and biologics. Sometimes surgery may also be needed to heal certain areas of the intestines. UC doesn’t yet have a cure, but these treatments make it possible to significantly reduce symptoms, and even bring on long-term remission.

Having UC also increases one’s risk for colorectal cancer, so it’s important to partner with your doctor to follow colon cancer screening recommendations for early detection.

Crohn’s disease

Crohn’s disease is another inflammatory bowel disease involving serious inflammation of the GI tract. But Crohn’s is different from ulcerative colitis in a few key ways. For one, Crohn’s disease can affect any part of the digestive tract – from the beginning to the end. And unlike UC, the inflammation affects the entire width, or thickness, of the bowel tissues, not just the interior wall. Crohn’s is also unique because it can leave “skipped” areas of the digestive tract that are healthy and unaffected by the disease.

Symptoms of Crohn’s disease include abdominal pain and cramping, diarrhea, anemia, fever, fatigue, reduced appetite and weight loss.

Similar to UC, people with Crohn’s are usually diagnosed between the ages of 20 and 30, but it can develop at any time. Crohn’s disease is a chronic condition that doesn’t have a cure yet, but it can be managed through medications that reduce inflammation, like steroids and immunosuppressants, as well as biologics. Surgery may also be needed to repair damaged areas of the intestines.

What is IBS and how is it different from IBD?

Irritable bowel syndrome (IBS) is considered a functional gastrointestinal (GI) disorder. That means that it causes problems for your digestive system, and often painful symptoms, but you can still go about your daily life without serious health implications.

However, just because IBS doesn’t lead to other health concerns doesn’t mean that it’s not a problem for sufferers. Similar to IBD, the impact level of IBS can range from mild to severe. Symptoms of IBS commonly include painful abdominal cramping, diarrhea, gas and bloating, nausea and constipation. These typically come on after eating certain foods or a large meal.

Common triggers for IBS include caffeine, alcohol, and dairy, as well as foods that are greasy, highly processed, or high in fiber. Another big trigger? Emotional stress. Experts consider functional GI disorders (like IBS) conditions of the brain-gut interaction. That means that due to the strong link between the brain and GI system, problems between the two can make the digestive system extra sensitive. Learning ways to manage stress is a recommended treatment for improving IBS flare-ups.

IBS can vary from a mild inconvenience to a debilitating obstacle. Not knowing when it’s going to happen, and dreading the painful or embarrassing symptoms, is often a major stressor for people with IBS. It can impact your self-esteem and mental health, as well as hinder your social life, ability to work or travel, and your willingness to do certain activities. The good news is that it’s possible, and common, to manage IBS symptoms through diet and lifestyle changes, stress management and medications.

Symptoms of IBD

Symptoms of IBD vary depending on the form of the disease, and the signs are often different from person to person. The most common symptoms include:

  • Abdominal pain and cramping (sometimes severe)
  • Diarrhea
  • Urgency to go
  • Blood in your stool
  • Rectal pain (and/or bleeding)
  • Loss of appetite, sometimes leading to weight loss
  • Low blood iron (anemia)
  • Fatigue

And similar to other inflammatory conditions, UC and Crohn’s disease symptoms can also include fever, joint pain and skin rashes.

What causes IBD?

While experts haven’t determined an exact cause, we do know that it results from a weakened immune system. Possible causes leading up to IBD include:

Immune system response

Our immune systems are designed to fight off threats like bacteria, viruses and infection. But when someone has IBD, their immune system mistakes certain foods as foreign invaders. Its reaction is to send out antibodies (proteins) to defend against the perceived threat, which leads to inflammation of the GI tract and those uncomfortable IBD symptoms.

Genetics

Heredity plays a big role in IBD. Experts believe that as many as 25% of people with the disease have a family history of the condition. So that means that someone with IBD in their family is more likely to develop it.

Environmental factors

For people with IBD in their family, certain external factors can trigger them to develop the disease. Triggers may include stress, smoking, certain medications and mental health conditions like depression.

