Inflammatory Bowel Disease: What it is, Causes, Symptoms, Treatment & Prevention

What Is Inflammatory Bowel Disease?

Inflammatory bowel disease is generally a result of chronic diseases caused by the presence of inflammation in the mucous membrane lining the gastrointestinal tract (GIT). The inflammation occurs when the body's own defence mechanisms attack the healthy cells in the digestive tract, leading to persistent inflammation.

IBD can affect different parts of the GIT and cause symptoms like diarrhoea, abdominal pain, fatigue, rectal bleeding, and weight loss. The condition is seen in ulcerative colitis or patches or segments of inflammation anywhere along the tract from the mouth to the anus in Crohn's disease.

What Are the Types of Inflammatory Bowel Disease?

Inflammatory Bowel Disease is classified into the following:

How Common Is Inflammatory Bowel Disease in India?

IBD is becoming increasingly common in India due to significant dietary changes, urbanisation, lifestyle changes, better awareness, and the availability of medical facilities.

According to research, IBD comprises about 5.4% of people experiencing symptoms during colonoscopy procedures in rural as well as urban India, rather than only 0.1% in 2006.

The mean age of patients diagnosed with IBD was 38.5 years, with 55.9% being male patients. Geographical variation can clearly be observed where UC is more common in the north, while CD is prevalent in southern India.

What Are the Symptoms of Inflammatory Bowel Disease?

Symptoms of IBD include:

What Causes Inflammatory Bowel Disease?

Common causes of IBD include:

• Dysregulated Immune System Response: The dysregulated response of the immune system towards the regular bacteria that exist in our intestines, as well as their walls, leads to IBD.

• Genetics: Over 200 different genes have been found linked with IBD. A person with relatives who suffer from IBD may have a higher risk of getting the disease compared to other people.

• Dysregulated Gut Microbiome: Imbalance between gut bacteria is one of the key reasons behind IBD-related inflammation.

• Westernisation of Indian Diet: The shift in diet from traditional Indian food, which used to consist of fibre-based ingredients, to a westernised diet of packaged and processed foods has contributed to the rise in the number of IBD patients in urban India.

• Hygiene Hypothesis: Growing up in extremely sanitised and clean urban environments can harm the immune system's ability to fight infections like IBD due to a lack of exposure to disease-causing microorganisms.

• Smoking: Smoking can worsen the symptoms of Crohn's disease.

• Infectious Gastroenteritis: People who have suffered from infectious diarrhoea due to Salmonella, Campylobacter, and/or C. difficile bacteria in the past have increased chances of suffering from IBD during the next five years.

Complications Associated With Inflammatory Bowel Disease

Untreated IBD can cause the following complications:

• Colorectal Cancer: A serious long-term consequence of IBD, the probability of developing colorectal cancer increases significantly.

• Bowel Stricture and Blockage: Long-standing transmural inflammation causes fibrosis and scarring, resulting in bowel strictures that can lead to bowel blockage.

• Fistula and Abscess Formation: Crohn's disease may result in the development of abnormal connections (fistulas) between segments of the bowel or between the bowel and other organs like the bladder and skin.

• Severe Malnutrition: Crohn's involving the small intestine results in malabsorption of iron, vitamin B12, vitamin D, calcium, zinc, and proteins. Such malabsorption can cause anaemia, osteoporosis, and impaired growth in children.

• Toxic Megacolon: Toxic megacolon is a rare yet life-threatening condition occurring in UC patients in which the colon stretches due to severe inflammation.

• Primary Sclerosing Cholangitis (PSC): Primary sclerosing cholangitis is a progressive liver disease associated with UC, characterised by inflammation and fibrosis of bile ducts, more likely to progress into liver failure or bile duct cancer (cholangiocarcinoma).

• Osteoporosis: Due to inflammation, treatment with steroids, and calcium/vitamin D deficiency, bones become weaker, resulting in increased fracture risk.

When Should I See My Healthcare Provider?

Contact a gastroenterologist if you encounter any of these symptoms:

• Diarrhoea for more than four weeks, especially if accompanied by abdominal pains

• Blood or mucus present in the stool, with no obvious cause from the anus (haemorrhoids)

• A weight loss of more than 5% of body weight within three months for no reason

• Multiple episodes of abdominal pain in the lower right part of the abdomen are particularly common in younger patients

• Pain, swelling, abscesses, or drainage in the anal region

• Anaemia in the blood work results, unexplained by diet or gynecology-related reasons

• Abdominal pain, diarrhea, poor development, and slow pubertal development among youngsters

• IBD patients with additional problems like joint swelling, red eyes, or jaundice

How Is Inflammatory Bowel Disease Diagnosed?

Doctors may conduct the following tests to diagnose IBD:

• Colonoscopy and Biopsy: A flexible endoscope fitted with a camera examines the colon and terminal ileum for specific lesions.

• Upper GI Endoscopy: Investigates the oesophagus, stomach, and duodenum for any suspected involvement in Crohn's disease.

• MRI/CT Enterography: Imaging techniques used to assess the involvement of the small bowel with respect to its extent, severity, strictures, fistulae, abscesses, and perianal disease in case of Crohn's. These tests aid surgical planning.

• Blood Tests: Tests carried out to determine the presence of anaemia and leukocytosis (inflammation). CRP and ESR levels indicate systemic inflammation and correlate with disease activity.

• Stool Tests: Calprotectin, a non-invasive test indicating intestinal inflammation in the stool, is particularly useful in distinguishing IBD from IBS.

• Histopathology: Histopathology involves the microscopic examination of biopsies taken from the colon.

Diagnostic Overview Table

How Is Inflammatory Bowel Disease Treated?

There is no pharmacological cure for IBD. However, the following management and treatment strategies can help maintain remission, prevent complications, preserve bowel function, and improve quality of life:

• Aminosalicylates (5-ASA): Anti-inflammatory drugs used mainly in UC to reduce irritation and inflammation locally by acting on the colon mucosa.

• Corticosteroids: Effective in inducing remission in patients with acute flare-ups of IBDs. However, these can cause complications when taken for long periods.

• Immunomodulators: These medicines work to suppress the hyperactive immune system that leads to inflammation in the intestines. It helps in maintaining remission in UC and CD and reduces dependence on steroids.

• Dietary and Lifestyle Changes: Adjusting diet, staying hydrated, and avoiding known trigger foods may help manage symptoms of IBD.

• Biologic Therapy: Anti-TNF and other biological medicines are used in treating moderate to severe forms of IBD where conventional treatment is ineffective.

• Surgical intervention: Surgery is required if there is no improvement in symptoms with medication, a complication develops, or to prevent colorectal cancer.

• Nutritional Support: Exclusive enteral nutrition acts as an effective treatment for inducing remission in children with Crohn's.

What Is the Prognosis?

A cure with medications for IBD is not currently available. The surgery involving the removal of the entire colon and rectum (total colectomy), on the contrary, ensures that the person does not have another episode of UC, but they can suffer from extraintestinal symptoms.

Surgery for Crohn's disease is not a cure, as inflammation may still occur in other sections of the intestines. Following the prescribed medicinal and therapy regimen, most patients have a favourable prognosis and can live a normal life.

How to Prevent Inflammatory Bowel Disease?

Minimising risk factors can often help reduce the risk of developing IBD. The following measures can help:

• Eat a high-fibre diet with a preference for vegetables, beans, whole grains, and probiotics to develop a diverse gut microbiome.

• Stay away from or consume as few ultra-processed products, too much red meat, and fatty diets, which cause an imbalance in gut flora and inflammation of the intestines.

• Reduce the usage of antibiotics if it is unnecessary, since they affect the gut flora and predispose children to developing IBD.

• Stop smoking, especially in the case of Crohn's disease, as it only worsens the course of the disease and makes surgeries more likely to take place.

• Breastfeeding prevents IBD in childhood since breast milk helps develop gut flora in children.

• Keep stress levels under control, as it is a known trigger of IBD.

Does Health Insurance Cover Inflammatory Bowel Disease?

Yes, health insurance policies in India usually cover hospitalisation, colonoscopy, surgeries, and bowel obstructions related to IBD, including CD and UC.

However, there might be a waiting period of 1 to 3 years in case it was a pre-existing condition when you purchased the policy, depending on the insurer.

How Much Health Insurance Coverage Is Needed for Inflammatory Bowel Disease Treatment?

Insurance coverage can vary depending on the seriousness of the disease and its treatment needs. In case of those patients who require conventional medicine therapy, a coverage sum of ₹2 to ₹5 lakh should cover annual medical expenses, including their medications, diagnostic tests, and surgeries. If the patient requires biological treatment, has a history of other related diseases or in case of complications like colon cancer, then a coverage of ₹15 to ₹20 lakh is advisable.

Always read the policy carefully and compare coverage benefits as well as applicable riders to get the best possible option.