Inflammatory bowel disease (IBD) refers to a collection of chronic inflammatory conditions affecting the digestive tract, and its prevalence has seen a notable increase in recent years.

The two most prevalent forms of IBD are ulcerative colitis, which predominantly impacts the large intestine, and Crohn’s disease, which can affect any part of the digestive tract, from the mouth to the anus. These conditions can emerge at any age, but they are most commonly identified in individuals between 15 to 30 years old and those aged 50 to 70. IBD can exert a considerable physical and emotional toll on patients, often disrupting their daily lives due to its symptoms.

Symptoms of Inflammatory Bowel Disease

Ulcerative colitis and Crohn’s disease are chronic or recurrent ailments characterized by alternating symptom exacerbation and remission periods. This fluctuation in clinical presentation frequently leads to a delayed diagnosis, usually by at least 3 to 4 years.

  • Ulcerative colitis typically presents with bloody diarrhea, often accompanied by mucus. Patients may also experience tenesmus, a sensation of incomplete bowel evacuation, and, in some cases, anemia.
  • Conversely, Crohn’s disease commonly begins with diarrhea and abdominal pain, particularly in the lower right abdomen, corresponding to the last section of the ileum, the most frequently affected area. These conditions can also give rise to extraintestinal symptoms, encompassing rheumatologic, dermatologic, ocular, or hepatologic issues.

As inflammation intensifies, additional symptoms like fever, weight loss, extreme fatigue, and loss of appetite may manifest. Crohn’s disease can also culminate in complications such as intestinal narrowing (stenosis), the formation of fistulas (abnormal connections between the intestine and skin or adjacent organs), or abscesses, sometimes necessitating surgery. Ulcerative colitis can lead to conditions like toxic megacolon, an acute colon dilation that requires surgery, and an elevated risk of colon cancer.

When to Seek Gastroenterological Evaluation

Specific indicators call for a comprehensive assessment by a gastroenterology specialist, including:

  • Persistent abdominal pain;
  • Frequent diarrhea;
  • Presence of mucus and blood in stool;
  • Urgent bowel movements and rectal tenesmus.

These subtle signs can indicate the onset of IBD, and early diagnosis by an experienced specialist is imperative. The process involves:

  • Evaluating patient-reported symptoms;
  • Conducting a thorough physical examination;
  • Initiating further diagnostic investigations, including laboratory tests and imaging.

Causes of Inflammatory Bowel Disease

At present, the precise cause of IBD remains elusive. However, its pathogenesis appears to be autoimmune, resulting from an abnormal immune response in the intestine to antigens, such as the bacteria typically present in the gut. This immune dysregulation likely stems from an individual’s genetic factors and environmental influences.

While there is a familial predisposition to IBD, it is not strictly hereditary. A gene called NOD2, which encodes the CARD15 protein, has been identified as a potential genetic factor that increases susceptibility to Crohn’s disease when mutated. Environmental factors, including cigarette smoking, play a significant role in predisposing individuals to Crohn’s disease while potentially protecting against ulcerative colitis. Psychological distress, such as anxiety and depression, may also contribute to the disease.

Treatment of Inflammatory Bowel Disease

Managing IBD necessitates a multifaceted approach:

  • Medical treatment seeks to induce clinical remission and prevent disease flares. Common medications include mesalazine, corticosteroids, immunosuppressants (azathioprine/6-mercaptopurine), antibiotics targeting gut bacteria, and newer biologic drugs like Tumor Necrosis Factor (anti-TNF) inhibitors.
  • Clinical surveillance is vital for monitoring the disease’s progression and tailoring treatment.
  • An appropriate treatment regimen, taking into account the type and severity of the disease, is essential.

Biologic drugs have significantly advanced the management of IBD, reducing complications and improving outcomes. Surgical intervention may be necessary in cases of treatment failure or the development of complications, particularly for intestinal stenosis in Crohn’s disease.