How IBD is diagnosed

Doctors use several different methods to diagnose IBD. First, they’ll listen to your symptoms and try to get a good understanding of your experience. They may also want to check your family medical history in case IBD-like conditions run in the family.

Next, they can order tests and procedures to get a definitive diagnosis.

  • Blood and stool laboratory tests – In the initial diagnosis process, doctors may order a blood test or a stool sample. These tests can show certain proteins, also called biomarkers, that are helpful in detecting inflammation. If inflammation is suspected, more tests can be done to find out the cause. Blood tests are also effective for detecting infection or anemia.
  • Imaging tests – Imaging tests like MRIs (magnetic resonance imaging) and CTs (computed tomography) take diagnostic pictures of your organs.
  • Endoscopy – Primarily used to diagnose Crohn’s disease, an endoscopy procedure involves inserting an endoscope (a tube with a small light and camera on the end) to examine the digestive tract.
  • Colonoscopy – Usually used for diagnosing ulcerative colitis, colonoscopy procedures are when your doctor looks at the lining of your rectum and colon through a thin, flexible tool called a colonoscope.

Once a diagnosis has been made, your doctor will explain what it means and work with you on a personalized treatment plan to help relieve symptoms and manage them long-term.

Treatment for IBD

IBD treatment aims to reduce the inflammation that causes the uncomfortable symptoms. In very successful cases, treatment may lead to both symptom relief and long-term remission, including lowering the risks of other health complications. IBD treatment methods include:

Medications

Medications are often the most effective way to manage IBD symptoms.

Corticosteroids (steroids)

These medications help control inflammation by reducing your immune system’s activity.

Immunosuppressants

This type of medicine helps stop your body’s immune system from attacking healthy tissues and joints.

Biologics

Made from living organisms, biologics work to stop or reduce inflammation. Biologics can be administered in the form of a pill, injection (shot) or infusion (through an IV).

Aminosalicylates

These anti-inflammatory medicines are used to minimize irritation in the intestines.

Targeted synthetic small molecule medications

These medications help reduce swelling and irritation by targeting parts of the immune system linked to inflammation in the intestines and other organs.

Surgery

In some cases, surgery may be needed to remove damaged areas of the GI tract and promote healing. There are several surgical procedures used for treating IBD, and the appropriate one is determined by the specific form of the condition, as well as the individuals’ needs.

Diet and lifestyle changes

While eating certain foods isn’t the cause of IBD (and also isn’t the cure), doctors find that avoiding particular foods that may trigger it can be helpful for improving symptoms. Your doctor can work with you to determine which foods to eat more or less of, and may even connect you with a dietitian for specialized help. When IBD is controlled or in remission, it can be helpful to follow a Mediterranean diet. A Mediterranean diet is a heart-healthy and gut-healthy way of eating that favors olive oil, nuts, whole grains and vegetables.

Additionally, including more self-care into your lifestyle can improve your overall well-being on a mind, body and spiritual level.

Mental health support

It’s important to be mindful of the impact IBD can have on one’s self-image and mental health. Finding mental health support, along with having the support of family and friends, can make a big difference in health outcomes and someone’s quality of life as they navigate this disease.

Can IBD go away on its own?

Inflammatory bowel diseases like ulcerative colitis and Crohn’s disease are chronic conditions, meaning people usually need to manage them throughout their lifetime. But treatments have come a long way, and symptoms of IBD can often be well managed, depending on the form and severity of the condition.

Patients with IBD typically have periods of improvement followed by periods of flare-ups that need to be managed. But the good news is that long periods of remission can be possible with the right treatments.

Don’t wait to talk to a doctor about symptoms of IBD

If you’re experiencing digestive problems or pain, don’t wait to talk to a doctor. IBD isn’t often life threatening, but if it goes untreated it can lead to GI damage and other health complications. Plus, you shouldn’t need to suffer through symptoms without answers or relief. It’s important to figure out what’s going on as soon as possible so you can begin a treatment plan that can help.

The best first step is to talk to your primary care doctor. They can listen to your symptoms and recommend the best plan forward. If they suspect that IBD may be the cause, they may refer you to a digestive health specialist for additional expertise and treatment.

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