What Is Inflammatory Bowel Disease (IBD)?

IBD is an overarching term for two conditions: Crohn's disease and ulcerative colitis.

Medically reviewed by Kumkum Sarkar Patel, MD

Inflammatory bowel disease is a term that encompasses two conditions: Crohn’s disease and ulcerative colitis (UC). Both conditions are characterized by chronic inflammation of the gastrointestinal tract, although ulcerative colitis specifically affects the mucosal lining of the colon. About 2.39 million people in the United States have IBD. It mostly occurs between ages 15 and 30, but in some cases can also develop during adolescence and later adulthood.

IBD most often develops due to abnormal immune functioning, genetics, or specific environmental triggers. Common symptoms include diarrhea, abdominal pain, weight loss, and blood in stool. There is no cure for IBD, however, many treatment approaches are available to improve symptoms and reduce inflammation, potentially helping you to achieve remission (no symptoms). If left untreated, IBD can become severe and can lead to serious complications.

Types of IBD

Inflammatory bowel disease is a broad term that includes Crohn’s disease and ulcerative colitis.

Crohn’s Disease

Crohn’s disease can cause any part of the gastrointestinal tract (GI), from the mouth to the anus, to become inflamed. Most often it affects the small intestine and the beginning of the large intestine. The inflammation due to Crohn’s disease is usually patchy with areas of unaffected tissue in between. The inflammation may affect multiple layers of the GI walls and can become worse over time or be continuous.

Ulcerative Colitis

While Crohn's disease can affect any part of the GI tract, ulcerative colitis affects the mucosal lining of the large intestine (colon). The mucosal lining is the moist inner lining of the inside of the colon. The inflammation due to UC is continuous.

Crohn's and Colitis Symptoms

The symptoms of IBD often vary in severity and may come and go. The period where you experience symptoms is termed flares while periods of no symptoms are termed remission.

A few symptoms that IBD may cause are:

• Persistent diarrhea

• Passing mucus or blood with your stool

• Abdominal pain and cramping

• Frequent urge to have bowel movements even when your bowels are empty, also known as tenesmus
  

In serious cases, IBD can also lead to the following symptoms:

• Fever

• Fatigue

• Nausea

• Weight loss

• Joint pain
  

Differences in Symptoms Between UC and Crohn's

While Crohn's and UC share many symptoms, there are some notable differences.

Causes

The exact cause of IBD is still unknown, although it is currently thought to be due to one or a combination of the following factors:

• Genes: You may be at a higher risk of developing IBD if you have family members with IBD, especially parents or siblings.

• Immune reaction: Your immune system helps protect you from infections. Abnormal functioning of the immune system causes it to become overactive, attacking natural bacteria or healthy cells of your GI tract, leading to IBD.

• Environment: Your surroundings can also increase your chances of developing IBD. A few common environmental triggers that may lead to IBD are smoking, taking certain medications, and diet.
  

Diagnosis

Diagnosing Crohn’s disease or ulcerative colitis cannot take place with a single test. Your healthcare provider (likely a gastroenterologist, a medical doctor who specializes in the digestive tract) will ask questions about your medical history and family history along with carrying out a physical examination as the first step of diagnosis.

They may then recommend a few tests to confirm IBD diagnosis. Some common ones include:

• Blood test: Blood tests can help to identify the presence of specific biomarkers such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) which help to indicate inflammation in the body.

• Stool test: Stool tests can help to identify certain proteins (lactoferrin and calprotectin) in stool samples that may indicate gastrointestinal inflammation.

• Colonoscopy: This procedure involves the insertion of a thin, flexible tube with a camera at one end, called a colonoscope, inside the colon. It helps your provider view your large intestine and the end part of your small intestine for any signs of inflammation.

• Upper GI endoscopy: Upper GI endoscopy is a procedure that involves a flexible tube with a camera (endoscope) to examine the inside of your upper GI tract starting from your mouth to the first part of your small intestine.

• Sigmoidoscopy: This procedure uses a flexible narrow tube with a light and camera at one end (sigmoidoscope) to view the rectum and lower colon.

• Biopsy: Your healthcare provider may obtain tissue from the inside of your GI tract during an endoscopy or colonoscopy. They may then examine the tissue samples in the laboratory for any signs of IBD.

