Inflammatory Bowel Disease (IBD) - Thesurgeons Pte Ltd

Inflammatory bowel disease (IBD) is a term referring to two conditions: Crohn’s disease and ulcerative colitis, both of which are characterised by chronic inflammation and damage of the gastrointestinal tract. If not managed well, IBD flare-ups can be aggressive and debilitating to a person’s quality of life.

While people of any age can get IBD, it is most commonly diagnosed between the ages of 15 and 40, and affects men and women equally. IBD currently affects around 1 in 10,000 Singaporeans, and is on the rise; making it all the more important to know what to look out for and seek medical attention.

CROHN'S DISEASE VS ULCERATIVE COLITIS

Crohn’s Disease	Ulcerative Colitis
Occurs anywhere along the gastrointestinal tract – from the mouth to the anus; though it most commonly affects the end of the small intestine	Occurs only in the colon and rectum
Affects all layers of the intestinal walls	Only affects the innermost lining of the intestine
Inflamed areas can appear in parts, even next to perfectly healthy parts of the intestines	Inflamed areas are continuous
Possible complications include: bowel obstruction, anal fissures, colon cancer, strictures, fistulas, and malabsorption	Possible complications include: colon perforation, colon cancer, severe dehydration and toxic megacolon

WHAT CAUSES IBD?

While the exact cause is not completely understood, it is known to be a mix of genetics, environmental factors and the immune system (in those with IBD, their immune system mounts a disproportionate response to the intestinal tract, resulting in inflammation and ulceration).

SIGNS & SYMPTOMS OF IBD

These symptoms can vary from mild to severe, depending on how serious the inflammation is and where it is located. Furthermore, IBD can come and go, alternating between moments of flare-ups and remissions.

Common symptoms of IBD include:

Cramping and pain in the abdomen | This can be very severe, often before a bowel movement.
Persistent diarrhoea | This can sometimes be mixed with blood, mucus, and pus.
Anaemia | You may have low red blood count if you are losing blood, or not eating much.
Weight loss | Your body may not be absorbing nutrients well due to the inflammation.
Fatigue | You may be tired from IBD itself, anaemia, or night wakings from pain or diarrhoea.

CAN IBD BE CURED?

Unfortunately, there is no known cure for IBD. However, it can be treated long-term to reduce the severity and frequency of flare-ups, and reduce the risk of complications from developing.

HOW IS IBD TREATED?

Treatment for IBD is very much personalised to the individual, which can be determined by:

Severity of disease
Location of disease
Past response to medication
Side effects of medication
Any comorbidities (other medical conditions that the person has)

TYPES OF MEDICATIONS

The first line of treatment for IBD is medications, which include:

Anti-inflammatories | Decreases inflammation
Corticosteroids | Keeps the immune system in check
Immunomodulators | Modifies the activity of the immune system
Antibiotics | Treats bacterial infection
Biologics | Interrupts specific immune system signals to prevent an inflammatory reaction from happening.

WHEN SURGICAL TREATMENT IS NEEDED

Sometimes, medications alone may not be enough to sufficiently control the disease (symptoms and complications), in which case surgery may be necessary.

After 30 years of disease, up to 1 in 3 with ulcerative colitis will require surgery
Around 70% of people with Crohn’s disease eventually requires surgery

In the case of ulcerative colitis, surgery typically involves the removal of the colon and rectum, along with the creation of a "pouch" in order to facilitate bowel movements.

In the case of Crohn’s disease, surgery typically includes the opening up of narrowed/blocked portions of the small intestine; or a removal of damaged portions of the intestines and joining the remaining ends back together. In severe cases, a total removal of the colon may be needed.