Inflammatory Bowel Disease (IBD)
This is the name for inflammatory conditions of the bowel, of which there are two main types:
- Ulcerative Colitis (affects the large intestine)
- Crohn’s disease (can occur in any part of the intestine)
There are over 15,000 people with these conditions in New Zealand, with an increasing incidence.
They are similar in that they cause inflammation of the intestines, but carry very different symptoms, signs, prognosis’s and treatments. IBD should not be confused with IBS (irritable bowel syndrome), in which there is no true inflammation of the bowel. However, sometimes they can have similar symptoms.
Symptoms:
These can be very variable, ranging from mild to very severe, requiring hospitalisation.
They may include:
- Loose stools (diarrhoea)
- Blood in the stool
- Mucus in the stool
- Abdominal pain or cramping
- Weight loss
- Pain in the eyes (red eyes), joints including the lower back and skin rashes
- Ulcers
- Tiredness or weakness
Why?
It is still not completely understood why this condition arises in some people, some ethnicities, and not others.
Genetics certainly plays a part – the DNA passed on by your parents. However, this does not explain the whole picture, as only 10-25% of people have a first degree relative with ulcerative colitis.
The current thought is that high risk genetics may be combined with an environment trigger (diet, stress, infection) that starts off a process in which the body's own immune system attacks the lining of the bowel.
Tests?
There are a number of tests which we will proceed through to confirm or rule out these conditions. This includes, blood tests, stool tests, and an examination of the intestinal tract, with colonoscopy and/or gastroscopy. Additional tests such as MRI scans or CT scans are sometimes required.
Treatments?
Once a diagnosis has been made, treatment can start.
This can be progressed along depending on severity of symptoms and response.
This includes focus on:
- Diet: a well-balanced, nutritious diet with protein to help support and heal the body. The colon often leaks protein, with difficulty absorbing this important requirement.
- Topical treatments (i.e. treatments that work like a ‘cream’ for the bowel). Imagine you had a bad, scaly, itchy rash on your arm. You would generally try to dampen things down frequently with creams, and we can do this with the bowel using tablets such as Pentasa or Asacol. Upon entering the stomach from the mouth, they start to disperse and coat the lining of the intestines.
- Steroids: These are powerful anti-inflammatory medicines that we use if symptoms are very severe and we need to quickly get control of the situation. Over prolonged periods of time, they can confer side-effects so should only be used with great thought, monitoring and for a defined period of time.
- Immuno-modulators: As their name suggests, these are a group of medicines which ‘modulate’ or alter/dampen down the immune system. These medicines take some time to work, and are intended as a ‘preventer’ to stop flares of disease. See Thiopurines information for more detail on one of these commonly used.
- Biologics: This is another class of medicines which work to vigorously dampen down the immune system. There are two main medicines currently in New Zealand: Infliximab (Remicade) and Adalimumab (Humira or Amgevita). Separate patient information will be uploaded on these medicines.
- Surgery: If there is no response to medicines, or you may be so unwell or unable to take medicines, surgical treatment may need to be considered. We will talk about this at length, and all of our team work together closely with surgical doctors who can help with these conditions.
This can be a scary condition with a lot of stories, anecdotes and misinformation. Together, we can work through your symptoms, diagnosis and treatment to make this a condition that you rule, not a condition that rules you.
More information: