Aliments – Inflammatory Bowel Disease

It is a group of inflammatory conditions that affect the colon and small intestine. It is sometimes referred to as idiopathic IBD because the cause of the disease is still unknown.

The major types of IBD are:

• Crohn’s disease, and
• Ulcerative colitis (UC)

Crohn’s disease affects any part of the gastrointestinal (GI) tract, whereas UC affects the large intestines. Inflammation occurs on the lining of the intestines (mucosa), and open sores may result on the surface. The ulcers may produce excessive amounts of mucus with pus, and the intestinal lining may bleed.

The condition is relatively rare in the Asian population. As it is a chronic ailment, it may recur any number of times in a lifetime. Managing IBD is complex as it is possible to be in remission for long periods, yet suffer relapses any time. There is no way of predicting the pattern of episodes as every patient is different.

Symptoms may vary greatly from patient to patient because IBD may affect various parts of the GI tract. Common symptoms of IBD are diarrhoea, bloody stools and passage of mucus with stools. Other symptoms include fever, weight loss, abdominal pain, cramps, bloating, anal pain or drainage, skin lesions, rectal abscess, fissure, and joint pain (arthritis).

The exact cause is not known. Current theories centre on an immunologic (the body’s defense system) and/or bacterial cause. IBD is not contagious, but there is evidence of a genetic component to susceptibility.

Since the cause of the disease is unclear, there is no known cure. Treatment aims to both reduce activity of disease, and minimize relapses. Drugs are prescribed to control and manage the symptoms, and patients have to medicate for life.

The most regularly used medicines are steroids (e.g. prednisolone) and various anti-inflammatory agents. Stronger drugs (e.g. 6-mercaptopurine, azathioprine) may be used in more severe cases. The stronger drugs tend to cause more side effects, and suppress the immune system. This makes the patient more prone to infection as a result of medication.

Medication may be taken by mouth, injected directly into the veins, or applied directly into the intestines through the anus. Depending on which part of the intestines is affected, the most effective route of administration will be selected.

Surgery may be recommended in more complicated cases of IBD. Emergency surgery may be required when complications (e.g. obstruction of the bowel, perforation of the intestine, or massive bleeding) occur with IBD.

Operations may also be required for the following groups of patients:

• those who do not respond to medication,
• those with abscess formation,
• those with fistulas (abnormal connections with the intestine), and
• those with severe anal disease.

Although medication is favoured as the initial form of therapy, up to 75% of patients may require surgery eventually. While surgery does not “eradicate” the problem, many patients never require additional operations. Surgeons usually adopt a conservative approach in surgery, removing only the diseased portion of the intestines. Surgery may offer relief of symptoms in the long-term, and decreases the reliance on medication.