Nine things you should know about Inflammatory Bowel Disease (IBD)
Gut Health Dr Barney Hawthorne, Chair of the British Society of Gastroenterology’s IBD Section discusses IBD. Further information about IBD for patients can be provided through Crohn’s Colitis UK at crohnsandcolitis.org.uk
- IBD is a hidden disease
IBD is made up of Crohn’s disease and Ulcerative Colitis (UC) and causes ill-health through repeated episodes (or persistent) inflammation of the bowel which can go on for years. Because talking about bowels is embarrassing, the condition is not as well recognised as other ‘chronic’ disorders like Parkinson’s disease, rheumatoid arthritis or multiple sclerosis.
- IBD is not Irritable Bowel Syndrome
Unlike IBS, IBD can cause progressive damage to the bowel, with ongoing disability, often resulting in the need for surgery to remove the colon, or parts of the small intestine. It also can cause anaemia, weight loss, and problems with other areas of the body (skin, eyes, and joints) – which can be inflamed just like the gut is inflamed.
- IBD is partly related to genes
IBD runs in families, more so for Crohn’s than for UC. It is known that there are over a hundred genes that are linked with the risk of getting IBD. The risk of having family members affected is higher in children getting IBD. You need more than just genes inherited from your parents to get IBD though (see no. 4).
- IBD affects youngsters
IBD starts most commonly in people in their 20’s, but a quarter of patients get it in childhood (ie under the age of 16). Children getting it have more areas of the gut involved, and are often sicker for longer, so it has a huge impact on their education, work and family life that can have big consequences for their later life.
- IBD is occurring more frequently andis to do with the environment
Four out of every 1000 people have IBD. It is gradually becoming more frequent especially in urbanised or industrialised societies. Children who move from rural societies to industrialised areas have the increased risk of developing IBD just like the population they are joining. Adults who move to an urban society don’t have the increased risk, but their children do. This tells us that there is something in the environment that is encountered in childhood. This has been very obvious in families moving from Pakistan, India and Bangladesh to the UK. (As these countries become more industrialised, the incidence of IBD is increasing in their own populations who don’t emigrate).
- IBD is to do with bugs in the gut
Perhaps the risk of getting IBD is influenced by things in the world around us, and by what we eat, by altering the millions of bacteria in the gut. It is known that patterns differ in IBD patients, and this is a new and complex area of research. If more can be understood about the relationship between the bugs that live in our gut, and our gut linings and immune system, we may find that in the future we can treat diseases like IBD by ‘manipulating’ the patterns of these bugs.
- Is it my diet doctor?
Its logical to think that diet is a key factor in causing IBD, particularly Crohn’s disease, but there is no strong evidence that any particular dietary habit causes Crohn’s or UC. Diets high in refined carbohydrates (sugars) or low in fruit and vegetables have been implicated, but evidence is not that strong. Some patients find that specific foods upset them, and there is good evidence that an exclusive liquid diet feed, (with no other food) can heal Crohn’s inflammation, particularly in children. The link with diet may well relate to its effect on the gut microbiota, but much more research is needed in this area to unravel this complex relationship.
- Smoking and IBD
Patients with Crohn’s disease are more likely to smoke, but UC patients often get their illness when they give up cigarettes! If they start smoking again the inflammation often improves (but its not a recommended treatment!). It is not known why smoking has this opposite effect in Crohn’s and UC, but the effect is related to nicotine in cigarette smoke.
- Treatment for IBD
There is no curative drug treatment for IBD, but there are a number of drugs that can control the inflammation. Because the traditional drugs (like ‘steroids’) have side-effects, and don’t work on all patients, there has been a huge amount of research to find new drugs, and some of these are now being used to control the disease, with a number of new ones also looking very promising. The hope is that this will enable more patients to get their lives back by stopping the inflammation, without needing surgical removal of large parts of the gut. These drugs are still targeting the inflammation however, which is probably a consequence of whatever triggers IBD (perhaps a ‘leaky gut’ or inappropriately excessive reaction to normal bugs that pass through the ‘gut barrier’). If we could target the underlying cause, then preventing the inflammation altogether would be possible. This is the target of much IBD research at present.