• Imaging tests: Imaging tests such as contrast X-rays, computed tomography (CT) scanning, and magnetic resonance imaging (MRI) can help to create images of your GI tract to detect inflammation.
  

Treatments for IBD

The treatment for IBD varies depending on the type and severity of symptoms. Your healthcare provider most often recommends medications to improve IBD symptoms. However, severe cases may require surgery.

Medications

A few common medications that can help to reduce inflammation and improve symptoms of IBD include:

• Aminosalicylates: These drugs help to control inflammation and may be effective for people with mild cases of IBD or those who are in remission.

• Corticosteroids: These medications help to reduce inflammation and induce remission for people with moderate to severe cases of IBD. Generally, corticosteroids are only taken for a short period, as their side effects can be significant.

• Immunomodulators: These can help to control the overactivity of your immune system that may be causing inflammation. They require about three months to start working.

• Biologics: Biologics target and counteract proteins made by the immune system, which in turn helps to decrease inflammation. They are most often recommended when people do not respond to other medications.
  

Surgery

Surgical treatment options may be recommended if you have severe IBD that does not improve with medications.

Surgical options for Crohn’s disease depend on the part of the affected GI tract. Common types of surgery options for Crohn’s disease include fistula removal, abscess drainage, strictureplasty, small and large bowel resection, and proctocolectomy.

Ulcerative colitis may be treated with surgery in serious situations where you experience complications such as excessive rectal bleeding, formation of small holes in the large intestine, and increased risk of colorectal cancer. The two most common types of surgery are ileostomy and ileoanal reservoir surgery.

Prevention

Following certain preventive approaches can help to improve your symptoms and your overall quality of life. A few approaches include:

• Not smoking

• Eating a balanced diet rich in fruits, vegetables, and lean protein

• Exercising regularly

• Getting plenty of sleep

• Limiting your alcohol intake

• Eating smaller, more frequent meals
  

Complications

If left untreated or not managed well, IBD can lead to serious complications that not only affect your intestines but also other parts of your body. Potential complications include:

• Strictures: Severe inflammation in the intestines can cause the thickening of its walls and the formation of scar tissue. This leads to the narrowing of a part of the intestine, called stricture, and intestinal blockage.

• Fistula: Chronic inflammation can cause ulcers to form inside the walls of the intestine, which can extend and form a connection or channel, called a fistula, with another organ.

• Abscess: Abscesses are swollen, pus-filled pockets of inflammation that can develop in the abdomen or around the anus due to chronic inflammation.

• Perforation: Severe cases of IBD can lead to the formation of holes in the intestines. This can cause leakage of intestinal contents and infection in the abdominal cavity (peritonitis).

• Toxic megacolon: This is a rare but life-threatening complication of IBD. It leads to severe inflammation of the colon and if left untreated can even cause colon rupture.

Related Conditions

Some conditions commonly co-occur with IBD, including:

• Anemia: About 1 in 3 people with IBD have anemia, which is characterized by having a low number of red blood cells.

• Colorectal cancer: People with severe cases of IBD are at higher risk of developing colorectal cancer due to persistent and chronic intestinal inflammation.

• Arthritis: About 30% of people with IBD also have arthritis, which is inflammation of the joints.
  

Living With IBD

IBD is a long-lasting condition that currently has no cure. In most cases, the symptoms may come and go without leading to complications. However, in some cases, IBD can cause serious complications which can also be life-threatening. IBD can also impact your mental health, leading to depression and anxiety, among other symptoms and conditions.

Although IBD is not curable, several medications are available to improve its symptoms and prevent the development of complications. If you think you have IBD, consult your healthcare provider so they can conduct the appropriate diagnostic tests and start you on treatment, if necessary.

Frequently Asked Questions

What is the difference between IBS and IBD?

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two different conditions, although they might share a few common symptoms, such as bloating, stomach pains, and gassiness. IBD is classified as a disease and mainly causes inflammation, whereas IBS is classified as a syndrome and is an overarching term for a group of bowel symptoms.

Can a colonoscopy tell if you have IBD?

A colonoscopy can be useful in the diagnosis of IBD. A colonoscopy can help your gastroenterologist view the walls of your colon and assess where inflammation is occurring and how serious it is.

Can you have both ulcerative colitis and Crohn's disease?

Having Crohn’s disease and ulcerative colitis together is so rare that it is generally regarded as impossible.

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