Inflammatory Bowel Disease

Guest post by Hema Cherukooru

Inflammatory bowel disease (IBD) is characterized by repetitive inflammation of the gastrointestinal tract¹. Crohn’s disease and Ulcerative colitis are chronic IBD that are emerging as a worldwide epidemic². It occurs after an abnormal immune response to normal stimulus such as food and inappropriate immune response to intestinal flora in genetically susceptible individuals¹. IBD occurs in 15 to 30 years for age¹. It is more prevalent in Europe and North America than in Africa or Asia¹.

The intestine acts as a barrier and prevents bacteria and antigen from entering the circulation¹. However, in the case of IBD the barrier function of the intestine is defective and leads to inflammation¹. Crohn’s disease and ulcerative colitis differ in their clinical and pathophysiology, but are defined as chronic IBD². Crohn’s disease can affect any part of the GI from mouth to anus and appears as patches of healthy tissue next to damaged parts³. The mucosa has a cobblestone like appearance¹. Ulcerative colitis affects the large intestine and rectum and the damaged areas are continuous³. 

Image credits: CDC.gov

Risk factors for developing IBD include:

  • Age: Most common in age groups 15 to 30 years¹. In some cases, it can develop in 50 and 60 year olds⁴.
  • Family history: Increased risk when close family members are affected⁴.
  • Race and Ethnicity: Can occur in all races but whites are most susceptible⁴.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs increase the risk of developing IBD or worsen IBD⁴.
  • Cigarette smoking: Most controllable factor to prevent Crohn’s disease. In case of ulcerative colitis, smoking may help prevent it, but the benefits of quitting smoking helps overall health and outweighs this benefit⁴.

Common symptoms include

  • Fatigue, 
  • Persistent diarrhea, 
  • Rectal bleeding/bloody stools, 
  • Abdominal pain, and 
  • Weight loss³.

Diagnosis: 

Healthcare professional would look for a combination of the following to help with diagnosis IBD: Clinical findings¹, Inflammation lab markers¹, Image findings¹, and Endoscopy or colonoscopy helps confirm IBD³.

Treatment: 

Treatment depends on the management of mild, moderate, and severe disease¹. Goal is to induce remission of Crohn’s disease or ulcerative colitis¹. The treatment options vary depending on the patient’s condition from medication like glucocorticosteroids, immunomodulators, and/or antibiotics, and surgery may be required¹.

Key micronutrients patients are risk of developing deficiency of the following⁵ (Please note this is general information and each individual should consult their healthcare professional):Iron deficiency or anemia, Vitamin D, Calcium, Zinc and Magnesium in case of chronic diarrhea⁵.

Complications of IBD may include⁴:

Increased risk of blood clots⁴. Medication side effects, for example corticosteroid can lead to high blood pressure and osteoporosis⁴. Increased risk of colon cancer⁴. Inflammation may occur during IBD flare ups⁴.

Dietary guidelines:

No evidence that what you eat can cause IBD, however certain foods can trigger signs and symptoms⁴. Some of the general guideline to manage symptoms include:

  • Limit dairy products, many people with IBD have symptoms such as diarrhea, gas, abdominal pain and limiting or eliminating dairy would be helpful⁶. 
  • Drinking plenty of liquids daily, especially water would be helpful⁶. Avoid alcohol and caffeinated beverages as they make diarrhea worse by stimulating the intestine⁶. Carbonated drinks produce gas and should be avoided as well⁶.
  • Small meals about five to six a day would be better than two to three large meals⁶.
  • Low FODMAPs (Fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet⁵.
  • Omega-3 fatty acids supplementation⁵
  • In case of vitamin or mineral deficiency, supplements taken as needed⁵.
  • Modify fiber intake, in case of high risk of obstruction, a low-fiber diet may be recommended⁵. In Crohn’s disease a low-residue diet, did not change the outcome⁵.
  • If uncontrolled weight loss occurs or if the diet is very limited, consult a registered dietitian⁴.
  • In case oral feeding is not sufficient, patient may be started on enteral or parenteral feeding⁵.

Stress

Stress and its relation to Crohn’s disease is controversial⁶. However, patients have reported during high stress periods, symptoms flare⁶. Managing stress by the following strategies might be helpful⁶:

  • Exercise – Mild exercise can help relieve depression, reduce stress, and normalize bowel movement⁶. Doctor should be consulted for an exercise plan⁶.
  • Breathing exercise and regular relaxation – Yoga, mediation, and practicing deep and slow breathing might be helpful⁶.

Coping and Support for patients with IBD

IBD affects patients physically and emotionally, as it could disrupt daily life due to flaring of symptoms and the need to use restroom more often⁶. Some of coping strategies could include:

  • Be informed of IBD and seek information from respectable sources such as Crohn’s and Colitis Foundation⁶.
  • Joining support groups helps on the emotional level as well as to get updates on the latest medical treatments therapies available⁶.
  • Consult a mental health professional who specializes in IBD if needed.

Once an individual is diagnosed with IBD, it would be helpful to learn how to manage symptoms and prevent flare ups and worsening the condition. Role of health care  professional to key to managing IBD.  Incase of uncontrolled weight loss a registered dietitian may need to be consulted.

Please join us in celebrating World IBD Day on May 19th, 2021. Click here to learn more on how to bring awareness to this condition in your part of the world.

Hema Cherukooru is a dietetics student at the University of Northern Colorado pursuing a Bachelor’s Degree in Nutrition and Dietetics. 

References:

  1. McDowell, C., Farooq, U., & Haseeb, M. (2020). Inflammatory Bowel Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK470312/
  2. Manichanh, C., Borruel, N., Casellas, F., & Guarner, F.  (2012). The gut microbiota in IBD. Natural Review. Gastroenterology & Hepatology, 9(10), 599-608. doi: 10.1038/nrgastro.2012.152.
  3. CDC.Inflammatory bowel disease (IBD) (2018). What is inflammatory bowel disease (IBD)? Retrieved March 3, 2021, from https://www.cdc.gov/ibd/what-is-IBD.htm
  4. Mayo Clinic (n.d.). Inflammatory bowel disease (IBD). Retrieved March 3, 2021 from https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/symptoms-causes/syc-20353315
  5. Halmos, E.P.,  & Gibson, P.R. (2015). Dietary management of IBD — insights and advice. Nature Reviews. Gastroenterology & Hepatology, 12(3), 133–146. https://doi.org/10.1038/nrgastro.2015.11
  6. Mayo Clinic (n.d.). Inflammatory bowel disease (IBD). Retrieved March 15, 2021, from https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/diagnosis-treatment/drc-20353320