Inflammatory Bowel Disease (IBD): Risk Factors, And Causes
Inflammatory bowel disease (IBD) is a condition that involves chronic inflammation in all or part of the digestive tract.
The digestive tract comprises the mouth, esophagus, stomach, small intestine, and large intestine. It’s responsible for breaking down food, extracting the nutrients, and removing any unusable material and waste products.
The two most common forms of IBD are ulcerative colitis and Crohn’s disease.
In Crohn’s, inflammation can occur anywhere in the digestive tract, from the mouth to the anus. Most times Inflammatory Bowel Disease (IBD) can lead to life-threatening complications as well as increase the risk for colon cancer.
Crohn’s disease can cause inflammation in any part of the digestive tract. However, it mostly affects the tail end of the small intestine.
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Ulcerative colitis involves inflammation of the large intestine. IBD is not the same as irritable bowel syndrome (IBS), which does not cause inflammation or damage in the intestines. It is estimated that as many as 1 million Americans suffer from IBD, and most sufferers begin to feel symptoms between the ages of 15 and 30.
What are the risk cause of inflammatory bowel disease?
The exact cause of IBD is unknown. However, genetics and problems with the immune system have been associated with IBD.
Genetics factor inflammatory bowel disease
You might be more likely to develop IBD if you have a sibling or parent with the disease. This is why scientists believe IBD may have a genetic component.
The immune system
The immune system may also play a role in IBD.
Normally, the immune system defends the body from pathogens (organisms that cause diseases and infections). A bacterial or viral infection of the digestive tract can trigger an immune response.
In people with IBD, however, digestive tract inflammation can happen even when there’s no infection. The immune system attacks the body’s own cells instead. This is known as an autoimmune response.
IBD can also occur when the inflammation doesn’t go away after the infection is cured. The inflammation may continue for months or even years.
Smoking is one of the main risk factors for developing Crohn’s disease.
Smoking also aggravates the pain and other symptoms of Crohn’s disease and increases the risk of complications. However, ulcerative colitis primarily affects nonsmokers and ex-smokers. [Why People Smoke When They Know It’s Unhealthy?]
Symptoms of IBD
With IBD, the intestines (small, large and bowels) become inflamed, including redness and swelling. Related symptoms, which can range from mild or severe, include:
- Severe or chronic abdominal pain
- Diarrhea, often bloody
- Sudden weight loss
- Lack of appetite
- Rectal bleeding
IBD can also have symptoms unrelated to the gastrointestinal tract, including:
- Joint pain
- Skin rashes
- Eye pain
- Mouth sores
Symptoms can come on suddenly and flare up at random times, often going away for months or even years at a time. These are known as “relapses” or “flare-ups.” When symptoms are gone (though never permanently, as IBD is chronic), the patient is considered to be in remission.
The most common symptoms of Crohn’s are diarrhea (sometimes blood) and abdominal pain, and sometimes nausea and vomiting, whereas the main symptoms of ulcerative colitis are bloody diarrhea or stool, an urgent/frequent need to go to the bathroom, and incomplete evacuation of bowel movements.
The primary difference between Crohn’s and ulcerative colitis is the part of the digestive tract that they affect.
Crohn’s disease causes patchy inflammation on all layers of the intestinal wall, whereas ulcerative colitis affects only the top layer of the large intestine. Ulcerative colitis causes swelling and ulcers to form on the surface of the lining, which bleed and produce pus. In severe cases, the ulcers can weaken the intestine and cause a hole, spilling the bacteria-laden contents of the large intestine into the abdominal cavity or the patient’s bloodstream.
Cause & diagnosis for IBD
Although doctors don’t know exactly what causes IBD, it has a genetic predisposition (to date, more than 160 genes have been linked to the disease), but there is usually some trigger in the environment, Geographical region, Family history, antibiotics, or infection — that causes a shift in a person’s bacteria that results in an abnormal immune response.
Though stress and diet can worsen IBD symptoms, they do not cause IBD.
To diagnose IBD, your doctor will first ask you questions about your family’s medical history and your bowel movements.
A physical exam may then be followed by one or more diagnostic tests.
There are a number of ways to diagnose IBD. Blood tests can find signs of inflammation and anemia, while stool tests can test for blood and signs of infection. Doctors may also use a long thin tube with a lighted camera to look into a person’s intestine — either a sigmoidoscopy, which goes as far as the lower part of the large intestine, or a colonoscopy, which goes through the entire large intestine and the last part of the small intestines — and take a biopsy of tissue.
A less invasive way to look for intestinal problems is an X-ray after the patient has consumed liquid barium to coat the digestive tract lining. Computerized axial tomography (CAT) scans and capsule endoscopies also provide insight into any damage that might be occurring to the digestive tract.
Treatment for IBD
Treatment for IBD varies per patient. Some may require medication, which can range from corticosteroids to biologic therapies and antibiotics. There are a number of different treatments for IBD.
Anti-inflammatory drugs are the first step in IBD treatment. These drugs decrease inflammation of the digestive tract. However, they have many side effects.
Anti-inflammatory drugs used for IBD include sulfasalazine and its byproducts, as well as corticosteroids.
Immune suppressants (or immunomodulators) prevent the immune system from attacking the bowel and causing inflammation.
This group includes drugs that block TNF. TNF is a chemical produced by the immune system that causes inflammation. Excess TNF in the blood is normally blocked, but in people with IBD, higher levels of TNF can lead to more inflammation.
Immune suppressants can have many side effects, including rashes and infections.
Antibiotics are used to kill bacteria that may trigger or aggravate IBD symptoms.
Antidiarrheal drugs and laxatives can also be used to treat IBD symptoms.
Patients with more severe flareups may require steroids such as prednisone, but this can have side effects. Immunosuppressants and biologics may also be prescribed.
For the most part, changes in diet, reducing stress, and getting enough rest are universal ways of treating symptoms. Some patients avoid greasy foods, cream sauces, processed meat products, spicy foods and high fiber foods.
Other patients with more serious prognoses may require surgery. With ulcerative colitis, 25 to 40 percent of patients will need surgery, which can include complete removal of the large intestine. Patients who undergo this type of surgery will need to have pouches attached either internally or externally, for waste removal.
With Crohn’s disease, 65 to 75 percent of patients will need surgery to correct strictures, fistulae or bleeding in the intestines. A strictureplasty widens the strictures without removing any part of the small intestine, and a bowel resection involves removing parts of the intestine and sewing the healthy ends together. Crohn’s patients can also have their large intestine removed but require an external pouch in its place.
Living with IBD can be stressful and taxing, because patients may miss school or work, or experience depression and anxiety. There are hundreds of support groups for people with Crohn’s disease and ulcerative colitis.
“These conditions are not curable,” “But if patients get on the appropriate medications, they can feel well.”
How you can prevent inflammatory bowel disease?
The hereditary causes of IBD can’t be prevented. However, you may be able reduce your risk of developing IBD or prevent a relapse by:
eating healthy foods
IBD can cause some discomfort, but there are ways you can manage the disease and still live a healthy, active lifestyle.
Additional resources for inflammatory bowel disease:
- The Mayo Clinic website is a useful reference for patients with IBD
- For more on the difference between Crohn’s disease and ulcerative colitis, on the Crohn’s & Colitis Foundation of America website.
- To find out about research on IBD, see the U.S. Centers for Disease Control and Prevention.