Inflammatory bowel disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract.

The digestive tract comprises the:

  • mouth
  • esophagus
  • stomach
  • small intestine
  • large intestine

It’s responsible for:

  • breaking down food
  • extracting nutrients
  • removing any unusable material and waste products

Inflammation anywhere along the digestive tract interferes with this normal process. IBD can be very painful and disruptive. In rare cases, it may even be life threatening.

Learn all about IBD, including:

  • the different types
  • what causes it
  • its complications

Types

The Crohn’s & Colitis Foundation of America (CCFA) estimates that around 3.1 million people in the United States have IBD.

Many diseases are included under the umbrella term IBD. The two most common ones are:

  • Ulcerative colitis (UC). This involves inflammation of the large intestine — but only in the digestive tract. It can lead to other non-digestive issues.
  • Crohn’s disease. This can cause inflammation in any part of the digestive tract. However, it mostly affects the tail end of the small intestine.

Symptoms of IBD vary depending on the location and severity of inflammation, but they may include:

People with Crohn’s disease may also get canker sores in their mouths. Sometimes ulcers and fissures also appear around the genital area or anus.

IBD can also be associated with problems outside of the digestive system, such as:

The exact cause of IBD is unknown.

However, several factors can increase your risk of developing UC and Crohn’s disease.

Family history and genetics

People who have a parent, sibling, or child with IBD are at a much higher risk of developing it themselves. This is why scientists believe IBD may have a genetic component, as noted in a 2016 study.

The immune system

The immune system may also play a role in IBD.

The immune system normally defends the body from pathogens, which are organisms that cause diseases and infections.

A bacterial or viral infection of the digestive tract can trigger an immune response. The digestive tract becomes inflamed as the body tries to create an immune response against the invaders.

In a healthy immune response, the inflammation goes away when the infection is gone.

In people with IBD, however, digestive tract inflammation can occur even when there’s no infection. The immune system attacks the body’s own cells instead. This is known as an autoimmune response.

IBD can also occur when the inflammation doesn’t go away after the infection is cured. The inflammation may continue for months or even years.

Smoking

Smoking is one of the main risk factors for developing Crohn’s disease. Smoking also aggravates the pain and other symptoms associated with Crohn’s disease. It increases the risk for complications too.

However, UC primarily affects nonsmokers and former smokers.

Ethnicity

IBD is present in all populations. However, according to research, certain ethnic groups, including white people and Ashkenazi Jews, have a higher risk of developing the condition.

IBD rates are also rising among Black people in the United Kingdom, especially young people, according to a 2011 study conducted by Crohn’s and Colitis UK. The research involved young people between the ages of 16 and 24 years, since IBD symptoms tend to present at a younger age in 20 to 25 percent of people.

Age

IBD can happen at any age, but in most cases, it starts before age 35.

Environmental factors

People who live in urban areas and industrialized countries have a higher risk of developing IBD, according to research published in 2019.

Residents of industrialized countries also tend to eat more fat and processed food, which has been shown to be connected to the development of IBD, according to a 2021 study. This study involved over 100,000 people of varying socioeconomic backgrounds across seven geographical regions around the world.

IBD is also more common among people living in northern climates, where it’s often cold.

Researchers reviewing the impact of environmental factors on IBD have also found that having a sedentary lifestyle or job increases the risk of IBD.

On the other hand, some studies, including a 2013 study, have shown that physical activity in the pre-illness period helped to reduce the risk of the onset of IBD. This reduction was found to be stronger for Crohn’s disease than UC.

Gender

IBD tends to affect men and women equally.

According to a 2018 study, UC is generally more common among men over 45 years old than it is among women of the same age range.

On the other hand, Crohn’s disease is more common among girls and women over the age 14.

Possible complications of IBD include:

  • malnutrition with resulting weight loss
  • colorectal cancer
  • fistulas, or tunnels that go through the bowel wall, creating a hole between different parts of the digestive tract
  • intestinal rupture, which is also known as perforation
  • bowel obstruction

In rare cases, a severe bout of IBD can make you go into shock. This can be life-threatening. Shock is usually caused by blood loss during a long, sudden episode of bloody diarrhea.

To diagnose IBD, your doctor will first ask you questions about your family’s medical history and your bowel movements.

A physical exam may then be followed by one or more diagnostic tests.

Stool sample and blood test

Stool samples and blood tests can be used to look for infections and other diseases.

Blood tests can also sometimes be used to distinguish between UC and Crohn’s disease. However, blood tests alone cannot be used to diagnose IBD.

Barium enema

A barium enema is an X-ray exam of the colon and small intestine. In the past, this type of test was often used, but now, other tests have largely replaced it.

Flexible sigmoidoscopy and colonoscopy

These procedures use a camera on the end of a thin, flexible probe to look at the colon.

The camera is inserted through the anus. It allows your doctor to look for ulcers, fistulas, and other damage or abnormalities in the rectum and colon.

A colonoscopy can examine the entire length of the large intestine. A sigmoidoscopy examines only the last 20 inches of the large intestine — the sigmoid colon.

During these procedures, a small sample of the tissue inside the intestine will sometimes be taken. This is called a biopsy. This sample can be examined under a microscope and used to diagnose IBD.

Capsule endoscopy

This test inspects the small intestine, which is much harder to examine than the large intestine. For the test, you swallow a small capsule containing a camera.

The camera takes pictures as it moves through your small intestine. Once you’ve passed the camera in your stool, the pictures can be seen on a computer.

This test is only used when other tests have failed to find the cause of Crohn’s disease symptoms.

