Inflammatory Bowel Disease

Dr Calvin Ong

mbbs M.Med (Surgery) MRCS FRCS

Types Symptoms Causes Diagnosis Treatment FAQ

What is Inflammatory Bowel Disease?

Inflammatory Bowel Disease (IBD) is a term used to describe chronic conditions that cause inflammation of the gastrointestinal (GI) tract, primarily Crohn’s disease and ulcerative colitis.

Crohn’s disease can affect any part of the GI tract, from the mouth to the anus, while ulcerative colitis is limited to the colon and rectum. Both conditions can cause discomfort and may lead to serious complications if not properly managed.

Types of Inflammatory Bowel Disease

IBD primarily includes two types: Crohn’s disease and ulcerative colitis, each with distinct characteristics and affected areas of the GI tract.

Crohn’s Disease

Can affect any part of the GI tract, from the mouth to the anus. It often involves the deeper layers of the bowel wall and can cause a variety of symptoms depending on the affected area. Crohn’s disease can lead to complications such as strictures (narrowing of the bowel), fistulas (abnormal connections between different parts of the bowel), and abscesses (collections of pus).

Ulcerative Colitis

Limited to the colon and rectum. It primarily affects the innermost lining of the colon, causing continuous inflammation and ulcers. Ulcerative colitis can lead to complications such as severe bleeding, perforated colon, and an increased risk of colon cancer.

Symptoms of Inflammatory Bowel Disease

The symptoms of IBD can vary depending on the severity and location of the inflammation. Common symptoms include:

Abdominal Pain and Cramping

Persistent pain, often in the lower abdomen, ranging from mild to severe, and may be accompanied by cramping, commonly seen in both Crohn’s disease and ulcerative colitis due to intestinal inflammation.

Diarrhoea

Frequent, loose, or watery stools, sometimes containing blood, which can be severe and lead to dehydration, often a symptom of active inflammation in both Crohn’s disease and ulcerative colitis.

Fatigue

Extreme tiredness not relieved by rest, which can be debilitating and affect daily activities, often due to chronic inflammation and the body’s effort to fight the disease.

Weight Loss

Unintentional and significant weight loss due to decreased appetite and poor absorption of nutrients, commonly seen in Crohn’s disease due to inflammation in the small intestine.

Fever

Episodes of fever during flare-ups indicate active inflammation.

Reduced Appetite

Decreased desire to eat, often due to nausea, pain, or discomfort, which can be a result of gastrointestinal inflammation and symptoms.

Blood in Stool

Presence of blood in bowel movements, more common in ulcerative colitis.

Urgency to Defecate

A sudden and urgent need to have a bowel movement, often experienced in ulcerative colitis due to inflammation and irritation of the rectum and colon.

Constipation

Particularly in Crohn’s disease, when it affects the small intestine, leading to inflammation that narrows the intestinal passage and hinders stool movement.

Causes and Risk Factors

The exact cause of IBD is unknown, but several factors are thought to contribute to its development.

Genetics

Family history of IBD increases the risk. Certain genetic mutations have been associated with a higher risk of developing IBD.

Immune System

An abnormal immune response that attacks the cells of the digestive tract can lead to chronic inflammation.

Environmental Factors

Certain lifestyle and environmental factors, such as smoking, diet, and stress, may influence the risk. Urban living and exposure to industrial pollutants have also been linked to higher rates of IBD.

Microbiome

Imbalances in the gut microbiome, including reduced diversity of gut bacteria, are often observed in patients with IBD.

Age and Gender

IBD can occur at any age but it is most commonly diagnosed in adolescents and young adults. Males are slightly more likely to be affected in childhood than females in adulthood.

Diagnosis of Inflammatory Bowel Disease

IBD is diagnosed through a variety of diagnostic procedures, including:

Blood Tests

This checks for anaemia and inflammation markers (e.g., C-reactive protein) and other signs of inflammation.

Stool Tests

This detects blood, pathogens, and inflammatory markers (e.g., calprotectin).

Colonoscopy/Sigmoidoscopy

These procedures allow doctors to view the colon and rectum and take biopsies.

Upper Endoscopy

This procedure may be used to examine the upper GI tract, especially in Crohn’s disease.

CT Scan/MRI

These provide detailed images of the GI tract, allowing doctors to assess the severity of inflammation and identify complications (e.g., fistulas, abscesses).

Capsule Endoscopy

This procedure involves swallowing a small capsule containing a camera to obtain images of the small intestine, which is especially useful for Crohn’s disease.

Treatment Options To Manage IBD Symptoms

While there is no cure for IBD, a variety of treatments can help manage symptoms and keep the condition in remission. Treatment options include both non-surgical and surgical approaches.

Non-surgical Treatment

Non-surgical treatments aim to manage inflammation and alleviate symptoms using various medications without the need for invasive procedures. These include:

Anti-inflammatory Drugs: Anti-inflammatory drugs such as aminosalicylates and corticosteroids reduce inflammation.
Immune System Suppressors: These include azathioprine, methotrexate, and cyclosporine to reduce immune response.
Biologics: TNF inhibitors (e.g., infliximab) and integrin inhibitors are examples of biologics that target specific inflammation-related proteins.
Antibiotics: Antibiotics treat or prevent infections that may accompany complications like abscesses.
Pain Relievers: Pain relievers are used to treat mild pain (with caution due to potential GI side effects).

Surgical Treatment

Surgical treatments are considered when non-surgical methods fail to control symptoms or when complications arise. These include:

Resection: Removal of damaged portions of the GI tract is commonly performed in severe Crohn’s disease cases.
Colectomy: Partial or total removal of the colon, often used in severe cases of ulcerative colitis.
Strictureplasty: Widening of narrowed areas in the intestines without removing any part of the GI tract, typically used in Crohn’s disease to treat strictures and preserve bowel length.
Proctocolectomy and Ileostomy: The colon and rectum are removed, and an ileostomy is created (an opening in the abdomen for waste removal), often necessary in severe ulcerative colitis or Crohn’s disease affecting the rectum, particularly when other treatments have failed to control the disease.

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Managing IBD

Certain measures can help reduce the risk of flare-ups and manage IBD.

Follow a balanced diet, avoid trigger foods, and consider nutritional supplements or enteral nutrition if needed.
Regular exercise, mindfulness, and yoga, as well as maintaining regular sleep patterns and incorporating relaxation practices, can all help manage stress and be beneficial.
Avoid smoking, which can worsen symptoms, and stay well-hydrated, especially if experiencing diarrhoea, to prevent dehydration.

Dr Calvin Ong Jianming

Senior Consultant, Colorectal & General Surgeon

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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