Plain film or X-ray

A plain abdominal X-ray is used in emergency situations where intestinal rupture is suspected.

CT and MRI scans

CT scans are basically computerized X-rays. They create a more detailed image than a standard X-ray. This makes them useful for examining the small intestine. They can also detect complications of IBD.

MRIs use magnetic fields to form images of the body. Since they don’t require radiation, they’re safer than X-rays. MRIs are especially helpful in examining soft tissues and detecting fistulas.

Both CT scans and MRIs can be used to determine how IBD affects much of the intestine.

There are a number of different treatments for IBD.

Medications

Anti-inflammatory drugs are the first step in IBD treatment. These drugs help decrease inflammation of the digestive tract. However, they have many side effects.

Corticosteroids

Glucocorticoids, a subcategory of corticosteroids, are examples of anti-inflammatory drugs used for IBD. They include:

  • budesonide (Uceris)
  • prednisone (Prednisone Intensol, Rayos)
  • prednisolone (Millipred, Prelone)
  • methylprednisolone (Medrol, Depo-Medrol)

These drugs are available in a variety of forms, including:

  • oral tablets
  • injections
  • rectal foams

They’re usually given at the lowest dose possible for the shortest amount of time.

5-ASA drugs (aminosalicylates)

5-ASA drugs (aminosalicylates) also decrease inflammation, mainly in the last part of the small intestine and in the colon. They include:

  • balsalazide (Colazal)
  • mesalamine (Apriso, Asacol HD, Canasa, Pentasa)
  • olsalazine (Dipentum), which is only available as a brand-name drug
  • sulfasalazine (Azulfidine)

In 2019, the American Gastroenterological Association (AGA) released treatment guidelines for adults with extensive mild to moderate UC. For this group, they strongly recommended:

  • standard-dose oral mesalamine
  • diazo-bonded 5-ASA drugs, such as balsalazide and olsalazine

The AGA prefers these over low-dose mesalamine, sulfasalazine, or no treatment at all. However, the AGA also says it’s fine to take sulfasalazine, as long as you’re aware that it comes with the risk of more severe side effects.

People who do not respond to standard-dose mesalamine or diazo-bonded 5-ASA drugs should try a combination of rectal mesalamine and high-dose oral mesalamine.

Immunomodulators

Immunomodulators may be an effective option if corticosteroids and 5-ASA drugs aren’t enough. They prevent the immune system from attacking the bowel and causing inflammation.

They include:

The Food and Drug Administration (FDA) has not approved these drugs for the treatment of IBD. However, your doctor may prescribe them anyway. They refer to this as off-label drug use.

OFF-LABEL DRUG USE

Off-label drug use is when a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat medical conditions in their patients.

So your doctor can prescribe a drug however they think is best for your care.

Biologics

Biologics are genetically designed drugs that may be a choice for people with moderate to severe IBD.

Some biologics block tumor necrosis factor (TNF). TNF is an inflammation-triggering chemical that the immune system produces. Excess TNF in the blood is normally blocked, but in people with IBD, higher levels of TNF can lead to more inflammation.

TNF-alpha inhibitors include:

Other biologics include:

Biologics are not available as generic drugs. Biosimilars, which are cheaper and have been reverse-engineered to produce the same results as biologics, are available for some of these drugs, though.

In 2020, the AGA released treatment guidelines for people with moderate to severe UC. The guidelines recommend that people who’ve never tried a biologic before opt for infliximab or vedolizumab over adalimumab. Adalimumab is less effective.

You can self-administer adalimumab, which may make it more convenient than the other drugs. If convenience is a concern, it’s fine to choose adalimumab instead.

Other drugs

Other drugs block separate pathways causing inflammation and include:

  • The UC drug tofacitinib (Xeljanz). The AGA recommends taking this oral drug only if you’ve tried taking tumor necrosis factor α (TNF-α) inhibitors and they aren’t successful for resolving symptoms. However, the FDA has ruled that manufacturers of this drug class, Janus kinase (JAK) inhibitors, must inform JAK inhibitor users of the severe side effects including cardiac events, cancers, and blood clots.
  • Antibiotics. These kill bacteria in the small intestine that may trigger or aggravate the symptoms of Crohn’s.
  • Antidiarrheal medications and laxatives. These can help keep your bowel movements regular.

Lifestyle choices

Lifestyle choices are important when you have IBD.

  • Drinking plenty of fluids. This helps you make up for fluids lost in your stool.
  • Avoiding triggers, like dairy products and stressful situations. This can help improve symptoms and reduce flare-ups.
  • Exercising and if you smoke, quitting smoking. These actions can help preserve your health if you have IBD.

Supplements

Vitamin and mineral supplements can help with nutritional deficiencies. For example, iron supplements can help treat anemia.

Talk with your doctor before adding any new supplements to your diet.

Surgery

Surgery can sometimes be necessary for people with IBD. Some IBD surgeries include:

Your doctor will likely recommend a routine colonoscopy to monitor for colorectal cancer, since those with IBD have a higher risk of developing it.

You cannot prevent the hereditary causes of IBD. But you may be able to reduce your risk of developing IBD or prevent a relapse of symptoms by:

IBD can cause some discomfort, but actively following your doctor-advised treatment plan, you can manage the disease and live a healthy, active lifestyle.

Bezzy IBD is a free community that connects you with others living with IBD through 1:1 messaging and live group chats while also providing access to expert-approved information on managing IBD.

Download the app for iPhone or Android.

You can also visit the Crohn’s & Colitis Foundation for resources and more information on IBD, including UC and Crohn’s disease.

It can also be helpful to talk with others who understand what you’re going through.

Read this article in Spanish.